Why can’t every person with diabetes have access to an effective retinopathy screening programme?


The personal, social and economic costs of sight loss are well recognised, with strong evidence that screening is an effective intervention when linked with access to appropriate treatment pathways.

DR screening programmes are relatively non-complex and low tech, using retinal fundus cameras to capture 2D digital images, which are then graded for the presence and severity of any DR. Anybody considered to be at risk of sight threatening retinopathy should then be referred to an appropriate eye care treatment centre.

There are 387 million people living with diabetes worldwide and this number is estimated to increase by more than 50% in the next 20 years. Just thinking about the global economic cost alone of dealing with the disease complications is mind-numbing. We have to start somewhere and thus in this discussion we will discuss the prevention of sight loss.

My question may initially appear simple, even naive. But considered in the context of the above, it may also strike you as profound.

Why can’t every person with diabetes have access to an effective retinopathy screening programme?


Despite of diabetic retinopathy being the major cause of blindness among adults in the world, 1 out of 3 people with diabetes having this disease, and the clinical and cost effectiveness of screening for DR, the access to these programs is still non existent in the majority of the world. An adequate implementation of DR screening programs can result in major savings for the healthcare systems. In the US the cost with diabetes-related blindness is about $500M annually. http://www.cdc.gov/visionhealth/pdf/factsheet.pdf

Although some questions remain to be answered regarding the most adequate screening intervals and target population. http://bjo.bmj.com/content/early/2015/01/13/bjophthalmol-2014-305938.full http://www.ncbi.nlm.nih.gov/pubmed/23819487 see also: http://www.ncbi.nlm.nih.gov/pubmed/20596693