Availability and variability in guidelines on diabetic retinopathy screening in Asian countries

Area of Science:

• Ophthalmology
• Public Health
• Diabetes Management

Background:

• Diabetic retinopathy (DR) is a leading cause of preventable blindness globally, particularly in Asia's growing diabetic population.
• Effective DR screening programs are crucial for early detection and treatment, yet regional prevalence data and screening guidelines are scarce.
• Understanding the current landscape of DR screening guidelines in Asia is vital for addressing the rising burden of diabetes-related eye disease.

Purpose of the Study:

• To systematically review and compare national DR screening guidelines from 50 Asian countries against International Council of Ophthalmology (ICO) standards.
• To summarize the prevalence of DR and sight-threatening DR (STDR) across these Asian nations.
• To identify gaps in current guidelines and provide recommendations for improvement.

Main Methods:

• A comprehensive search for national DR screening guidelines was conducted across 50 Asian countries.
• Guidelines were systematically evaluated against ICO standards for screening initiation, intervals, referral criteria, and process recommendations.
• Prevalence data for DR and STDR were compiled from available literature and national reports.

Main Results:

• Only 11 Asian countries have published relevant DR screening guidelines, covering less than half the region's population.
• The median DR prevalence in Asian patients with diabetes is 30.5%, with consistently higher rates of STDR compared to Western countries.
• While most guidelines align with ICO on screening timing, significant deficiencies exist in referral criteria and recommendations for screening processes, equipment, and personnel.

Conclusions:

• Asian countries require more robust, evidence-based DR screening guidelines to effectively combat DR-related blindness.
• Enhancing guidelines to meet international standards for referral and screening processes is essential for improving patient outcomes.
• Strengthening national DR screening programs can reduce the incidence of preventable blindness and lower healthcare costs associated with diabetes complications.