Recently updated global diabetic retinopathy screening guidelines: commonalities, differences, and future...

Area of Science:

• Ophthalmology
• Public Health
• Health Policy

Background:

• Diabetic retinopathy (DR) represents a significant global health challenge.
• Effective screening for sight-threatening DR (STDR) is crucial for mitigating its impact.
• Existing DR screening guidelines show considerable variation worldwide.

Purpose of the Study:

• To analyze similarities and differences between country-specific and International Council of Ophthalmology (ICO) DR guidelines.
• To identify gaps in current DR screening practices.
• To propose solutions for a more universal DR screening approach.

Main Methods:

• Comparative analysis of six representative national DR guidelines (Canada, England, India, Kenya, New Zealand, AAO PPP) and ICO guidelines.
• Evaluation of traditional versus newer screening technologies (digital fundus photography, AI).

Main Results:

• All guidelines emphasize ophthalmologist-led DR/STDR screening, with limited non-ophthalmologist involvement.
• Significant variations noted in screening locations and referral timelines.
• Digital fundus photography is prevalent, with growing interest in non-mydriatic cameras and sparse use of automated grading/tele-screening.

Conclusions:

• Country-specific guidelines are essential for addressing national needs and resources.
• International guidelines like ICO's are valuable where national guidelines are absent.
• Urgent policy decisions are needed to integrate AI and tele-screening into universal health coverage for DR screening.