Present and future screening programs for diabetic retinopathy: a narrative review.

Area of Science:

• Ophthalmology
• Public Health
• Medical Technology

Background:

• Diabetes is a growing global health issue, with diabetic retinopathy (DR) being a major cause of vision loss.
• Effective screening programs are crucial but face challenges due to varying healthcare resources worldwide.
• High-income countries are implementing national screening programs, while progress in low- and middle-income countries is slower.

Purpose of the Study:

• To review the global landscape of diabetic retinopathy screening programs.
• To highlight the impact of technological advancements on DR screening accessibility and effectiveness.
• To discuss the challenges and future directions for DR screening, particularly in resource-limited settings.

Main Methods:

• This narrative review synthesizes current literature on diabetic retinopathy epidemiology and screening strategies.
• It examines various screening modalities, including fundus photography and emerging technologies like AI-powered algorithms and mobile retinal cameras.
• The review analyzes the implementation status of national screening programs across different income-level countries.

Main Results:

• Many high-income nations have established national diabetic eye screening programs (DESP).
• Lower-income countries show limited implementation of DESP, with screening often sporadic and not evidence-based.
• Newer technologies like 2-4 field fundus imaging, handheld cameras, and AI algorithms demonstrate high sensitivity and specificity, offering cost-effective solutions.

Conclusions:

• Technological advancements are enhancing the cost-effectiveness and accessibility of DR screening.
• AI and handheld devices show promise for improving DR detection, especially in underserved regions.
• Further global efforts are needed to implement and optimize DR screening programs to prevent vision loss.