Diabetic eye screening in people with diabetes undergoing haemodialysis: A systematic review and meta-analysis

People with diabetes receiving haemodialysis are at increased risk of diabetic retinopathy (DR) and other ocular complications. Despite this heightened vulnerability, evidence on the prevalence of such conditions in this population is limited.  This review aimed to synthesise the existing literature on the prevalence of DR and other ocular conditions, and to evaluate screening rates in people with diabetes undergoing haemodialysis.

A systematic search of MEDLINE, EMBASE and CINAHL databases was conducted to identify studies reporting on the prevalence of DR, diabetic maculopathy and other ocular conditions in people with diabetes on haemodialysis. Eight articles meeting inclusion criteria were included. Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated using random-effects models.

The pooled prevalence of DR was 49.1% (95% CI: 23.1-75.4), while diabetic maculopathy prevalence was 32.5% (95% CI: 10.9-59.1). Other ocular complications reported included cataracts (53.4%), conjunctival calcification (63%) and corneal calcification (45.3%). Notably, 54.3% (95% CI: 35.4-72.6) of individuals on haemodialysis had not undergone eye screening in over two years.

This review reveals a high prevalence of DR and other ocular complications in people with diabetes undergoing haemodialysis, alongside significant under-screening. Future research should focus on developing and accessing targeted interventions to improve screening uptake in this vulnerable population.