A Roadmap for National Diabetic Retinopathy Screening in Croatia: Integrating European Evidence, Telemedicine, and AI

Diabetic retinopathy (DR) is a leading cause of preventable blindness among working-age adults. Systematic screening programmes in the United Kingdom, Ireland, and the Nordic countries have reduced diabetes-related visual loss, yet many European countries, including Croatia, lack organised screening. This narrative review examines European DR screening programmes, evaluates telemedicine and artificial intelligence (AI) as enabling technologies, and proposes a phased roadmap for a national programme in Croatia. Croatia has nearly 400,000 registered persons with diabetes, a national diabetes registry (CroDiab) linked to the Central Health Information System (CEZIH), and pilot screening data showing 40% DR prevalence among screened patients with type 2 diabetes. The proposed programme combines decentralised telemedicine-based imaging at primary care sites with centralised grading, a staged rollout across three phases targeting 400,000 annual screenings, and stepwise AI integration for triage. Successful European programmes share standardised digital imaging, trained grading workforces, embedded quality assurance, and registry linkage. With dedicated funding and sustained political commitment, Croatia could adopt a hybrid telemedicine-AI model and, under favourable implementation conditions, reduce the burden of advanced DR over the coming decade.