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Review of Diabetic Retinopathy Screening Methods and Programmes
Adopted in Different Parts of the World
Janusz Pieczynski, 1,2 and Andrzej Grzybowski 1,3
1. Chair of Ophthalmology, University of Warmia and Mazury, Olsztyn, Warszawska, Poland;
2. The Voivodal Specialistic Hospital, Olsztyn, Zolnierska, Poland; 3. Department of Ophthalmology, Poznan City Hospital, Poznan, Poland
Abstract Introduction: One of most common diabetic complications is diabetic retinopathy (DR). Sight-threatening DR can be avoided when
diagnosed early and treated in a timely fashion. The aim of this study is to review current worldwide DR screening programmes and studies.
Methods: A PubMed platform search was performed to find clinical trials or studies of current DR screening methods. Results: Direct and
indirect ophthalmoscopy is still used, but digital photography of the retina seems to be the most efficient, objective and cost-effective.
Conclusions: DR screening programmes are developed all over the world. They help to detect early sight-threatening DR, treat it in a timely
fashion and in this fashion help to avoid expensive, advanced treatment or even prevent to develop blindness among working age people.
Keywords Diabetic retinopathy, screening methods, telemedicine
Disclosure: Janusz Pieczynski and Andrzej Grzybowski have no conflicts of interest to declare. No funding was received in the publication of this article.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation
and reproduction provided the original author(s) and source are given appropriate credit.
Compliance with Ethical Guidelines: This study involves a review of the literature and did not involve any studies with human or animal subjects.
performed by any of the authors.
Received: 31 May 2015 Accepted: 10 July 2015 Citation: European Ophthalmic Review, 2015;9(1):49–55
Correspondence: Janusz Pieczynski, Voivodal Specialistic Hospital, Zolnierska 18, 10-560 Olsztyn, Poland. E: firstname.lastname@example.org
Diabetes mellitus (DM) is a growing socio-medical problem because of
its increasing prevalence and diabetic complication rate. This is also the
reason for the large amount of money spent on diabetes treatment and
on diabetic complications despite continually improving diabetes care. 1,2
The International Diabetes Federation’s latest study has shown the
number of people with diabetes rise from 382 million worldwide in 2013
to 592 million in 2035. 3
One of most common microvascular diabetic complications is
diabetic retinopathy (DR). It is a most common reason for blindness
in developed countries. Sight-threatening DR can be avoided when
identified early and cured in a timely fashion. 4–7 This is the reason for
diabetic screening implementation.
Rules of screening in medicine were established by Wilson and Jungner
in 1968 and accepted by the World Health Organization (WHO). 8 The
• There should be an agreed policy on whom to treat as patients.
• The cost of case finding (including diagnosis and treatment of
patients diagnosed) should be economically balanced in relation
to possible expenditure on medical care as a whole.
• Case finding should be a continuing process and not a ‘once and
for all’ project.
These rules could be adapted for DR screening. The first attempts
were made in 1989, when the St Vincent Declaration was made.
According to this declaration, reduction of blindness due to DR by
one-third in the following 5 years was planned. 9 The next attempts
on DR blindness reduction were established in 2005 in the Liverpool
Declaration. 10 The consensus was to reduce blindness due to DR by
2010, by DR systematic screening covering at least 80 % of the people
with diabetes population with the use of trained personnel and access
to the proper therapy.
basic principles for disease screening were as following:
Aim of Study
• The condition sought should be an important health problem.
• There should be an accepted treatment for patients with
• Facilities for diagnosis and treatment should be available.
• There should be a recognisable latent or early symptomatic stage.
• There should be a suitable test or examination.
• The test should be acceptable to the population.
• The natural history of the condition, including development from
latent to declared disease, should be adequately understood.
Tou ch MEd ica l MEdia
The aim of this study is to review current worldwide DR screening
programmes and studies performed by technicians or primary care
physicians (not ophthalmologists), quickly and simply.
Methods This is a review study. A PubMed platform search was performed, using
the following keywords: diabetic retinopathy screening programme,
telemedicine and DR, prevented diabetic vision lost to find clinical
trials or review studies of current DR screening programmes. We found