Should retinopathy-free older adults continue to be screened for diabetic eye disease?

A new study published in Eye has examined the clinical benefit offered by routine diabetic eye screening among patients aged 80 and older without retinopathy.

Researchers from King’s College Hospital NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust examined long-term follow up data from 3599 patients aged 80 and over within the South East London NHS Diabetic Eye Screening Programme (DESP). None of the patients within the study cohort had diabetic retinopathy or maculopathy at the beginning of the study period.

Among the study cohort, 90.5% of individuals remained free of referable diabetic retinopathy or diabetic maculopathy after at least five years of follow-up.

While 14.8% of patients were referred to the hospital eye service over the follow up period, more than half of these referrals (56.6%) were for non-diabetic eye disease.

Referrals for sight-threatening diabetic retinopathy accounted for 2.5% of referrals – 89 cases in total. Among the study cohort, only four of the 3599 patients required treatment for diabetic eye disease over the follow up period.

All of these patients were treated for diabetic macular oedema, with no cases of proliferative diabetic retinopathy detected.

The researchers concluded that among individuals aged 80 and older without diabetic retinopathy at the outset of the study, the incidence of sight-threatening disease and treatment need over a five-year follow up period was “extremely low.”

“Routine DESP recall in this population may offer limited clinical benefit and should be reconsidered within a risk-stratified screening framework,” the authors noted.