Less frequent diabetic eye disease screening would result in inequality

New research has suggested that biennial screening for diabetic eye disease would result in the delayed detection of sight-threatening diabetic retinopathy and proliferative diabetic retinopathy in some patients.

The study, which was published in British Journal of Ophthalmology, also found that shifting to biennial screening could lead to health inequalities, with black patients particularly adversely affected by less frequent screening. 

The UK Screening Committee has recommended that individuals with diabetes at low risk of sight loss be screened for diabetic retinopathy every two years. Previously, all diabetes patients were offered screening on an annual basis.

In their study, US and UK researchers found that extending the screening interval would have a disproportionate effect on younger people and people of black and Asian ethnicities.

“National implementation of a two-year diabetic eye screening interval for people with low-risk diabetic retinopathy grades does not affect all population sub-groups equally with respect to delays in the detection and referral of the most serious eye disease,” the authors wrote.

Across all of the populations studied, implementation of biennial screening would have delayed detection by a year in 56% of patients with sight-threatening diabetic retinopathy and 44% of patients with proliferative retinopathy.

The researchers suggest the potential of alternative technologies in enabling annual screening for those at low risk of sight loss due to diabetic eye disease to continue.

Alternatively, they suggest that more nuanced screening intervals among different socioeconomic groups could provide more equitable healthcare.