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Cited by 34Retinal Imaging and AnalysisRetinal Diseases and TreatmentsHealth Promotion and Cardiovascular Prevention

Factors Affecting Global Adherence for the Uptake of Diabetic Retinopathy Screening: A Systematic Review and Meta-Analysis

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RAHMATI, MASOUD, SMITH, LEE, BOYER, LAURENT, FOND, GUILLAUME, YON, DONG KEON, LEE, HAYEON, SOYSAL, PINAR, PIYASENA, MAPA PRABHATH +1 more·2024·American Journal of Ophthalmology
DOI 10.1016/j.ajo.2024.07.028
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Abstract

PURPOSE: To evaluate diabetic retinopathy (DR) screening global adherence rate and the association between sociodemographic and clinical variables and adherence rates to DR screening in individuals with diabetes. DESIGN: Systematic review and meta-analysis. METHODS: This systematic review was registered with International Prospective Register of Systematic Reviews (ID: CRD42024507035). We conducted a systematic review of relevant literature from inception of databases to February 24, 2024, using electronic databases searches including PubMed, MEDLINE (Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CDSR and national level DR screening databases through Google searches following PRISMA guidelines. The articles were screened for title and abstract and then for the full-text reports by two independent reviewers and study quality was appraised. Meta-analysis was performed using random effects model to calculate the pooled effects size and 95% confidence interval (CI) of each finding. RESULTS: Data from a total of 11,383,715 participants from 77 studies and two national websites from 28 countries over five continents were included. Global DR screening adherence rate was 66.9% in high-income countries and 39.3% in low-and-middle-income countries. DR screening adherence rate was lowest in Africa (36.1%) and was highest in Europe (81.3%). Older age (odds ratio [OR] 1.45, 95% CI 1.30-1.62), higher education level (OR = 1.65, 95% CI 1.45-1.78), marriage (OR = 1.42, 95% CI 1.14-1.77), living in an urban area (OR = 1.57, 95% CI 1.08-2.29), higher family income (OR = 1.29, 95% CI 1.24-1.35), having any health insurance (OR = 1.90, 95% CI 1.56-2.31), longer duration of diabetes (OR = 1.57, 95% CI 1.27-1.94), type 2 diabetes (OR = 1.68, 95% CI 1.34-2.10), family history of diabetes (OR = 2.25, 95% CI 1.56-3.25), vision impairment (OR = 2.07, 95% CI 1.43-2.98), history of eye diseases (OR = 1.99, 95% CI 1.36-2.90), insulin treatment (OR = 1.38, 95% CI 1.37-1.39), and good mental health (OR = 1.14, 95% CI 1.04-1.24) were associated with DR screening adherence. CONCLUSION: This meta-analysis provides key information about which population subgroups may require more targeted intervention and highlights the urgent need to identify ways to improve adherence to DR screening. REGISTRATION INFORMATION: PROSPERO; ref. no. CRD42024507035, (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=507035).

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  • Sub-optimal referral uptake results in unmanaged patients at risk of blindness.

    “Indeed, beyond challenges of access and attendance at routine DR screening, referral uptake for those with referable DR is sub-optimal11,12 resulting in unmanaged patients at risk of blindness.”

    From Referral uptake after diabetic retinopathy screening with artificial intelligence-assisted care pathways: a systematic review and meta-analysis (2026) · cites this paper as [11]

    The Discussion (page unavailable) reports suboptimal uptake of routine diabetic retinopathy screening, and the Introduction (page unavailable) says prompt treatment can reduce sight-threatening disease and visual impairment. Neither passage establishes that uptake of referrals among patients with referable retinopathy is suboptimal or that missed referrals leave those patients unmanaged. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Referral uptake for those with referable diabetic retinopathy is sub-optimal.

    “Indeed, beyond challenges of access and attendance at routine DR screening, referral uptake for those with referable DR is sub-optimal11,12 resulting in unmanaged patients at risk of blindness.”

    From Referral uptake after diabetic retinopathy screening with artificial intelligence-assisted care pathways: a systematic review and meta-analysis (2026) · cites this paper as [11]

    The Eligibility Criteria and §3.2 measure attendance at routine diabetic retinopathy screening among people with diabetes, not uptake of referrals after referable retinopathy is detected. Searches for referable DR and referral follow-up found no passage reporting referral uptake. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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References 40 · Cited by 34

Research works printed but not linked: 33

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Authors
RAHMATI, M., SMITH, L., BOYER, L., FOND, G., YON, D. K., LEE, H., SOYSAL, P., PIYASENA, M. P., & PARDHAN, S.
Affiliations
  • Aix-Marseille Université (FR)
  • Anglia Ruskin University (GB)
  • Kyung Hee University (KR)
Corresponding author
  • RAHMATI, MASOUD
  • PARDHAN, SHAHINA
ORCID
Venue
American Journal of Ophthalmology
Publisher
Elsevier BV
Published
2024-12
Volume
268
Pages
94-107
ISSN
0002-9394 (ISSN-L)
DOI
10.1016/j.ajo.2024.07.028
OpenAlex
W4401275084
Cited by
34
References
40
Citations by year
2026: 18 · 2025: 15 · 2024: 1
FWCI
2.23
Type
journal article
Language
en
Open access
Licence
Locations
  • American Journal of Ophthalmology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Figshare (submittedVersion, cc-by-nc-nd)
Funders
Anglia Ruskin University
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
diabetic retinopathy screening, screening adherence, diabetes mellitus, sociodemographic factors, health insurance, health literacy, diabetes duration, type 2 diabetes, low- and middle-income countries, health equity, barriers to screening, health system governance, health system performance, health system sustainability, health system resilience, health system adaptability
MeSH terms
Diabetic Retinopathy, Humans, Mass Screening, Patient Compliance, Global Health

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