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Cited by 671Retinal Imaging and AnalysisRetinal Diseases and TreatmentsOphthalmology and Visual Health Research

Screening for diabetic retinopathy: new perspectives and challenges

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Vujosevic, Stela, Aldington, Stephen J, Silva, Paolo, Hernández, Cristina, Scanlon, Peter, Peto, Tunde, Simó, Rafael·2020·The Lancet Diabetes & Endocrinology
DOI 10.1016/s2213-8587(19)30411-5
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Abstract

Although the prevalence of all stages of diabetic retinopathy has been declining since 1980 in populations with improved diabetes control, the crude prevalence of visual impairment and blindness caused by diabetic retinopathy worldwide increased between 1990 and 2015, largely because of the increasing prevalence of type 2 diabetes, particularly in low-income and middle-income countries. Screening for diabetic retinopathy is essential to detect referable cases that need timely full ophthalmic examination and treatment to avoid permanent visual loss. In the past few years, personalised screening intervals that take into account several risk factors have been proposed, with good cost-effectiveness ratios. However, resources for nationwide screening programmes are scarce in many countries. New technologies, such as scanning confocal ophthalmology with ultrawide field imaging and handheld mobile devices, teleophthalmology for remote grading, and artificial intelligence for automated detection and classification of diabetic retinopathy, are changing screening strategies and improving cost-effectiveness. Additionally, emerging evidence suggests that retinal imaging could be useful for identifying individuals at risk of cardiovascular disease or cognitive impairment, which could expand the role of diabetic retinopathy screening beyond the prevention of sight-threatening disease.

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  • UK and Australia recommendations suggested a minimum sensitivity of either 80% or 60%, and a specificity of at least 95%.

    “In the UK and Australia, previous recommendations suggested a minimum sensitivity of either 80% or 60%, and a specificity of at least 95%25–30.”

    From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [25]

    The “Current guidelines and procedures” section (page unavailable) says effective diabetic-retinopathy screening requires sensitivity above 80%, supporting the claim’s 80% component. It does not identify that threshold as a previous UK or Australian recommendation, or report a 60% sensitivity minimum or a 95% specificity minimum. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • These criteria were mostly developed based on empirical considerations from different screening modalities and without explicit evidence, especially from cost-effective perspectives.

    “These criteria were mostly developed based on empirical considerations from different screening modalities (e.g., fundus cameras), and without explicit evidence, especially from cost-effective perspectives25.”

    From Economic evaluation for medical artificial intelligence: accuracy vs. cost-effectiveness in a diabetic retinopathy screening case (2024) · cites this paper as [25]

    The Current guidelines and procedures section discusses fundus-camera approaches and evidence comparing their screening performance. The cost-effectiveness of screening section reports economic studies. Neither section says that the criteria were mostly developed empirically or without explicit evidence, particularly cost-effectiveness evidence (searched: empirical, criteria, fundus cameras and cost-effectiveness). (LLM, conf=0.69)

    Experimental — accuracy not yet measured

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Authors
Vujosevic, S., Aldington, S. J., Silva, P., Hernández, C., Scanlon, P., Peto, T., & Simó, R.
Affiliations
  • Azienda Ospedaliero Universitaria Maggiore della Carita (IT)
  • Gloucestershire Hospitals NHS Foundation Trust (GB)
  • Joslin Diabetes Center (US)
  • Universitat Autònoma de Barcelona (ES)
Corresponding author
Simó, Rafael
ORCID
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2020-04
Volume
8
Issue
4
Pages
337-347
ISSN
2213-8587 (ISSN-L)
DOI
10.1016/s2213-8587(19)30411-5
OpenAlex
W3007579635
Cited by
671
References
6
Citations by year
2026: 89 · 2025: 157 · 2024: 154 · 2023: 119 · 2022: 86 · 2021: 50 · 2020: 16
FWCI
9.99
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc-nd)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
Keywords
diabetic retinopathy, screening, type 2 diabetes, visual impairment, blindness, cost-effectiveness, ultra-widefield imaging, handheld devices, teleophthalmology, artificial intelligence, automated detection, retinal imaging, cardiovascular risk, cognitive impairment
MeSH terms
Cost-Benefit Analysis, Diabetic Retinopathy, Humans, Ophthalmology, Referral and Consultation, Vision Screening, Disease Progression, Risk Assessment, Early Diagnosis

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