The War on Diabetic Retinopathy: Where Are We Now?
Open accessAbstract
Diabetic retinopathy (DR), a major cause of blindness in working-age adults, is emerging as a major public health issue worldwide, in particular in low- and middle-income countries (LMIC). Traditionally, the management of DR has been on tertiary-level treatment (eg, laser, anti-VEGF injections and surgery) in specialized settings by highly trained ophthalmologists on individual patients. To win the war on DR, a paradigm shift in strategic focus and resources must be made from such tertiary treatment toward primary and secondary prevention, which are broader, more impactful, and cost-effective for the larger population. These include improving education and awareness of risk of DR among people initially diagnosed with diabetes, promoting behavioral modifications such as physical activity and medication adherence for improving glycemic and blood pressure control, setting up systematic screening programs for DR to detect the onset or progression of the disease, and implementing cost-effective, evidence-based policies and guidelines for managing DR. Additionally, there is a need to leverage on novel technology including the application of digital big data to predict people at risk of diabetes and DR, the use of wearable devices and smart phone apps, behavioral techniques including social media for self-management of diabetes, and telemedicine-based DR screening incorporating artificial intelligence (AI) to broaden access to screening in all settings. To turn the tide on the war on DR, we must reframe DR not only as a specific condition that can be managed by ophthalmologists, but fundamentally, as a preventable condition by shifting the weight of strategies from tertiary to secondary and primary battlegrounds.
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Diabetic retinopathy is a leading cause of blindness in working-age adults globally and disproportionately affects low- and middle-income countries.
“Diabetic retinopathy (DR), a leading cause of blindness in working-age adults, disproportionately affects low- and middle-income countries (LMICs).”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [2]
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Self-citationDiabetic retinopathy screening model in low and middle-income countries: a scoping review
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- Authors
- Wong, T. Y., & Sabanayagam, C.
- Affiliations
- National University of Singapore (SG)
- Corresponding author
- Wong, Tien Y.
- Sabanayagam, Charumathi
- Venue
- Asia-Pacific Journal of Ophthalmology
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 8
- Issue
- 6
- Pages
- 448-456
- ISSN
- 2162-0989 (ISSN-L)
- PMC
- PMC6903323
- OpenAlex
- W2992080259
- Cited by
- 84
- References
- 62
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 22 · 2023: 13 · 2022: 16 · 2021: 17 · 2020: 7
- FWCI
- 9.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Asia-Pacific Journal of Ophthalmology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- National University of Singapore (submittedVersion)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Keywords
- diabetic retinopathy, blindness prevention, primary prevention, secondary prevention, diabetes screening, glycemic control, blood pressure control, medication adherence, physical activity, telemedicine screening, artificial intelligence, wearable devices, mobile application, digital health, low- and middle-income countries, public health policy
- MeSH terms
- Blindness, Diabetic Retinopathy, Humans, Mass Screening, Patient Education as Topic, Primary Health Care, Telemedicine, Evidence-Based Medicine
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