Analysis of a comprehensive diabetic retinopathy screening model for rural and urban diabetics in developing countries
Open accessAbstract
AIM: To present an analysis of a screening model for diabetic retinopathy and compare the results of screening between rural and urban populations. METHODS: Between June 2003 and September 2004, 51 diabetic retinopathy screening camps (rural, 25; urban, 26) were conducted in three southern districts of India. The target population, aged 30 years and above, underwent comprehensive eye evaluation and those with referable diabetic retinopathy (proliferative diabetic retinopathy, severe non-proliferative diabetic retinopathy, severe diabetic macular oedema, or a combination of these) were referred to the base hospital for further treatment. RESULTS: Among 7716 diabetic subjects, the age and sex adjusted prevalence of diabetic retinopathy was 18% in the rural areas and 17% in the urban areas. The prevalence of referable retinopathy was 6.8% in rural areas and 4.6% in urban areas (p<0.001). Around 63% of individuals in rural areas and 75% in urban areas had never previously had their eyes examined for diabetic retinopathy. Multivariate analysis revealed the following risk factors for diabetic retinopathy: age more than 50 years, known diabetes, prolonged duration of diabetes, and eyes with moderate or severe visual impairment (p<0.0001). CONCLUSIONS: The study describes a comprehensive diabetic retinopathy screening model which can identify sight threatening retinopathy and provide necessary treatment for rural and urban populations.
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The International Clinical Diabetic Retinopathy severity scale was the most commonly utilized severity scale, used in 15 out of 30 studies.
“Various severity scales are used to classify diabetic retinopathy (DR), with the International Clinical Diabetic Retinopathy (ICDR) severity scale being the most commonly utilized in 15 out of 30 studies [9, 11–13, 15, 18, 21–23, 32, 34–36].”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [11]
Sight-threatening diabetic retinopathy is most commonly defined as severe non-proliferative DR, proliferative DR, or clinically significant macular edema.
“Sight-threatening diabetic retinopathy (STDR) is most commonly defined as severe non-proliferative DR (NPDR), proliferative DR (PDR), or clinically significant macular edema (CSME) [8, 10, 11, 13, 14, 21, 33]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [11]
Image acquisition was often performed by trained non-physician staff, while final grading was typically carried out by ophthalmologists or retinal specialists in 22 out of 30 studies.
“Image acquisition was often performed by trained non-physician staff (technicians, optometrists, nurses, paramedics), while final grading was typically carried out by ophthalmologists or retinal specialists (22/30 studies) [8–13, 15, 16, 18, 21, 22, 24, 26, 27, 30–37]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [11]
The included studies reported barriers and limitations affecting the effectiveness and efficiency of diabetic retinopathy screening, including staff commitment, logistical challenges such as limited space for equipment, and IT-related issues like backup file creation.
“The included studies reported several barriers and limitations that affected the effectiveness and efficiency of DR screening. These included staff commitment, logistical challenges such as limited space for equipment, and IT-related issues like backup file creation.”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [11]
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Gulshan, V., Rajan, R. P., Widner, K., Wu, D., Wubbels, P., Rhodes, T., Whitehouse, K., Coram, M., Corrado, G., Ramasamy, K., et al. (2019) · JAMA Ophthalmology · doi:10.1001/jamaophthalmol.2019.2004 · Cited by 303 · see citing works
Self-citationDiabetic retinopathy screening model in low and middle-income countries: a scoping review
Lestari, Y. D., Sitompul, R., Widyahening, I. S., Tahapary, D. L., Yusuf, P. A., Sasongko, M. B., Riono, P., Nursakina, Y., & Alexandra, G. (2025) · BMC Public Health · doi:10.1186/s12889-025-25543-6 · Cited by 11 · see citing works
- Authors
- Rani, P. K., Raman, R., Sharma, V., Mahuli, S. V., Tarigopala, A., Sudhir, R. R., Kumaramanickavel, G., & Sharma, T.
- Affiliations
- Sankara Nethralaya (IN)
- Corresponding author
- Sharma, T.
- Venue
- British Journal of Ophthalmology
- Publisher
- BMJ
- Published
- 2007-10-18
- Volume
- 91
- Issue
- 11
- Pages
- 1425-1429
- ISSN
- 0007-1161 (ISSN-L)
- PMC
- PMC2095459
- OpenAlex
- W2120638124
- Cited by
- 51
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 2 · 2013: 3 · 2012: 5
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Ophthalmology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (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 › Epidemiology › Ophthalmology and Visual Impairment Studies
- Keywords
- diabetic retinopathy, diabetic retinopathy screening, urban-rural differences, prevalence, risk factors, diabetic macular edema, proliferative diabetic retinopathy, non-proliferative diabetic retinopathy, visual impairment, developing countries, India
- MeSH terms
- Adult, Age Factors, Aged, Developing Countries, Diabetic Retinopathy, Female, Humans, India, Male, Mass Screening, Middle Aged, Risk Factors, Rural Health, Severity of Illness Index, Time Factors, Urban Health, Models, Organizational, Patient Selection
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