Introduction
Eye screening is crucial for managing diabetes, regardless of the type. Diabetes can increase the risk of developing eye problems, including diabetic retinopathy, which can cause vision loss. Diabetic retinopathy is a major complication of diabetes that damages the eyes. Since diabetic retinopathy may not show symptoms in the early stages, it can become severe before becoming noticeable. Regular eye screening can aid in the early detection and treatment of diabetic retinopathy, preventing it from progressing to a more advanced stage that is more challenging to treat. For eye screening, diabetic retinopathy screening programs are conducted worldwide to detect retinopathy early and prevent it from getting worse. This article will emphasize these diabetic retinopathy screening programs.
What Is the Diabetic Retinopathy Screening Program?
Diabetic retinopathy is causing many employed individuals in developed countries to lose their sight. To combat this, the Saint Vincent Declaration was created to reduce new cases of blindness caused by diabetes. This global initiative was established in 1989 and aimed to improve diabetes care by creating a set of goals and guidelines. One of the main objectives was to decrease the incidence of new cases of blindness caused by diabetic retinopathy by at least one-third within a five-year period. Furthermore, screening for diabetic retinopathy across the entire country is crucial to achieving this goal.
What Are the Screening Methods for Diabetic Retinopathy?
In 2018, the American Diabetes Association (ADA) and the International Council of Ophthalmology (ICO) updated their guidelines for detecting diabetic retinopathy. According to the ICO/ADA guidelines of 2018, proper screening for diabetic retinopathy should consist of a retinal examination and a visual acuity test.
The screening method used for diabetic retinopathy depends on the resources available. Adequate screening should include both a visual acuity exam and a retinal examination. To assess visual acuity, healthcare professionals can use one of the following methods:
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Utilizing a high-contrast chart and a three- or four-meter visual acuity lane, a refracted visual acuity examination is performed.
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Use a pin-hole option if necessary and a near or distant eye chart to present a visual acuity test.
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Presenting a visual acuity test with a portable chart that has at least five common letters or symbols and, if necessary, a pin-hole option.
For a retinal examination, healthcare professionals can use one of the following methods:
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Direct or indirect ophthalmoscopy.
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Slit-lamp biomicroscopic examination of the retina.
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Retinal photography (fundus photography) uses 30° to a wide field.
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Mono photography.
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Stereo photography.
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Dilated or undilated photography.
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Optical coherence tomography (OCT) may also be used for retinal examination. Healthcare professionals who are trained to perform ophthalmoscopy or retinal photography and can assess disease severity may perform the retinal examination, regardless of whether they hold a medical degree.
Which Is the Best Diabetic Retinopathy Screening Method?
For a screening program to work well, the test used must be able to identify most people who have the condition (high sensitivity) while also not mistakenly identifying people who do not have the condition (high specificity). The British Diabetic Association recommends that any screening method for diabetic retinopathy should have at least 80 percent sensitivity and specificity. As discussed earlier, there are different methods used for diabetic retinopathy screening, such as direct ophthalmoscopy, retinal photography, and screening by optometrists using the indirect ophthalmoscope or the slit lamp biomicroscope. Among all of these methods, direct ophthalmoscopy is not considered effective for screening because it consistently fails to meet the 80 percent sensitivity and specificity targets.
On the other hand, it has been found that retinal photography through dilated pupils is the most effective screening method for diabetic retinopathy; however, more research is needed to understand more about it.
Why Is Diabetic Retinopathy Screening Important?
Screening for diabetic retinopathy is important because it helps to identify the disease before symptoms appear. This is important because laser treatment is very effective in preventing vision loss if it is done at the right time. Research has shown that laser treatment can reduce the risk of vision loss in people with diabetic retinopathy by about 50 percent. Screening helps to catch the disease early so that treatment can be given when it is most effective.
What Age Does Diabetic Eye Screening Start?
Individuals with diabetes who are 12 years old or older should go for regular eye screening. Screening is not automatically offered to children under 12 years old, as eye problems are uncommon in that age group. Therefore, they should attend the screening by themselves. Upon first diagnosis, individuals with diabetes aged 12 and over will receive an invitation to attend regular eye screenings. The recommended frequency for eye screening is once a year initially, with subsequent screenings being adjusted according to the results.
How Is the Result of the Diabetic Retinopathy Screening Program Depicted?
The results of the diabetic retinopathy screening represent the current status of the eye. After attending the screening, individuals will receive a letter with their results within six weeks. The letter will contain an 'R' followed by a number, with the 'R' standing for retinopathy and the number indicating the extent of damage, if any, that has occurred. Depending on the results, different steps will need to be taken.
Those with no retinopathy (R0) can continue with their regular eye screening. Those with background changes (R1) may be asked to return for screening sooner. Individuals with non-proliferative retinopathy (R2) will need more frequent eye screenings, while those with proliferative retinopathy (R3) will be referred to an eye specialist for further evaluation and discussion of treatment options.
How to Prevent Diabetic Retinopathy?
Regular eye screening helps people with diabetes keep track of their eye health, but there are additional steps they can take to reduce the risk of serious eye complications. These include monitoring changes in vision, knowing their target blood sugar levels, maintaining healthy blood pressure and cholesterol levels, eating a balanced diet, exercising regularly, and quitting smoking. Healthcare teams can provide support and discuss treatment options if complications develop. Early detection is critical for preventing worsening eye damage.
Conclusion
To conclude, all diabetic individuals must actively participate in diabetic retinopathy screening programs, as these programs benefit them by alerting them to the state of their eyes. In addition, early detection of diabetic retinopathy through regular screening is crucial to preventing vision loss and other serious complications. It is important for individuals with diabetes to work closely with their healthcare team and follow the recommended screening guidelines to ensure optimal eye health. By taking these proactive steps, individuals with diabetes can better manage their condition and reduce their risk of long-term complications.
