From the Guidelines
Diabetic patients should undergo regular comprehensive dilated eye examinations to screen for diabetic retinopathy, starting at diagnosis for type 2 diabetes and within 5 years after the onset of diabetes for type 1 diabetes, with follow-up exams every 1-2 years if no retinopathy is present, or more frequently if abnormalities are detected, as recommended by the 2025 standards of care in diabetes 1. The screening test used for diabetes is a comprehensive dilated eye examination by an ophthalmologist or optometrist, which may include retinal photography with remote reading or the use of U.S. Food and Drug Administration–approved artificial intelligence algorithms to improve access to diabetic retinopathy screening 1. Some key points to consider when screening for diabetic retinopathy include:
- The initial examination should be performed by an ophthalmologist or optometrist, and subsequent exams can be done at least annually if any level of diabetic retinopathy is present 1.
- If retinopathy is progressing or sight-threatening, then examinations by an ophthalmologist will be required more frequently 1.
- Programs that use retinal photography with remote reading or artificial intelligence algorithms can be used as screening strategies, but should provide pathways for timely referral for a comprehensive eye examination when indicated 1. The goal of these screenings is to detect signs of retinopathy, including microaneurysms, hemorrhages, hard exudates, cotton wool spots, and abnormal blood vessel growth, and to allow for timely intervention to prevent vision loss 1.
From the Research
Ophthalmic Screening Tests for Diabetes
- A dilated eye examination is recommended for patients with diabetes mellitus during an initial assessment and at least annually thereafter 2
- Optical coherence tomography angiography (OCTA) is an innovative imaging technology that can detect various pathologies and quantifiable changes in retinal microvasculature, and can be used for screening or management of people with diabetes 3, 4
- A portable, noncontact, nonmydriatic handheld retinal camera can be used to obtain retinal images for diabetic retinopathy screening, with high sensitivity and acceptable specificity compared to clinical exam 5
Key Features of Ophthalmic Screening Tests
- Dilated eye examination: can detect retinopathy, glaucoma, and cataracts 6, 2
- OCTA: can detect early microvascular alterations, measure ischemia, detect retinal neovascularization, and evaluate the progression or regression of neovascular complexes 3, 4
- Handheld retinal camera: can capture retinal images of sufficient quality to screen for diabetic retinopathy with and without dilation 5