There is strong evidence from high-resource countries, such as the United Kingdom, United States, and Iceland that systematic screening for, and treatment of sight-threatening Diabetes-related Retinopathy is both effective and cost-effective, compared with no screening, in terms of cost per quality adjusted life year (QALY) gained and sight years saved.[10-13] However, the implementation of screening programmes that reach all people living with diabetes remains a challenge, particularly in low- and middle-income countries. A summary of the main barriers to implementation of widespread screening is provided below [14-16]:
- Shortage of trained eye care professionals to perform screening
- Lack of access/funding to equipment for screening, or inability to refer people living with diabetes for Diabetes-related Retinopathy treatment
- Unequal distribution of eye care resources between rural and urban areas
- Lack of epidemiological data relating to the number of people in the population living with diabetes and Diabetes-related Retinopathy within the population (also referred to as the ‘prevalence’).
- The creation of registries for people living with diabetes is important in order to identify the target population for Diabetes-related Retinopathy screening and to estimate the amount of healthcare and financial resources required to implement the screening programme
- Lack of country-specific data relating to the economic costs of vision loss due to Diabetes-related Retinopathy, and the potential cost-savings of early detection through population-based screening
- Organisational issues, including absence of clear management guidelines or clinical care pathways for people living with diabetes and Diabetes-related Retinopathy.
- A lack of clearly defined care pathways can make it difficult to define national screening policies, or design and implement screening programmes
- Organisational issues as a barrier are not just limited to low- and medium-income countries; systematic screening programmes can also be difficult to implement in resource-rich countries that have mixed public and private insurance-based health care, due to the lack of a public health system ensuring universal funding and coverage for screening