Barriers for the implementation of diabetic eye screening programmes

Barriers for the implementation of diabetic eye screening programmes

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 DR 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.[15-18] However, the implementation of screening programmes that reach all people 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 [19-21]:

  • Shortage of trained eye care professionals to perform screening 
  • Lack of access/funding to equipment for screening, or inability to refer patients for DR 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 affected by diabetes and DR within the population (also referred to as the ‘prevalence’). 
    • The creation of registries for diabetes patients is important in order to identify the target population for DR 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 DR, 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 patients with diabetes or DR
    • 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