The development of screening programmes for diabetic eye disease in Europe was initially encouraged by the “St Vincent Declaration” published in 1989, which set a target of reducing diabetes-related blindness by one third in the following 5 years.
Progress towards achieving the St Vincent Declaration target was reviewed and revised at a consensus conference held in Liverpool, UK in 2005. This meeting was attended by national representatives of diabetology and ophthalmology from 29 European countries.
The discussions led to the development of the “The Liverpool Declaration”, which set a target to reduce the risk of visual impairment due to diabetic retinopathy by 2010 by:
- Systematic programmes of screening reaching at least 80% of the population with diabetes
- Using trained professionals and personnel
- Universal access to laser therapy
Several follow-up conferences have been held since Liverpool to review the progress of countries towards these targets. These have been held as satellite meetings of the Annual European Association for the Study of Diabetes conference in Amsterdam in 2008, Gdansk in 2011, and most recently, Manchester in 2016.
The report from Manchester meeting details the current status of screening programs in different European countries (full copy available here)
European countries who participated in the development of the Liverpool Declaration
|Finland||Republic of Ireland|
While many European countries have made progress towards the implementing screening for DR, very few have established systematic (organised) screening programmes designed to reach all people in the population with diabetes. Countries with established systematic screening programmes include:
Many other European countries have taken a stepwise approach to the implementation of screening, by initially establishing city wide or smaller regional screening programs, with the aim of eventually developing national programmes.
Although screening for DR in people with diabetes is recommended by clinical guidelines in the United States, non-adherence to these guidelines is common problem . It has been estimated that more than 50% of people with diabetes do not receive eye health screening as recommended. A number of reasons are understood to contribute to the lack of screening, including low health literacy, lack of access to care, and physician adherence to the guidelines.
The 2011 Clinical Practice Guide for Diabetic Retinopathy in Latin American countries, developed by VISION 2020, provides comprehensive recommendations relating the classification, detection, and treatment of DR. It also includes guidance on how to create a retinopathy screening program for DR.
Despite these recommendations, no country in the region has appeared to have implemented a systematic screening program, although regional and local screening initiatives have been reported in the literature (see further details below).
In April 2017, the International Federation on Ageing (IFA) hosted the “DR Barometer Latin American Advocacy Workshop” in Mexico City to identify barriers and create solutions to improve vision health outcomes for adults with diabetes in the region.
The workshop, organized in partnership with International Agency for the Prevention of Blindness (IAPB), the International Diabetes Federation (IDF) and Bayer, brought together 46 delegates from several Latin America countries (Argentina, Brazil, Chile, Colombia, Costa Rica, and Mexico). The output from the meeting was the development of consensus document (click here for further details on this initiative and for information regarding the current status of screening in these Latin American countries).
Regional screening programmes he also been reported for other Latin American countries, including Peru, where a diabetic referral network has been established in the North of the country. (for further details on this project, see: http://www.who.int/bulletin/volumes/96/10/18-212613/en/)
The majority of countries in Asia do not have specific recommendations relating to screening for DR. A systematic literature review searching for national DR screening guidelines in 50 Asian countries found that only 11 had published some form of guidelines.
Australia: A new national diabetes eye screening program (an Australian-First initiative) was announced in July 2018. This is being funded by an initial grant from the Australian Government and matching funding from private sector organisations.
China: Lifeline Express (LEX) has established a large-scale, free-of-charge, nationwide diabetic retinopathy screening program in China . A total of 29 DR screening centres have been established across mainland China as part of this initiative.
Japan: Despite good access to health care in Japan for people with diabetes, a study evaluating claims data found that screening of DR was performed less frequently than recommended by the national guidelines
No nationwide systematic screening programs have been implemented, although there have been several reports in the literature of regional screening initiatives in some countries, including South Africa and Tanzania