How often should diabetes-related eye screening be performed?

How often should diabetic eye screening be performed?

The International Diabetes Federation (IDF) guidelines recommend screening examinations should be done annually or at least every two years. The International Council of Ophthalmologists (ICO) Guidelines provide detailed recommendations for screening schedule and referral based on the classification of Diabetes-related Retinopathy (DR) for both low-/intermediate- and high-resource settings (shown below).

Screening Recommendations:

(Low income setting differences are in brackets)

Classification Re-examination/ Next Screening Schedule Referral to Ophthalmologist
No apparent DR, mild non-proliferative DR, and no DME 1-2 years Referral Not required
Mild non-proliferative DR 6-12 months ( Low income 1-2 years) Referral Not required
Moderate non-proliferative DR 3-6 months (Low income 6-12 months) Referral required
Severe non-proliferative DR <3 months Referral required
Proliferative DR <1 month Referral required
Non center-involving DME 3 months Referral required (Low income not required but recommended if laser available)
Center-involving DME 1 month Referral required

Follow-up Schedule and Management Based on Diabetes-related Retinopathy Severity

(Low income setting differences in brackets)

Classification Follow Up Schedule for Management by Ophthalmologists
DR severity
No apparent DR Re- examination 1-2yrs  may not require ophthalmologist
Mild non-proliferative DR Re- examination 6-12months  (1-2 years low income) may not require ophthalmologist
Moderate non-proliferative DR 3-6 months (6-12 months low income)
Severe non-proliferative DR <3 months; consider early pan-retinal photocoagulation in high income only
Proliferative DR <1 month; consider pan-retinal photocoagulation
Stable (treated) DR 6-12 months
DME Severity
Non centre-involving DME 3-6 months; consider focal laser photocoagulation in high income only
Centre-involving DME 1-3 months; consider laser photocoagulation or anti-VEGF therapy
Stable DME 3-6 months