Clinical Implications of Diabetic Retinopathy Screening among Type 2 Diabetes: An Experience of Population-Based Study in Kinmen, Taiwan

Epidemiologic and clinical studies have shown that diabetic retinopathy is a common chronic ocular disorder that developed in most type 2 diabetes. From the viewpoint of preventive medicine, the most crucial topic for preventing diabetic retinopathy is how to achieve early detection and appropriate treatment by using effective screening tools. To understand the morbidity of diabetic retinopathy and to prevent its occurrence requires considering the disease progression of this complication. Early prevention of diabetic retinopathy is needed to understand the relevant risk factors of its occurrence and transitional influence. There are several findings showed in this screening. Firstly, in addition to poor glycemic control, which is the most significant risk factor for the development of diabetic retinopathy and significant prognostic factor for the progression of non-proliferative diabetic retinopathy to proliferative diabetic retinopathy or blindness among type 2 diabetics, longer duration of diabetes, higher systolic blood pressure, and elevated serum triglyceride levels are also associated with the development of diabetic retinopathy. Secondly, for estimates of disease natural history of diabetic retinopathy, the average time of developing from no diabetic retinopathy to blindness is approximately 26.5 years for type 2 diabetics. Thirdly, the different degrees of diabetic retinopathy revealed to decrease the utility value and increase the willingness-to-pay values in type 2 diabetics after adjustment for the confounders. Finally, assessing the progression of diabetic retinopathy following the proliferative pathway and through economic evaluation suggests that screening for diabetic retinopathy is worthwhile and that annual screening interval for type 2 diabetics should be recommended. In conclusion, this eye screening experience not only indicated a series demographic and biochemical markers related to diabetic retinopathy, but also demonstrated the screening efficacy and optimal screening interval for early detection of diabetic retinopathy. Further organized evaluating quality of care programs should consider costs and benefits carefully before setting universal screening standards of diabetic retinopathy among type 2 diabetes.