Authors' objectives:

To review the current scientific foundation concerning the occurrence of diabetic retinopathy and the methods available for early detection and treatment. Results from a survey of the current status of screening and treatment in Sweden are also presented as well as an economic analysis.

Authors' results and conclusions: An estimated 3% of the Swedish population (about 250,000), have diabetes, 80% of whom are over 50 years old. The results of the questionnaire study suggest that the need for diabetic retinopathy screening is generally well met for diabetics treated with insulin. Currently, the screening programme covers only a limited portion of those treated by oral agents or a diet regime. The current screening programme in Sweden results in a social economic savings for Type I diabetes and offers a major benefit for many patients by preventing blindness. The cases of prevented blindness are substantially lower for Type II diabetes. Expanding screening activities to include all persons with Type II diabetes would have a social economic cost of about 50 000 SEK per prevented year of blindness.

Authors' recommendations: Sight loss is a common complication of diabetes. Regular check-ups and treatment can help to prevent this problem. Persons with insulin-dependent diabetes, older than 10 years of age, should have regular eye examination (fundus examination and visual acuity testing). Subsequently, examinations should be every second year. If retinopathy is detected, the frequency of check ups should be decided on an individual basis. Physicians who treat diabetes should be well versed on the principles of eye treatment, and ophthalmologists should be well informed on a patient's diabetes. Physicians treating diabetes should inform all patients that sight threatening changes in the eyes are a usual complication, but often asymptomatic at early stages, and that early detection and correct treatment substantially reduce the risk for serious sight disorders or loss. Physicians treating diabetes should receive information on the results of the eye examination and should be responsible for informing the patient. The fundus may be examined by ophthalmoscopy/biomicroscopy via dilated pupils, or by using fundus photography. Pupils should be dilated even for photography and at least two fields per eye should be imaged, including stereophotography of the macula area. Photocoagulation should be performed by an experience ophthalmologist or under the supervision of one, and is indicated at clinically manifest macular oedema, proliferative retinopathy and in certain cases of preproliferative retinopathy. Vitrectomy is indicated in cases of retinal detachment, frequent vitreous haemorrhaging and increasing neovascularization and new connective tissue formation which is not halted by appropriate photocoagulation.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.sbu.se/Published

Year Published: 1993

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Sweden

Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services

Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260

Contact Name: registrator@sbu.se

Contact Email: registrator@sbu.se

Copyright: The Swedish Council on Technology Assessment in Health Care