Diabetic Retinopathy Screening Lacking in Many Patients With Diabetes

Woman using glucometer, checking blood sugar level.
Woman using glucometer, checking blood sugar level. Concept of diabetes and health care
Younger age, mental health history, and lower income predict a greater likelihood of failure to screen individuals with diabetes for diabetic retinopathy.

Approximately one-third of patients with diabetes are not screened for diabetic retinopathy (DR), according to a study published in the Canadian Journal of Ophthalmology. Age, income, and mental health status are among several variables affecting an individual’s screening status.

Investigators assessed population-based factors associated with failure to screen individuals aged 20 years or older with type 1 or type 2 diabetes for diabetic retinopathy. The team performed a retroscopic analysis of 1,145,645 and 1,346,578 patients between  2011-2013 and 2017-2019, respectively and examined secondary characteristics including duration of diabetes, chronic disease comorbidities, and aggregated diagnosis groups (ADG). 

The team noted that the number of patients  who were not screened for diabetic retinopathy was 35% between 2011 and 2013. This value declined slightly to 34% between 2017 and 2019 (RR, 0.967; P <.0001). They identified several factors that predicted failure to screen including younger age (20-39 years), lower income (RR, 1.039; 95% CI, 1.036-1.044), recent immigration (RR, 1.286; 95% CI, 1.280-1.293), urban residence (RR, 1.149; 95% CI, 1.145-1.154), history of psychiatric illness (RR, 1.117; 95% CI, 1.112-1.122), and not having a primary-care provider (RR, 1.658; 95% CI, 1.644-1.662). Researchers identified hypertension (66%-67%), chronic obstructive pulmonary disease (17%-18%) and asthma (15%-16%) as the most common comorbidities among screened participants.

“Our findings demonstrated that the proportion of DR unscreened individuals among the high ADG and very high health care users was 29%-33%,” according to the investigators. “Given their high comorbidities and interaction with the health care system, these individuals are at a high risk of having DR. This suggests that thousands of individuals in our population most likely have DR that has not been identified.”

Study limitations include its retroscopic nature and failure to include data from some Indigenous populations and those paying out-of-pocket or with private insurance.


Felfeli T, Katsnelson G, Kiss A, et al. Prevalence and predictors for being unscreened for diabetic retinopathy: a population-based study over a decade. Can J Ophthalmol. Published online May 13, 2022. doi:10.1016/j.jcjo.2022.04.002