Global DR Screening: Why Aren’t We There Yet?
A look at the hope and hurdles of global screening implementation.
Majda Hadziahmetovic, MD; Michael D. Abramoff, MD, PhD; Abdullah AlQahtani, MD, DES, DISSO, FEBO; Gavin Tan Siew Wei, MBBS, PhD; Sobha Sivaprasad, MBBS, MS, DM, FRCS, FRCOphth; Lloyd Harrison-Williams, MD; and Jorge C. P. Rocha, MD, PhD
Retina Today 
KEY TAKEAWAYS Despite recent advances, diabetic retinopathy (DR) screening remains underused and highly variable worldwide, particularly in low- and middle-income countries. Experts from Brazil, Saudi Arabia, Sierra Leone, Singapore, United Kingdom, and the United States discuss their experiences with DR screening efforts in their region. Barriers to global screening efforts include limited access to specialized care, patient awareness, integration with larger health systems, proper treatment follow-through, and technology constraints. Diabetic retinopathy (DR) remains a leading cause of vision loss among the working-age population worldwide. The numbers are overwhelming; approximately 103 million adults are affected globally, and the burden is projected to exceed 160 million by 2045.1,2 Luckily, DR screening programs have expanded substantially over the past 2 decades. Among the most established examples are the United Kingdom’s National Diabetic Eye Screening Program and Singapore’s Integrated Diabetic Retinopathy Program. Both demonstrate the feasibility of large-scale, systematic DR screening and serve as important models for implementation across diverse health care settings.3-5 Recent advances in autonomous AI systems have marked an important step forward in DR screening, expanding the potential for disease detection beyond traditional eye care settings. LumineticsCore (formerly IDx-DR, Digital Diagnostics) was the first autonomous systems introduced to detect more-than-mild DR (mtmDR) in adults with diabetes. Subsequent systems, including Eyenuk’s EyeArt platform, have expanded automated screening to detect both mtmDR and vision-threatening DR (vtDR). More recently, AEYE Health introduced autonomous mtmDR detection using a portable handheld device, enabling screening across a wider range of clinical and community-based settings.