Table 2.

Four stages to develop systematic screening of diabetic retinopathy (DR) (modified from information provided by the Screening for Diabetic Retinopathy in Europe [5]).

Stage 1: Enhanced access to Effective Diabetic Retinopathy Treatment

- Minimum number of lasers per 100,000 population - Equal access to diagnosis and treatment for all patient groups - Maximum waiting time from diagnosis to treatment (≤3 months)

Stage 2: Establish Opportunistic Screening

- Mydriatic fundus examination performed during routine clinic visits - Annual evaluation - National guidelines for referral to an ophthalmologist

Stage 3: Establish systematic screening.

- Diabetic registry to identify the target population - Systematic call-recall for registered diabetic patients - Annual fundus examination: sensitivity ≥ 80%, specificity ≥ 90%, coverage ≥ 80%.

Stage 4: Establishment of systematic screening with complete quality assurance and coverage

- Digital photographic screening - Trained and certified photograders - Quality assurance at all stages of the process - Data collection for monitoring and effectiveness