Disparities in Adherence to Screening Guidelines for Diabetic Retinopathy in the United States: A Comprehensive Review and Guide for Future Directions

Semin Ophthalmol. 2016;31(4):364-77. doi: 10.3109/08820538.2016.1154170. Epub 2016 Apr 26.


Diabetic retinopathy (DR) is the leading cause of new-onset blindness in American adults aged 20-74 years old. The number of diabetics living with diagnosed DR increased by 89%, from 4.06 million to 7.69 million, between 2000 and 2010. Projected numbers from the Vision Health Initiative by the CDC predict that the rate of DR will triple by 2050, from 5.5 million people living with DR to 16 million. Screening guidelines aim to detect cases early because the treatments for DR can reduce severe vision loss by up to 94%. However, adherence to these guidelines is quite low. It is estimated that more than half of patients with diabetes may fail to receive necessary screening. Risk factors for non-screening discussed in this study include low health literacy, lack of access to care, pregnancy, physician adherence to guidelines, unique factors present in different minority populations, gender and age disparities, and living in rural regions. This paper also aims to address potential interventions that may improve adherence rates.

Keywords: Diabetes; diabetic retinopathy; health disparities; ophthalmology; screening.

Publication types

  • Review

MeSH terms

  • Diabetic Retinopathy / diagnosis*
  • Diabetic Retinopathy / epidemiology*
  • Guideline Adherence / statistics & numerical data*
  • Health Status Disparities*
  • Humans
  • Ophthalmology / standards*
  • Practice Guidelines as Topic / standards*
  • United States / epidemiology