The Evolution of Diabetic Retinopathy Screening Programmes: A Chronology of Retinal Photography from 35 mm Slides to Artificial Intelligence

Figures & data

Table 1 Selected Population Screenings and Selected Regional Screening Programs

Name	Starting Date (and End)	(n) Screened Per Annum	Country	(n)ational (r)egional	(i)nstant Reporting (a)Synchronous Reporting
NHS DESP^Citation151	2003	2.250.000	England	n	a
NHS Scotland DRS^Citation152	2003	264.000	Scotland	n	a
DESW^Citation153	2003	170.000	Wales	n	a
NIDESP^Citation154	2008	66.000	Northern Ireland	n	a
SiDRP^Citation155	2010	600.000	Singapore	n	i
Iceland^Citation156	1980	5000 diabetics- biannual screening	Iceland	n	i
Aboriginal controlled community Health services (ACCHS)^Citation157	2000–2004	1318 Aboriginals and 271 non Aboriginals over 5 years (318p/a)	Australia	r	a
Ophdiat^Citation158	2004–2009	38,596 over 5 years (7719 p/a)	France	r	a
South-Ostrobothnia digital mobile screening^Citation31	1999–2006	17.471 over 7 years (2496 p/a)	Finland	r	a
EyePACS^Citation159	2006	140000^Citation160	USA	r	i
Diabetic retinopathy screening Canary Islands^Citation37	2007	42.000 (in 2015)	Spain	r	a

Abbreviations: NHS, National Health Service; DESP, diabetic eye screening program; DRS, diabetic retinopathy screening; DESW, Diabetic Eye Screening Wales; NIDESP, Northern Ireland diabetic eye screening program; SiDRP, Singapore diabetic retinopathy screening program.

Figure 1 Timeline bubble chart displaying selected regional screenings with either synchronous (green) or asynchronous (blue) reporting of screening outcomes. The bubble diameter is an approximation of the number of screened patients with diabetes per annum (yellow), references can be found in Table 1.

Table 2 Overview of Selected Diabetic Retinopathy Clinical Decision Support Systems

Name	Classification	Year of Implementation	Country	Regulatory Status and Relevance to DR
iGradingM	Presence/absence of DR	2010	Scotland, UK	CE mark for medical device in EU, Level 1 Grading NHS Scotland DRS
Retmarker	Presence/absence of DR; microaneurysm turnover	2014	Denmark/Portugal	Class IIa medical device in EU, used in local screening program in Portugal
EyeART	Refer/no refer recommendation	2015	USA	Class IIa medical device in EU, commercially available in Canada
IDx-DR	Referable/non-referable DR	2016	USA	first FDA approved autonomous AI device
SELENA+	DR grading, referable/non-referable DR	2017	Singapore	planned to be implemented in Singapore by 2022
Google Inc	Referable/non-referable DR	2016	USA	CE mark for medical device in EU, current studies in India, Thailand
RETCAD	Referable/non-referable DR	2020	Netherlands	Class IIa medical device in EU
MEDIOS AI	Referable/non-referable DR	2019	India	CE mark for medical device in EU, offline smartphone based

Diabetic eye screening annual data tables 2016 to 2017. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/720462/Diabetic_eye_screening_annual_data_tables_2016_to_2017.xlsx. Accessed July 3, 2020. Accessed April 16, 2020.

 Google Scholar

Diabetic retinopathy screening (DRS) in Scotland. Available from: https://www.nhsinform.scot/healthy-living/screening/diabetic-retinopathy/diabetic-retinopathy-screening-drs. Accessed April 16, 2020.

 Google Scholar

Public Health Wales Observatory. Public Health Wales Observatory - Diabetic Eye Screening Wales Publishes First Annual Statistical Report 2017-18. February 2019. Available from: http://www.publichealthwalesobservatory.wales.nhs.uk/news/50464. Accessed April 16, 2020.

 Google Scholar

Northern Ireland diabetic eye screening programme. Available from: https://www.publichealth.hscni.net/sites/default/files/2018-12/NIDESP%20Annual%20Report%201617%20Final260618.pdf. Accessed April 16, 2020.

 Google Scholar

Nguyen HV, Tan GSW, Tapp RJ, et al. Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore. Ophthalmology. 2016;123(12):2571–2580. doi:10.1016/j.ophtha.2016.08.021

 PubMed Web of Science ®Google Scholar

Kristinsson, J.K., Stefánsson, E., Jónasson, F., Gislason, I. Screening for eye disease in type 2 diabetes mellitus. Wiley Online Lib. 1994;72:341–346. doi:10.1111/j.1755-3768.1994.tb02770.x

 Google Scholar

Murray, R.B., Metcalf, S.M., Lewis, P.M, et al. Sustaining remote-area programs: retinal camera use by Aboriginal health workers and nurses in a Kimberley partnership. Med J Aust. 2005;182:520.

 PubMed Web of Science ®Google Scholar

Schulze-Döbold C, Erginay A, Robert N, Chabouis A, Massin P. Ophdiat(®): five-year experience of a telemedical screening programme for diabetic retinopathy in Paris and the surrounding area. Diabetes Metab. 2012;38(5):450–457. doi:10.1016/j.diabet.2012.05.003

 Web of Science ®Google Scholar

Lemmetty R, Mäkelä K. Mobile digital fundus screening of type 2 diabetes patients in the Finnish county of South-Ostrobothnia. J Telemed Telecare. 2009;15(2):68–72. doi:10.1258/jtt.2008.080804

 Web of Science ®Google Scholar

Cuadros J, Bresnick G. EyePACS: an adaptable telemedicine system for diabetic retinopathy screening. - PubMed - NCBI. J Diabetes Sci Technol. 2009;3(3):509–516. doi:10.1177/193229680900300315

 PubMedGoogle Scholar

EyePACS LLC EyePACS Surpasses 750,000 patient encounters for diabetic retinopathy assessment. PR Newswire. Available from: https://www.prnewswire.com/news-releases/eyepacs-surpasses-750-000-patient-encounters-for-diabetic-retinopathy-assessment-300870295.html. Accessed May 6, 2020.

 Google Scholar

Pareja-Ríos A, Bonaque-González S, Serrano-García M, Cabrera-López F, Abreu-Reyes P, Marrero-Saavedra MD. Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience. Arch Soc Esp Oftalmol. 2017;92(2):63–70. doi:10.1016/j.oftal.2016.08.006

 PubMedGoogle Scholar