Young people are less likely to obtain screening for diabetic retinopathy, according to a study in Diabetic Medicine. Despite the clinical value and cost-effectiveness of screening for sight-threatening retinopathy, and the increasing number of young adults with type 2 diabetes, researchers say patients younger than 34 are more likely to skip their appointments than those in older age groups.

The study analyzed data from 3 screening programs in the United Kingdom. Researchers looked at screening attendance using 2 different approaches: the time a participant took from registration with the screening program to their first screening attendance (cohort A) and the screening uptake within a 15-month study period (cohort B), to capture at least 1 screening during a “screening cycle.”

Each participant’s age, sex, self-reported ethnicity, type and duration of diabetes, and retinopathy grading was recorded, as well as their home community’s ranking on the Index of Multiple Deprivation.


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Of the 97,048 newly registered participants in cohort A, 15,919 patients (16%) didn’t attend their first screening within 40 months. The time it took to attend their first screening was greater for the 8,710 participants who were aged 18 to 34 years at registration, and 20% of this group still hadn’t attended a screening after 3 years. 

Analysis also shows participants 18 to 34 years old were more likely to have referable retinopathy than those aged 35 to 59 years (odds ratio [OR] 1.26, 95% CI, 1.10–1.45). Based on retinopathy grading, the researchers defined “referable retinopathy” as a grade requiring closer observation through digital surveillance, or referral to an ophthalmologist. The longer the interval between registration and screening attendance, the more likely the person was to have referable retinopathy, the investigators explained.

Of the 291,296 people included in cohort B, 14,960 (5%) didn’t attend for screening during the 15-month reporting period, with 14% non-attendance in those aged 24 to 29 and 30 to 35 years.

Participants aged 24 to 29 years were the least likely to attend compared with those aged 60 years and older (OR 0.25, 95% CI, 0.22–0.29). They were also more likely to have referable retinopathy compared with those aged older than 60 years (adjusted OR 1.85, 95% CI, 1.37–2.50). Other risk factors for referable retinopathy included having type 1 diabetes, being of Black/minority ethnicity, and living in areas of high socio-economic deprivation.

Looking at cohort A, researchers found that only 70% of people aged 18 to 34 met the National Diabetic Eye Screening Program’s standard for annual screening. The longer the gap between registration and screening, the greater the risk of developing sight-threatening retinopathy. 

Additionally, in cohort B, the odds of someone aged 24 to 29 attending a screening were approximately 70% lower than in the reference group of people aged older than 60 years. Young adults were more likely to present with referable retinopathy.

Researchers believe the study shows a significant problem with poor screening attendance in young adults and call for more work to be done to investigate the issue, as well as policy initiatives to increase attendance.

Reference

Lawrenson JG, Bourmpaki E, Bunce C, Stratton IM, Gardner P, Anderson J. Trends in diabetic retinopathy screening attendance and associations with vision impairment attributable to diabetes in a large nationwide cohort. Diabet Med. Published online October 16, 2020. doi: 10.1111/dme.14425