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Availability and variability in guidelines on diabetic retinopathy screening in Asian countries
  1. Louis Zizhao Wang1,2,
  2. Carol Y Cheung1,3,
  3. Robyn J Tapp1,4,5,
  4. Haslina Hamzah1,
  5. Gavin Tan1,
  6. Daniel Ting1,
  7. Ecosse Lamoureux1,6,
  8. Tien Yin Wong1,6
  1. 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
  2. 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  3. 3Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  4. 4Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  5. 5School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
  6. 6Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
  1. Correspondence to Professor Tien Y Wong, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore; wong.tien.yin{at}


Background Diabetic retinopathy (DR) is a blinding yet treatable complication of diabetes. DR screening is highly cost-effective at reducing blindness. Amidst the rapidly growing diabetic population in Asia, the prevalence of DR in the region is relatively less well known.

Aims To review existing national DR screening guidelines of 50 countries in Asia, compare them against the International Council of Ophthalmology (ICO) guideline, and summarise the prevalence rates of DR and sight-threatening DR (STDR) in these countries.

Methods We systematically searched for published guidelines from the National Guideline Clearinghouse and other databases, and contacted local diabetic and ophthalmological associations of all 50 Asian countries.

Results Eleven Asian countries have published relevant guidelines, nine of which pertain to general diabetes care and two are DR-specific, covering less than half of Asia's population. The median DR prevalence among patients with diabetes is 30.5% (IQR: 23.2%–36.8%), similar to the USA and the UK. However, rates of STDR are consistently higher. All guidelines from the 11 Asian countries fulfil the ICO standard on when to start and repeat screening, except for screening interval for pregnant patients. However, only 2 of the 11 guidelines fulfil the ICO referral criteria and 6 partially fulfil. A third of the recommendations on screening process, equipment and personnel is either unavailable or incomplete.

Conclusions Countries in Asia need to establish more comprehensive and evidence-based DR screening guidelines to facilitate the execution of robust screening programmes that could help reduce DR-related blindness, improve patient outcomes and reduce healthcare costs.

  • Retina
  • Epidemiology

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  • Contributors LZW, CYC and TYW were involved in (1) conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published. RJT, HH, GT, DT and EL have contributed substantially to (1) conception and design, acquisition and interpretation of data; (2) revising it critically for important intellectual content.

  • Funding National Medical Research Council (NMRC) Singapore, grant number STaR/0016/2013.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.