Effectiveness of Interventions to Promote Screening for Diabetic Retinopathy

Xuanping Zhang, Susan L. Norris, Jinan Saadine, Farah M. Chowdhury, Tanya Horsley, Sanjat Kanjilal, Carol M. Mangione, Ralf Buhrmann

Research output: Contribution to journalReview articlepeer-review

47 Scopus citations


Objective: To assess the effectiveness of interventions aimed to increase retinal screening among people with diabetes. Methods: A systematic literature search was conducted of multiple electronic bibliographic databases up to May 2005. Studies were included if interventions were used to promote screening for diabetic retinopathy in any language and with any study design. Results: Forty-eight studies (12 randomized controlled trials [RCTs], four nonrandomized studies, and 32 pre-post studies) with a total of 162,157 participants, examined a wide range of interventions, which focused on one or more of the following: (1) patients or populations, (2) providers or practices, and (3) healthcare system infrastructure and processes. Four of five RCTs focusing on patients demonstrated that interventions increased screening significantly, with relative risk ranging from 1.05 (95% confidence interval [CI]=1.01-1.08) to 2.01 (95% CI=1.48-2.73). Five RCTs with a focus on the system all demonstrated significant increases in screening with relative risk ranging from 1.12 (95% CI=1.03-1.22) to 5.56 (95% CI=2.19-14.10). Thirty-six non-RCTs, which included interventions with single or multiple foci, also generally demonstrated positive effects. Conclusions: Increasing patient awareness of diabetic retinopathy, improving provider and practice performance, and improving healthcare system infrastructure and processes, can significantly increase screening for diabetic retinopathy. Further research should explore strategies for increasing the rate of retinal screening among diverse or disadvantaged populations and the economic efficiency of effective interventions in large community populations.

Original languageEnglish (US)
Pages (from-to)318-335
Number of pages18
JournalAmerican journal of preventive medicine
Issue number4
StatePublished - Oct 2007
Externally publishedYes

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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