DIABETIC RETINOPATHY: FACTORS ASSOCIATED WITH PROGRESSION AND ADHERENCE TO SCREENING

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0882

Abstract

Diabetic retinopathy (DR) remains a leading cause of preventable visual impairment in adults with diabetes mellitus. Its clinical and public health relevance lies not only in the burden of disease but also in the fact that a significant proportion of cases with visual impairment can be prevented through intensive metabolic control, multifactorial management of cardiovascular risk, and early detection strategies. The objective of this narrative review was to synthesize recent evidence on factors associated with DR progression and adherence to screening, with an emphasis on high-impact publications and updated clinical guidelines. A narrative literature update was conducted, prioritizing international guidelines, systematic reviews, meta-analyses, and key studies available in high-impact biomedical journals. Particular emphasis was placed on recent documents related to screening, teleophthalmology, artificial intelligence, and clinical predictors of progression. Evidence shows that diabetic retinopathy (DR) progression is consistently associated with longer duration of diabetes, poor sustained glycemic control, hypertension, diabetic kidney disease, baseline retinopathy severity, and, in specific contexts, with rapid reductions in glycated hemoglobin (HbA1c). In contrast, adherence to screening depends on a complex network of individual, social, and healthcare system factors, including age, education level, income, insurance coverage, urban residence, health literacy, risk perception, history of eye disease, and service accessibility. The best-supported interventions include reminders, multicomponent approaches, teleophthalmology, fundus photography screening in primary care, and artificial intelligence algorithms. It is concluded that preventing blindness from DR requires integrating intensive clinical management with timely, accessible, and risk-centered screening models. In Latin American and resource-limited settings, combining primary care, remote retinal imaging, and outreach strategies can improve coverage and reduce inequities.

Keywords: diabetic retinopathy; screening; adherence; progression; teleophthalmology; artificial intelligence; blindness prevention.