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Screening for Diabetic Retinopathy

Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida

In this issue, Malone et al. (1) use their analysis of the retinal photographs taken in the Diabetes Control and Complications Trial (DCCT) to try to challenge the well-established dictum that it is not useful to perform early screening (<5 years duration) for diabetic retinopathy in juvenile-onset type 1 diabetes. I share their enthusiasm for preventing vision loss; however, in my judgment, the data do not support their challenge, but rather strongly support the current recommendation.

Screening examinations or any tests performed in medicine should only be done when the results have a reasonable probability of altering the treatment, when the risk-to-benefit ratio of undergoing the test is favorable for the individual patient, and when the cost-to-benefit ratio is competitive with other uses of health care dollars. Early screening for diabetic retinopathy in juvenile-onset type 1 diabetes fails on all three counts.

First, consider that not one of the 1,613 patients screened for the DCCT at <5 years duration of diabetes had proliferative retinopathy . . . [Full Text of this Article]

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				R. M. Ehrlich Response to Malone et al. Diabetes Care, September 1, 2001; 24(9): 1698 - 1699. [Full Text] [PDF]

				J. I. Malone Response to Ehrlich Diabetes Care, September 1, 2001; 24(9): 1699 - 1699. [Full Text] [PDF]