To characterize diabetic retinopathy care in the US using a cascade-of-care framework.
Approach:
Study Inclusion: Included English-language US-based studies published from 2018 through 2025, totaling 46 sources.
Methodology: Utilized a cascade-of-care framework and assessed risk of bias using established tools.
Key Findings:
55% to 89% of patients with photographic evidence of diabetic retinopathy were unaware of their diagnosis, with a median of about 70%.
Annual screening adherence ranged from 3% to 69%, with a median of about 47%. Biennial screening adherence ranged from 16% to 79%, with a median of about 59%.
In primary care, 31% to 63% of diagnosed patients were linked to ophthalmic care, with a median of about 52%.
Follow-up adherence for diabetic retinopathy care was reported at 55% to 78%.
Interpretation:
The review identifies gaps in awareness, screening, and follow-up care for diabetic retinopathy among patients.
Limitations:
Included studies analyzed data collected before 2018, which may not reflect current care patterns.
Substantial variability in study populations, methods, and outcome definitions may affect the findings.
Sparse evidence for some cascade stages, particularly awareness of diabetic retinopathy diagnosis.
Conclusion:
Further research and intervention are needed in areas of awareness of diabetic retinopathy diagnosis, linkage to care, and follow-up adherence.
An artificial intelligence–based optical coherence tomography pathway met noninferiority criteria for false-positive diabetic macular edema referrals and was associated with fewer referral decisions in a randomized clinical trial.
