Dilation before automated diabetic retinopathy screening in a primary care setting was found to enhance effectiveness of screening programs, especially for underserved patients who may otherwise miss care.

“One-third of US diabetic adults do not receive annual eye exams. Patients with lower income, lower educational levels, and identifying as Black or Hispanic are associated with missing eye examinations. Previous research in the primary care setting has also shown that the proportion of ungradable exams is ~30%,” researchers noted in Annals of Family Medicine.

Initial screening efforts before dilation included using digital fundus photography and automated retinal imaging analysis. From November 2022 to May 2023, the researchers saw an increase from 20% to 35% in the number of retinal photos that their automated software could interpret. Still, they noted, exam insufficiency occurred in 36% of exams.

In May 2023, study researchers started offering dilation to patients who were over 65, patients who had failed previous exams, or both. Over 8 months exam insufficiency rates dropped to 22%, with 41% performed after dilation 

Retinopathy detection rate also improved, rising from 11% (September 2023 to May 2023) to 18% (May 2023 to January 2024). Additionally, offering dilated eye exams to select patients led to an increase in the proportion of images the software could interpret. Prior to dilating, insufficient exam rate was comparable to previous studies, but it dropped by about one-third after introducing dilation

They also found that electronic health record reminders played a role in ensuring that screening was performed during appointments: “Toward the end of January 2024, our overall screening rate was 57% for patients who hadn’t been seen in our office in a year and 65% for patients who had been seen in a year.”

A full list of author disclosures can be found in the published research.