Effectiveness of technology-enabled teleophthalmology and emerging retinal imaging techniques for diabetic retinopathy screening: a systematic review and meta-analysis
In brief
Teleophthalmology nearly doubles diabetic eye screening completion across studies
Across 33 studies, technology-enabled screening nearly doubled screening completion and was associated with more than twice the odds of recommended eye-care adherence versus usual or prior practice. About 7% of images could not be graded, and substantial variation across studies means results may differ by setting.
- Journal
- Diabetes research and clinical practice (Q1)
- Published
- 14 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Kai-Yang Chen, Hoi-Chun Chan, Chi-Ming Chan
- PMID
- 42874783
- DOI
- 10.1016/j.diabres.2026.113610
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 17 October 2026): Teleophthalmology increased screening uptake, improved adherence
Abstract
INTRODUCTION: Diabetic retinopathy (DR) is a major microvascular complication of diabetes and causes preventable visual loss. Technology-enabled screening can extend retinal assessment beyond specialist settings and strengthen screening, referral, and follow-up across diabetes care pathways. METHODS: We systematically reviewed randomized and non-randomized implementation studies, diagnostic-accuracy and comparative retinal-imaging studies, and economic evaluations of technology-enabled DR screening. PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched from inception to 23 May 2026 without language restriction. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Random-effects meta-analyses synthesized comparative and proportional outcomes, and GRADE assessed certainty. RESULTS: Thirty-three studies were included. Teleophthalmology increased DR screening uptake/completion versus usual care or pre-implementation practice (RR 1.966, 95% CI 1.451-2.664; I2 = 75.2%) and improved adherence to recommended eye care (OR 2.464, 95% CI 1.477-4.112; I2 = 66.47%). The pooled ungradable-image rate was 7.4% (95% CI 3.0%-17.1%; I2 = 59.17%). Advanced retinal imaging showed pooled sensitivity of 97.59% (95% CI 94.50%-100.00%; I2 = 0%) and specificity of 91.22% (95% CI 78.46%-100.00%; I2 = 88.7%) for prespecified vascular lesion detection. OCTA demonstrated a pooled eye-level retinal neovascularization detection yield of 63.6% (95% CI 49.9%-75.4%; I2 = 46.29%). Economic evaluations supported cost-effective or cost-saving technology-enabled screening across assessed health systems. CONCLUSION: Technology-enabled DR care improves screening participation, adherence, and health-system efficiency, supporting integration of teleophthalmology and advanced imaging into scalable diabetes complication-management pathways.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.