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Purpose: Microvascular and macrovascular complications of diabetes, such as retinopathy and nephropathy, progress over time and may be associated with cognitive decline. In this article, we aim to gain further insight into the association between cognitive function and retinopathy in type 2 diabetes., Methods and Results: In this observational 8-year prospective study of 498 outpatients, demographic and clinical variables were monitored, along with retinopathy, depression, anxiety, and cognitive function. Baseline fundus photographs were available in 477 patients, 240 with no retinopathy, 110 with mild retinopathy, and 127 with moderate/more severe retinopathy. Of the first 2 groups, 279 patients were reevaluated after 8 years, of whom 181 still had no/mild retinopathy and 98 had progressed to more severe stages. On multivariate analysis, retinopathy progression was associated with being insulin-treated (p = 0.036), and worse cognitive function (p = 0.025) at baseline., Conclusions: Cognitive function may be an independent predictor of retinopathy progression.

Purpose: To evaluate the use of telemedicine retinal screening in Italy and to identify potential elements of implementation of this system., Methods: Patients with either new-onset diabetes or no ophthalmologic visit over the previous 2 years and attending 33 referral diabetic centers between mid-April 2013 and mid December 2015 were screened. Two partially overlapping nonstereoscopic 45° digital color images were captured from each eye using a fully automated nonmydriatic digital fundus camera. Factors limiting the assessment of retinopathy were explored., Results: Out of 24,473 eligible individuals, 22,466 had complete data. Among them, good-quality images enabling appropriate evaluation of at least one eye were obtained from 19,712 patients (both eyes, n = 18,887). Although nonmydriatic retinographs were provided, 39% of patients were evaluated using mydriasis. The rate of low-quality images in each center was inversely associated with the number of patients assessed. This was more evident for screening in mydriasis: adjusted odds ratio (OR) 0.79 (95% confidence interval (CI) 0.76-0.82) (p<0.001) vs 0.96 (95% CI 0.94-0.97) (p<0.001). Finally, both the number of patients assessed and use of mydriasis were inversely related to the presence of diabetic retinopathy (DR): adjusted OR 0.93 (95% CI 0.92-0.93) (p<0.001) and 0.88 (95% CI 0.82-0.96) (p<0.001), respectively., Conclusions: This program confirmed a role for teleophthalmology in the systematic screening of DR and provided important suggestions to improve the system deployed. A high level of training is required for operators to optimize imaging. The role of mydriasis should be evaluated further.

Diabetes eye complications, and particularly diabetic retinopathy, are the major cause of blindness in the working age groups of industrialised countries. Laser photocoagulation has been proven to reduce blindness due to retinopathy by at least 60% but even more patients would benefit if treatment were delivered at an early enough stage. High risk retinopathy, though, does not cause visual symptoms and when the latter occur it is often too late to reverse them. Hence, a screening programme for diabetic retinopathy should aim at detecting patients at risk when they can still be effectively treated. This can be obtained by regularly checking the patients' eyes. Its target, as defined by the joint World Health Organisation/International Diabetes Federation Saint Vincent Declaration Working Group, is to reduce diabetes-related blindness by one third or more in the next 5 years. The number of persons to be screened is high, 30,000/million total population/year, but available data indicate that this is feasible and that the initial investments in professional and material resources are more than justified by the reduction of preventable blindness and of the financial burdens that go with it. Indeed, prevention of the major cause of blindness in the working age should rate the same priority as other widely deployed programmes, such as those to screen for cancer, neonatal hypothyroidism and phenylketonuria. The concerted action of government health departments, patients' and professional associations will be vital for the successful implementation of this programme. The texts of this document (a protocol for the screening of diabetic retinopathy and cataract), Appendix 1 (data collection card) and Appendix 2 (informative leaflet for the patients) were approved by 57 specialists, representing 30 diabetic and ophthalmic societies from 21 European countries, and endorsed for translation into all European languages and distribution at the appropriate levels.