Effectiveness of technology-enabled teleophthalmology and emerging retinal imaging techniques for diabetic retinopathy screening: a systematic review and meta-analysis.

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.