ICO Guidelines for Diabetic Eye Care

The International Council of Ophthalmology (ICO) Guidelines for Diabetic Eye Care are designed specifically to work across different resource settings — a practical strength for a country like India where access to retinal specialists varies enormously between urban and rural areas.

Screening intervals (key numbers to know)

Initial screening timing

• Type 1 diabetes: initial dilated eye exam within 3-5 years of diagnosis, after age 10, then annual follow-up
• Type 2 diabetes: initial dilated eye exam shortly after diagnosis (retinopathy may already be present at diagnosis, unlike Type 1), then annual follow-up

Why resource-setting-specific guidelines matter

The scale of the problem driving these guidelines is substantial: an estimated 1 in 3 people with diabetes has some degree of diabetic retinopathy, and 20-30 million globally have sight-threatening PDR or DME. Crucially, the global prevalence of diabetic retinopathy has been declining with better diabetes control since 1980 — yet the absolute burden of vision loss from DR has still risen since 1990, driven by the sheer growth in type 2 diabetes cases, disproportionately in low- and middle-income countries. This is precisely why the ICO built resource-tiered recommendations rather than a single one-size-fits-all protocol — a fixed high-resource schedule is not achievable or sustainable in many screening programs.

Emerging tools referenced in current guidance

• Ultra-widefield imaging and handheld fundus cameras for community-level screening
• Teleophthalmology for remote grading, extending specialist reach into low-resource areas
• AI-based automated detection algorithms — increasingly validated for triaging referable disease in large screening programs

Key reference: Wong TY, et al. Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. Ophthalmology. 2018;125(10):1608-1622.