# Digital eyes on diabetes: a systematic review of attitudes toward telemedicine-based retinopathy screening

## TL;DR

This paper reviews attitudes toward using telemedicine for diabetic retinopathy screening, highlighting factors that influence its adoption.

## Contribution

The study uniquely highlights psychosocial and systemic factors affecting telemedicine acceptance for diabetic retinopathy screening.

## Key findings

- Patient non-attendance is often due to low awareness and asymptomatic disease perception.
- Providers face challenges related to training, technical issues, and referral pathways.
- Telemedicine adoption requires addressing knowledge gaps, financial barriers, and streamlined workflows.

## Abstract

Diabetic Retinopathy (DR) is a leading cause of vision loss among people with Diabetes Mellitus worldwide. Early stages are asymptomatic, making timely screening essential to prevent irreversible damage. Telemedicine offers a promising avenue to improve screening accessibility, especially where specialist services are limited. This study aims to explore the attitudes of patients and healthcare providers towards telemedicine-based screening for Diabetic Retinopathy. Objectives include identifying beliefs, biases and barriers influencing the adoption of teleophthalmology for DR screening. A meta-ethnography was conducted, synthesising qualitative studies from PubMed, Scopus and MEDLINE that utilized interviews, focus groups and document analysis to investigate perceptions of telemedicine in DR screening. Nineteen studies met the inclusion criteria and underwent quality appraisal. Five higher-order themes emerged: lack of knowledge, economic factors, provider challenges, ease of integration and perceived benefits of screening. Patient non-attendance was largely due to low awareness and asymptomatic disease perception, while providers faced training, technical and referral pathway challenges. Telemedicine’s integration requires leadership engagement and clear workflows. Both patient and provider perspectives significantly influence telemedicine adoption for DR screening. Addressing knowledge gaps, financial barriers and provider training, alongside streamlined referral systems, could enhance screening uptake and effectiveness. This synthesis uniquely highlights the complex psychosocial and systemic factors affecting telemedicine-based DR screening acceptance, providing actionable insights for improving screening programmes globally.