Diabetic Eye Disease Often Overlooked in Patients Undergoing Hemodialysis

This recent study revealed a significant burden of ocular complications, particularly DR and DME, in people with diabetes undergoing hemodialysis. Patient-centered screening models within dialysis settings are needed, potentially using portable or AI-enabled technologies to improve access and reduce patient burden. Photo: Julie Torbit, OD, Anna Kathryn Bedwell, OD, and Brad Sutton, OD. Click image to enlarge. People with diabetes receiving hemodialysis for kidney dysfunction are at increased risk of diabetic retinopathy (DR) and other ocular complications. “Both the retina and kidneys are supplied by small, low-resistance blood vessels, which are prone to damage from fluctuations in blood glucose levels and hypertension,” writes a multidisciplinary group in a recent paper. “This shared microvascular vulnerability often leads to the concurrent progression of DR and diabetic nephropathy.”Despite this heightened vulnerability, evidence on the prevalence of such conditions in this population is limited. The researchers aimed to synthesize the existing literature on the prevalence of DR and other ocular conditions, and to evaluate screening rates in people with diabetes undergoing hemodialysis. They found a high prevalence of DR and maculopathy in these individuals, along with significant under-screening that could be addressed with more effective patient-centered DR screening models.A systematic search of several databases was conducted to identify studies reporting on the prevalence of DR, diabetic maculopathy and other ocular conditions in people with diabetes on hemodialysis. Eight articles meeting inclusion criteria were included. Pooled prevalence estimates and 95% confidence intervals were calculated using random-effects models.There was a high prevalence of ocular complications, with nearly half having DR and one in three (32.5%) experiencing diabetic maculopathy. This is not unexpected, the authors noted, given the shared pathophysiology. However, substantial heterogeneity was observed across studies, indicating wide variation in reported prevalence rates.“This variability is likely influenced by differences in patient demographics, DR grading protocols and screening technologies” among the studies, the researchers explained in their paper for Diabetic Medicine, and thus the findings should be interpreted with caution. “The small number of included studies limited our ability to conduct subgroup analyses or meta-regression, restricting further exploration of these sources of heterogeneity. As such, the results should be considered hypothesis-generating.”Other ocular complications reported included cataracts (53.4%), conjunctival calcification (63%) and corneal calcification (45.3%), optic atrophy (29%) and hypertensive retinopathy (32.2%), highlighting the wider impact of microvascular and metabolic disturbances in this group. These complications may be driven by chronic hyperglycemia, disrupted calcium-phosphate metabolism, medication effects and the physiological demands of dialysis. “For instance, cataracts are frequently observed in diabetes and chronic kidney disease due to long-term metabolic stress and altered ocular perfusion, while ocular surface calcifications may reflect underlying mineral imbalances linked to renal dysfunction,” the authors explained in their paper.They found significant under-screening, as over half of people with diabetes on hemodialysis had not undergone eye screening in over two years. The authors found this concerning and said it reflects missed opportunities for early intervention, as well as broader inequalities in care provision. Current clinical guidelines, including those from the American Diabetes Association and the UK’s national screening program, recommend annual to biennial DR screening depending on individual risk—supporting the use of a two-year threshold to define suboptimal screening.While screening rates in the general population in high-income countries typically range from 65% to 80%, uptake is markedly lower among those on hemodialysis. “Available estimates suggest that fewer than 50% of patients in Canada, less than 60% in Japan and only around 40% in North Central London receive regular eye examinations,” the authors wrote in their paper. “These disparities underline the urgent need to develop more accessible, integrated screening pathways that address the complex healthcare needs of this vulnerable group.”The authors also found significant barriers to screening. People on hemodialysis often face reduced mobility and frequent appointments, making it difficult to attend additional screening appointments. Addressing these barriers through more convenient and accessible options, such as incorporating handheld retinal imaging in dialysis centers and exploring the use of AI, could significantly improve access to care and patient outcomes.“Aligning these models with National Institute for Health and Care Excellence and the American Diabetes Association diabetes care standards may facilitate their implementation and help close critical care gaps, reducing disparities and protecting vision in this vulnerable population,” the authors concluded.Click here for the journal source. Habte-Asres HH, Hailu F, Forbes A, et al. Diabetic eye screening in people with diabetes undergoing hemodialysis: a systemic review and meta-analysis. Diabetic Medicine. October 7, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.