Surreal image of a retina transforming into a landscape, symbolizing diabetic retinopathy prevention.

Diabetic Retinopathy Screening: New Danish Guidelines for Prevention

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Updated evidence-based recommendations for early detection and personalized management of diabetic retinopathy could help preserve vision for those at risk."

Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults. Early detection through effective screening programs is crucial for timely treatment and prevention of blindness. The financial burden of diabetic blindness underscores the importance of preventative measures.

In Denmark, while DR screening is fully implemented, regional disparities in eye care access and guideline interpretation persist. Patients undergo screening at private practices or hospitals, with the public health system covering costs. Vision-threatening DR cases are referred to public hospitals for treatment, and results are reported to a national quality database (DiaBase).

To address these challenges and incorporate recent advancements, the Danish Ophthalmological Society formed a group of retinal specialists to develop evidence-based guidelines for DR screening. This article presents the updated Danish guidelines for screening of DR as of 2018, including supporting evidence and specific recommendations.

Classifying Diabetic Retinopathy: Why a Standard Scale Matters

Surreal image of a retina transforming into a landscape, symbolizing diabetic retinopathy prevention.

A standardized classification system is essential for accurately defining the severity of DR. The Early Treatment of Diabetic Retinopathy Study (ETDRS) scale, based on the modified Airlie House classification, has been a gold standard in research. However, its complexity limits practical use.

To address this, the American Academy of Ophthalmology developed a simplified 5-step scale for clinical severity, stratifying patients by their risk of DR progression. This scale identifies high-risk patients for proliferative DR (PDR) and facilitates close monitoring.

Level 0: No DR.
Level 1: Mild NPDR (microaneurysms and/or dot hemorrhages only).
Level 2: Moderate NPDR (more than microaneurysms and/or dot hemorrhages but less than Level 3).
Level 3: Severe NPDR (more than 20 intraretinal hemorrhages in each of 4 quadrants OR definite venous beading in at least 2 quadrants OR prominent IRMA in at least 1 quadrant AND no PDR).
Level 4: PDR (neovascularization (active or treated by panretinal photocoagulation) OR vitreous/pre-retinal hemorrhage).

The ETDRS scale is also used to classify diabetic macular edema (DMO). The definition of clinically significant macular edema (CSMO) by the ETDRS has been widely accepted for identifying screening patients who require treatment. This is based on retinal thickening within 1 disc diameter from the macular center.

The Future of DR Screening: Personalized, Efficient, and Accessible

The Danish Ophthalmological Society emphasizes the importance of high-quality imaging and flexible, individualized screening intervals for DR management. These guidelines aim to optimize resource allocation, improve diagnostic accuracy, and, ultimately, reduce the burden of vision loss associated with diabetes.

About this Article -

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Everything You Need To Know

What is Diabetic Retinopathy (DR), and why is it a major concern?

Diabetic Retinopathy (DR) is a leading cause of vision loss, especially among working-age adults. It's a condition that arises from diabetes and affects the blood vessels in the retina. Early detection and timely treatment are crucial to prevent blindness, and the financial burden associated with diabetic blindness highlights the importance of preventative measures.

How are DR cases managed within the Danish healthcare system?

In Denmark, DR screening is fully implemented, but disparities exist in eye care access and interpretation of guidelines. Patients are screened at private practices or hospitals, with the public health system covering the costs. Vision-threatening DR cases are referred to public hospitals for treatment, and the results are reported to a national quality database (DiaBase).

What are the different levels of Diabetic Retinopathy, and what do they signify?

The American Academy of Ophthalmology developed a simplified 5-step scale for clinical severity: * **Level 0:** No DR. * **Level 1:** Mild NPDR (microaneurysms and/or dot hemorrhages only). * **Level 2:** Moderate NPDR (more than microaneurysms and/or dot hemorrhages but less than Level 3). * **Level 3:** Severe NPDR (more than 20 intraretinal hemorrhages in each of 4 quadrants OR definite venous beading in at least 2 quadrants OR prominent IRMA in at least 1 quadrant AND no PDR). * **Level 4:** PDR (neovascularization (active or treated by panretinal photocoagulation) OR vitreous/pre-retinal hemorrhage). This scale helps stratify patients by risk of DR progression and facilitates close monitoring, especially identifying those at high risk for proliferative DR (PDR).

What is the significance of the ETDRS scale, and how is it used in DR?

The Early Treatment of Diabetic Retinopathy Study (ETDRS) scale, based on the modified Airlie House classification, is a gold standard in research for DR. It is used to classify the severity of Diabetic Macular Edema (DMO). The definition of clinically significant macular edema (CSMO) by the ETDRS is widely accepted for identifying patients needing treatment based on retinal thickening within 1 disc diameter from the macular center. While complex, the ETDRS scale helps define the severity of DR.

How are the Danish guidelines for DR screening evolving to improve patient outcomes?

The Danish Ophthalmological Society developed updated guidelines for DR screening incorporating recent advancements. These guidelines focus on high-quality imaging and flexible, individualized screening intervals. The goal is to optimize resource allocation, improve diagnostic accuracy, and ultimately reduce vision loss associated with diabetes. These personalized and efficient screening methods are crucial for the future of DR management.