Knowledge, Attitudes, and Practices of Non-ophthalmologist Physicians and Optometrists Regarding Diabetic Retinopathy: A Scoping Review

Knowledge, attitudes, and practices (KAP) of non-ophthalmologist physicians and optometrists are crucial for early detection and timely referral of patients with diabetes mellitus (DM). This scoping review aims to systematically map the available evidence on KAP related to diabetic retinopathy (DR) among these healthcare professionals. A scoping review was conducted following PRISMA-ScR guidelines. Electronic databases (MEDLINE, Embase, Cochrane Library, and LILACS), gray literature (medRxiv), and reference lists of included studies were searched. Two independent reviewers performed study selection and data extraction. Descriptive synthesis, evidence mapping, and summary tables were utilized to summarize findings. Seventeen studies from 10 countries, including a total of 2,627 participants, were included. The proportion of clinicians performing fundus examinations ranged from 1.3% to 54%. Knowledge of the recommended timing of DR screening in patients with type 1 DM was low (2.3%-66%), but high for type 2 DM (53%-85.5%). Common barriers to DR screening included limited confidence in fundoscopic examination, insufficient training, lack of equipment, and concerns regarding the use of mydriatics. In conclusion, substantial KAP gaps were identified across professional groups and healthcare settings. Significant deficiencies in DR-related KAP among non-ophthalmologist physicians and optometrists may limit early detection and appropriate referral. These findings underscore the need for targeted educational interventions and system-level strategies to enhance DR screening capacity in primary care.