Diabetic Retinopathy Screening: Predictors and Barriers Among Patients With Diabetes Mellitus in South-West Nigeria

Background: Diabetic retinopathy (DR) remains a leading cause of preventable visual impairment globally, particularly in low- and middle-income countries where structured screening programs are limited. This study assessed the uptake of DR screening, identified predictors of attendance, and explored barriers among adults with diabetes mellitus (DM) attending public secondary healthcare facilities in Lagos State, Nigeria. Methods: A hospital-based cross-sectional study was conducted among 288 adults with confirmed diabetes using a systematic sampling approach. Data were collected using an interviewer-administered questionnaire assessing sociodemographic, clinical, knowledge, and screening characteristics. Retinal examination was performed to determine DR status. Bivariate analyses were conducted using chi-square tests, and multivariate logistic regression identified independent predictors of screening uptake. In-depth interviews with four physicians and eight patients were analyzed thematically to contextualize quantitative findings. Results: The mean age was 60.4 ± 10.8 years, and 185 (64.2%) were female. Overall, 106 participants (36.8%) reported prior DR screening, while 182 (63.2%) had never been screened. On examination, 85 (29.5%) had DR, including 77 (26.7%) with non-proliferative DR and 3 (1.0%) with proliferative DR. Among never-screened participants, lack of physician referral (166; 91.2%), lack of health insurance (163; 89.6%), and poor awareness (159; 87.4%) were common barriers. Screening uptake was significantly associated with occupation (p = 0.003), duration of diabetes (p = 0.006), previous eye intervention (p < 0.001), good knowledge of DR (p < 0.001), and awareness that diabetes affects the eye (p < 0.001). In multivariate analysis, physician referral was the strongest independent predictor of screening (adjusted odds ratio (AOR) 15.93; 95% CI 4.70-54.07; p < 0.001), followed by good knowledge of DR (AOR 3.73; 95% CI 1.66-8.39; p = 0.002), previous eye intervention (AOR 3.99; 95% CI 1.66-9.57; p = 0.002), and diabetes duration >5 years (AOR 1.94; 95% CI 1.02-3.70; p = 0.043). Qualitative findings revealed symptom-driven referral practices and limited awareness of screening guidelines. Conclusion: DR screening uptake remains suboptimal in this setting, with provider referral and patient knowledge emerging as critical determinants. Strengthening guideline-based referral systems and structured patient education within diabetes clinics may substantially improve early detection and prevent avoidable blindness.