Multiskilling in Diabetes and Ophthalmology Improves Patient Outcomes

Growing demand for multiskilled care in diabetes and ophthalmology

The global prevalence of diabetes has risen substantially and is projected to continue increasing, placing significant pressure on health systems worldwide (International Diabetes Federation, 2021; World Health Organization, 2023). At the same time, ophthalmology workforce adequacy is a growing concern. For example, US projections suggest ophthalmology may only have around 70% of the workforce required by 2035 (Berkowitz et al., 2024). In many low- and middle-income countries, maldistribution and shortage of ophthalmologists remain major barriers to access (Resnikoff et al., 2020).

Primary care teams are therefore increasingly required to expand their remit. Multiskilled clinicians who understand how diabetes affects your eyes can provide earlier interventions, reduce the burden on specialists, and improve long-term outcomes. Building capacity in areas such as diabetic retinopathy (DR) screening and the management of diabetes-related eye disorders is no longer optional but essential.

Why diabetic eye disease cannot wait for referral

Diabetic eye disease is often asymptomatic until advanced stages. In the United States alone, an estimated 9.6 million people had diabetic retinopathy in 2021 (Lundeen et al., 2023). Yet screening coverage remains suboptimal: depending on the dataset and year, between one-third and one-half of adults with diabetes do not receive an annual eye exam (Centers for Disease Control and Prevention, 2023).

Specialist referral pathways are frequently overwhelmed, leaving patients waiting too long for care. Primary care clinicians are often restricted to a “refer and wait” model when, with additional training, they could intervene earlier. Integrating vision and eye care into community health settings reduces preventable blindness and strengthens chronic disease management (VanNasdale, Menchavez and Primo, 2025).

How multiskilled practice changes outcomes in diabetes vision problems

Training in ophthalmology enables clinicians to perform early detection checks, identify cataracts or glaucoma sooner, and make more timely referrals. This reduces demand on specialists and directly supports vision preservation.

Similarly, further education in diabetes management equips healthcare professionals to screen for diabetic eye disease, advise on glycaemic control, manage complications, and provide consistent follow-up. Evidence shows that integrating DR screening and teleophthalmology into primary care improves detection rates and is cost-effective compared to delayed treatment (Muqri et al., 2022; Vellido-Cotelo et al., 2020).

Note: The specific scope of practice varies by jurisdiction, and regulations determine what non-specialist clinicians are authorised to do. Training improves detection, triage, and appropriate referral rather than replacing specialist care.

Evidence that integrating diabetes and eye care works

The World Health Organization’s Eye Care Competency Framework highlights the need to integrate ophthalmic skills into wider workforce planning (Yu et al., 2023). Community health centres embedding both diabetes and eye health into routine care achieve earlier interventions, fewer years of sight lost, and better outcomes for patients with comorbidities (VanNasdale, Menchavez and Primo, 2025).

Meanwhile, projections by the American Academy of Ophthalmology warn that unless multiskilling and system redesign are implemented, ophthalmology workforce adequacy in the United States may drop to around 70% by 2035 (Berkowitz et al., 2024).

Where multiskilling in diabetes and ophthalmology has the greatest impact

Reducing delays and preventable damage

Conditions such as diabetic retinopathy, glaucoma, and cataracts often progress quietly. With additional ophthalmology training, primary care teams can identify issues earlier and act sooner.

Reaching underserved populations

In low- and middle-income regions, where specialist ophthalmologists are scarce, multiskilled primary care providers make local access to diabetic eye care feasible.

Containing costs

Preventing advanced DR is consistently more cost-effective than treating late-stage complications. Screening, early management, and fewer unnecessary referrals all reduce costs for health systems (Muqri et al., 2022).

Building patient trust

Patients benefit from continuity. When GPs and nurses manage both diabetes and its eye complications, they are more likely to remain with the same team, supporting adherence and trust.

Using resources more effectively

Specialists are freed to focus on complex cases when primary care handles the basics. Tele-ophthalmology and digital imaging strengthen this model further.

Advancing your skills through an ophthalmology postgraduate course

Expanding expertise in ophthalmology and diabetes translates into tangible results for patients and healthcare systems. Completing a postgraduate or online ophthalmology course provides recognised skills in eye care, enabling earlier detection of diabetes-related vision problems and reducing preventable blindness.

By combining ophthalmology and diabetes knowledge, clinicians enhance their ability to manage chronic disease, conduct DR screening, and reduce long-term complications. This commitment to professional development ensures clinicians remain current, credible, and confident in applying new skills.

These courses translate directly into better outcomes: multiskilled clinicians improve access, prevent avoidable blindness, and deliver continuity that patients trust.

Explore our courses:

• Postgraduate Diploma in Ophthalmology
• MSc in Ophthalmology
• Postgraduate Diploma in Diabetes
• MSc in Diabetes

References

• Berkowitz, S.T., Shipman, S.A., Quigley, H.A., Portela, M. and Mullan, F., 2024. Ophthalmology workforce projections in the United States. Ophthalmology, 131(6), pp.585–593. Available here [Accessed 23 September 2025].
• Centers for Disease Control and Prevention (CDC), 2023. Diabetic retinopathy and eye exam data. Available here [Accessed 23 September 2025].
• International Diabetes Federation (IDF), 2021. IDF Diabetes Atlas, 10th ed. Brussels: IDF.
• Lundeen, E.A., Saaddine, J.B., Narayan, K.M.V., Klein, R., and Saaddine, J.B., 2023. Prevalence of diabetic retinopathy in the United States in 2021. JAMA Ophthalmology, 141(4), pp.330–338.
• Muqri, F.A., Alon, R., Zelikson, A., and Dolev, N., 2022. Cost-effectiveness of teleophthalmology for diabetic retinopathy screening: a systematic review. BMJ Open Ophthalmology, 7(1), e000919.
• Resnikoff, S., Lansingh, V.C., Washburn, L., Felch, W., Gauthier, T.M., Taylor, H.R. and Eckert, K.A., 2020. Estimated number of ophthalmologists worldwide (International Council of Ophthalmology update): Will we meet the needs? British Journal of Ophthalmology, 104(4), pp.588–592.
• VanNasdale, D., Menchavez, S. and Primo, S., 2025. The case for primary eye care integration in community health centers. Journal of Primary Care & Community Health, 16, pp.1–5. doi:10.1177/21501319251355047.
• Vellido-Cotelo, R., Muñoz-Negrete, F.J., Rebolleda, G. and Martínez-de-la-Casa, J.M., 2020. Cost-effectiveness of screening for diabetic retinopathy using teleophthalmology. Diabetes Research and Clinical Practice, 169, p.108399.
• World Health Organization (WHO), 2023. Global report on diabetes, 2023 update. Geneva: WHO.
• Yu, M., Keeffe, J.E., Wang, M., Ramke, J., Lansingh, V.C., Jan, C., Gilbert, C.E., Resnikoff, S. and He, M., 2023. Development of the WHO eye care competency framework. Human Resources for Health, 21, p.78.

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