Use of the RETeval™ handheld device to assess the risk of diabetic retinopathy – A literature review

Diabetic retinopathy (DR) is a leading cause of visual impairment among adults with diabetes and represents a growing burden for healthcare systems worldwide. Although traditionally regarded as a microvascular complication, increasing evidence indicates that functional impairment of retinal neurons and the neurovascular unit occurs at early preclinical stages of the disease. Objective assessment of these changes may improve early detection and risk stratification. Electroretinography (ERG) provides a direct measure of retinal function, but its routine use has historically been limited by technical complexity. The introduction of portable, non-mydriatic devices has renewed interest in functional retinal testing in both clinical and screening settings. The RETeval™ handheld system enables rapid acquisition of flicker ERG responses combined with automated pupillometry, generating an integrated risk score for DR. The present narrative review summarizes and critically appraises current evidence on the use of the RETeval™ device for the detection, staging, and risk assessment of DR. Particular attention is given to its performance in early disease, prognostic value, practical limitations, and potential role as a complementary tool in diabetes-related eye care.