Abstract and Introduction
Diabetic retinopathy (DR) is an important cause of avoidable blindness worldwide. Seventy percent of diabetes occur in low and lower-middle income countries. Clinical practice guidelines for the management of DR have been implemented throughout the world, but mainly in developed nations. However, there is considerable variation between existing guidelines in the recommended frequency of referral, methods for examination and personnel involved in screening and review. This review compares the differences between current available guidelines in the context of the current medical evidence and also addresses the implications for management of DR in countries with limited resources.
Clinical practice guidelines are defined as 'systematically developed statements' that assist practitioners in making appropriate decisions for healthcare for specific clinical circumstances. Guidelines are now commonly developed and used for a variety of medical specialties including ophthalmology. Traditionally, guidelines were based on consensus among experts. However, this does not necessarily represent current medical knowledge. Therefore, the paradigm for guideline development has shifted towards systematic identification and appraisal of the best available evidence. The main purpose of clinical guidelines is to better health outcomes through improving practice of health professionals. The process of development and implementation of guidelines is a major undertaking, requiring contribution from individuals and groups in a multidisciplinary approach to ensure that consensus is achieved to make the guidelines work effectively.
Diabetic retinopathy (DR) is a microvascular complication of diabetes. Research has clearly demonstrated that blindness from diabetes is almost entirely preventable with early diagnosis, optimization of risk factors and timely photocoagulation where appropriate.[2–4] Presently, 70% of diabetes occurs in lower and middle-income countries, where systematic screening for retinopathy is rare. This has prompted a worldwide interest in the development of guidelines that address varying aspects of DR screening and management. This review will outline the differences between guidelines and the issues faced in adapting the evidence in low-resourced countries.
Expert Rev Ophthalmol. 2012;7(5):417-439. © 2012 Expert Reviews Ltd.