Diabetic Retinopathy Management Guidelines

Rahul Chakrabarti; C Alex Harper; Jill Elizabeth Keeffe


Expert Rev Ophthalmol. 2012;7(5):417-439. 

In This Article

Expert Commentary

The preparation of evidence-based guidelines is highlighted by the WHO as an important component in the concerted effort to eliminate avoidable blindness.[149] This review has highlighted considerable regional variation in recommendations between guidelines, despite the availability of common medical evidence. Consensus among guidelines was achieved overall regarding the need for optimization of the established risk factors, timing of initial screening and indications for laser photocoagulation and vitrectomy.

Differences between guidelines have been addressed by a growing body of evidence. Ethnic background is emerging as an important risk factor. As such, south Asian and Pacific Island populations should now be considered 'high-risk' populations. Current evidence supports all patients with Type 2 DM commence screening at the time of diagnosis. Patients with Type 1 DM require examination at puberty. Women with DM should be examined before pregnancy, and during their first trimester. Patients with DM, regardless of the severity of DR, should be examined at least every 2 years. The detection of referrable retinopathy in accordance with the international scoring system can be reliably made with a single, 45°, non-mydriatic camera, using a trained operator, with off-site grading by an ophthalmologist. In areas where this is not possible, an ophthalmologist or trained ophthalmic medical officer or optometrist can be used to perform retinal examination through a dilated pupil.

Worldwide, DM and DR is escalating, particularly in low and low-middle income countries.[30] However, this review demonstrated that of the comprehensive DR guidelines available, a minority were developed from low-resource regions. This is pertinent, given that none of the guidelines reviewed addressed the feasibility of implementing recommendations. In order to plan DR services in these 'high-risk' regions, key themes have emerged from Latin America, south India and rural China. These have prioritized the need to obtain accurate epidemiologic data, patient identification, retinal examination methods that take into account available resources, establishing centers for photocoagulation, education for the whole population and need for integration into a public health system.[150–152]