Diabetic retinopathy clinical practice guidelines: Customized for Iranian population

Abstract

Purpose:To customize clinical practice guidelines (CPGs) for management of diabetic retinopathy (DR) in the Iranian population.Methods:Three DR CPGs (The Royal College of Ophthalmologists 2013, American Academy of Ophthalmology [Preferred Practice Pattern 2012], and Australian Diabetes Society 2008) were selected from the literature using the AGREE tool. Clinical questions were designed and summarized into four tables by the customization team. The components of the clinical questions along with pertinent recommendations extracted from the above-mentioned CPGs; details of the supporting articles and their levels of evidence; clinical recommendations considering clinical benefits, cost and side effects; and revised recommendations based on customization capability (applicability, acceptability, external validity) were recorded in 4 tables, respectively. Customized recommendations were sent to the faculty members of all universities across the country to score the recommendations from 1 to 9.Results:Agreed recommendations were accepted as the final recommendations while the non-agreed ones were approved after revision. Eventually, 29 customized recommendations under three major categories consisting of screening, diagnosis and treatment of DR were developed along with their sources and levels of evidence.Conclusion:This customized CPGs for management of DR can be used to standardize the referral pathway, diagnosis and treatment of patients with diabetic retinopathy.

Modeling a Telemedicine Screening Program for Diabetic Retinopathy in Iran and Implementing a Pilot Project in Tehran Suburb

“…International Council of Ophthalmology Guidelines for Diabetic Eye Care was translated to Farsi and introduced to participants as the instructional material [ 14 ]. Other sources included Clinical Practice Guidelines for Iranian Population and the Online Self-Directed Diabetic Retinopathy Grading Course affiliated to the University of Melbourne [ 17 , 26 ]. The participants were assessed by both formative and summative evaluation methods during and at the end of the course.…”

“…DR meets the Wilson and Jungner criteria for evaluating the needs of a screening program [ 13 ]. The WHO, International Council of Ophthalmology (ICO), clinical guidelines, and the National Program for Prevention and Control of Diabetes (NPPCD) have recommended regular eye examinations in patients with DM [ 14 – 17 ]. Despite these recommendations, population-based studies performed in Iran have reported a gap in regular eye examination in individuals with DM [ 10 , 11 ].…”

MALAT1 as a Diagnostic and Therapeutic Target in Diabetes-Related Complications: A Promising Long-Noncoding RNA

“…Diabetic retinopathy (DR) is a devastating ocular impediment and the leading cause of vision loss among working-age adults in developed countries 21. Worldwide, the prevalence of DR has been predicted to be 35% and the prevalence of vision-impairing is estimated around 10% 22, 23. Various risk factors such as poor glycaemic control, hypertension, hyperlipidaemia, longer diabetes duration and albuminuria are reported to be the origination and development of DR 24, 25.…”

Panretinal Photocoagulation Versus Intravitreal Bevacizumab Versus a Proposed Modified Combination Therapy for Treatment of Proliferative Diabetic Retinopathy

“…The evidence shows that PRP may induce DME or exacerbate preexisting DME. 15,16,18 Peripheral VF loss is the other concern regarding application of PRP for treatment of PDR. 19 Proliferative diabetic retinopathy control can be achieved through frequent intravitreal anti-VEGF injections.…”

“…The evidence shows that PRP may induce DME or exacerbate preexisting DME. 15,16,18 Peripheral VF loss is the other concern regarding application of PRP for treatment of PDR. 19…”