Guidelines on Diabetic Eye Care

Abstract

Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.

Availability and variability in guidelines on diabetic retinopathy screening in Asian countries

“…The ICO currently also supports repeating screening up to 2 years. Along with the lead of key international guidelines,22 70 it is likely that more countries will start adopting a biennial screening approach for patients with no DR in the future.…”

“…In this review, we determined the availability and variability of national DR screening guidelines in Asian countries, summarised their recommendations and compared them with the gold standard, Guidelines For Diabetic Eye Care by the International Council of Ophthalmology (ICO), which is an authoritative international organisation consisting of 120 national and subspecialty member societies from around the globe 22. Areas for improvement have been identified and may serve as a feedback for future versions of guidelines, in an effort to effectively combat DR-related vision loss in the region.…”

Barriers for Adherence to Diabetic Retinopathy Screening among Saudi Adults

“…Tight glycemic control decreases the onset of DR by 76% and delays the progression of DR by 54% [10]. Frequent screening for the early detection of DR along with appropriate, timely, effective treatment reduces blindness by as much as 98% [11]. In addition, several studies have reported that the control of hypertension and dyslipidemia improved patient outcomes and reduced the risk of blindness by 24% [12].…”

“…This goal can be achieved by multi-level public health strategies, starting with increasing public awareness and implementing evidence-based national screening programs for all patients with diabetes that ensure timely referral and timely, appropriate treatment. However, these need to be adjusted according to each country's resource settings and population characteristics [11].…”

En face slab optical coherence tomography imaging successfully monitors progressive degenerative changes in the innermost layer of the diabetic retina

“…Although accumulating evidence suggest that the eyes of patients with DM can have histological and/or functional retinal changes even before the onset of clinically detectable microvascular damage, 2-4 the gold standard classification of DR is based on funduscopically apparent clinical signs secondary to severely impaired retinal vasculature. 5 The Early Treatment Diabetic Retinopathy Study classification according to vascular abnormality has been used in many randomized controlled trials (RCTs). However, although one intervention (intensive blood sugar control) decreased the risk of DR development and/or progression, there remains a large number of patients with vision loss in almost all RCTs, suggesting that funduscopy-based DR classification is not sufficient to maintain long-term good vision in diabetic eyes.…”