Development of diabetic retinopathy management guidelines for implementation

Development of diabetic retinopathy management guidelines for implementation in low-resource settings. Dr Rahul Chakrabarti IAPB 9 th General assembly, 19 th September, 2012

Methods • Published guidelines (n=32) Multi-database • Satisfying inclusion criteria (n=11) search Inclusion criteria • Epidemiology • Stages of DR • Detection • Management • Evidence-based recommendations • Developed by panel of experts • English-language Update evidence Face-Validity Feasibility Issues • Lack of agreement in recommendations • Health systems and resource limitations • Age of evidence Implement • Literature review • Draft guidelines • Review of guidelines by expert panel of retinal specialists • Feasibility for implementation in lowresource countries • Case study methodology • Implementing guidelines in a low-resource setting

Screening for DR Guideline Screening method NICE (2005) 45 degree mydriatic photography 12 -18 months NHMRC (2008) Dilated ophthalmoscopy Non-mydriatic photography if not available 24 months WHO (2005) Dilated two field photography 12 months AAO (2008) Slit-lamp biomicroscopy 12 months Evidence Single field 45°, non-mydriatic image is adequate to detect ‘referable’ retinopathy 24 months Further details on Poster #73 Examination interval: Patients with Diabetes, without baseline DR

Framework to assess Feasibility of Guidelines Feasibility Health services Governance Health workforce Technology and equipment Financing Linkages Adopting Guidelines Cadre Affordability Government Education Local responsibility Distribution Access NGO Capacity Quality assurance Task-shift Training Local govt Other

Acknowledgement • Ph. D supervisors: Professor Jill Keeffe, Dr Alex Harper • This research is being supported by the University of Melbourne Australian Postgraduate Award, Riady Scholarship, and M. A. Bartlett Research Fund. • CERA receives Operational Infrastructure Support from the State Government of Victoria.