Diabetic retinopathy management guidelines

Clinical practice guidelines are defined as ‘systematically developed statements’ that assist practitioners in making appropriate decisions for healthcare for specific clinical circumstances [1]. 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 middleincome countries, where systematic screening for retinopathy is rare [5]. 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.