Development of Diabetic retinopathy screening guidelines in South-East Asia region using the context, challenges, and future technology

ABSTRACT

Objective

To formulate guidelines for screening of diabetic retinopathy (DR) for the World Health Organization (WHO) South-East Asia Region (SEAR) aligned with the current infrastructure and human resources for health (HRH).

Design

A consultative group discussion of technical experts of the International Agency for the Prevention of Blindness (IAPB) from SEAR.

Participants

IAPB country chairs and DR technical experts from SEAR countries.

Methods

Data related to DR in SEAR was collected from published literature on available DM and DR guidelines and the participating experts. The 10 SEAR countries (the Democratic Republic of Korea was not included for lack of sufficient data) were divided into 3 resource levels (low, medium, and high) based on gross national income/per capita, cataract service indicators (cataract surgical rate and cataract surgical service), current infrastructure and available HRH. Two countries each were assigned to low (Myanmar, Timor-Leste) and high resource (India, Thailand) levels, and the remaining 6 countries (Bangladesh, Bhutan, Indonesia, Maldives, Nepal, Sri Lanka) were assigned the medium resource level. The DR care system was divided into 3 levels of care (essential, recommended, and desirable) and 3 levels of service delivery (primary, secondary, and tertiary).

Main outcome measures

Primary, secondary, and tertiary level guidelines for screening of DR

Results

Nine WHO SEAR countries participated in the formulation of the new country-specific DR screening guidelines. The DR screening recommendations were: advocacy at the community level, visual acuity measurement, and non-mydriatic fundus photography at the primary level, comprehensive eye examination and retinal laser at the secondary level, and intravitreal therapy and vitrectomy at the tertiary level. The systemic care of DM and hypertension are recommended at all levels commiserating with their care capabilities.

Conclusions

The DR guidelines for the SEAR region are the first region-specific and resource-aligned recommendations for comprehensive DR care in each country of the region. In the future, the new technological advances in retinal camera technology, teleophthalmology, and artificial intelligence should be included within the structure of the public DR care system.

KEYWORDS:

• Diabetic retinopathy
• Diabetes Mellitus
• Screening for Diabetic retinopathy
• Health burden in South East Asia

Acknowledgments

Enayet AHM Hussain, MD; Khaleda Islam, MPH; Nor Tsering Lepcha, MD; Indra P Sharma, M Sc; Phanindra B Nukellla, Ph.D.; Aldiana Halim, MD; Abdulla Junaid, MD; Sailesh Mishra, MBA; Yuddha D Sapkota, M Sc; Marcelino Correia, MD.

DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST

Financial Disclosure: Hyderabad Eye Research Foundation, Hyderabad, India. Research work of Dr BT is additionally supported by India Alliance CRTP grant.

CONFLICTS OF INTEREST

The author(s) report no conflict of interest.

SUPPORT

Hyderabad Eye Research Foundation, Hyderabad, India