Screening of Diabetic Retinopathy

STATEMENT OF INTENT These clinical practice guidelines (CPG) are meant to be guides for clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not necessarily guarantee the best outcome in every case. Every healthcare provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally.

These guidelines were issued in 2011 and will be reviewed in 2015 or sooner if new evidence becomes available.

CPG Secretariat Health Technology Assessment Section Medical Development Division Ministry of Health Malaysia 4th Floor, Block E1, Parcel E 62590 Putrajaya

Electronic version available on the following website:

http://www.moh.gov.my

http://www.acadmed.org.my

GUIDELINES DEVELOPMENT The Development Group for these Clinical Practice Guidelines (CPG) was from the Ministry of Health (MOH) and Ministry of Higher Education. They consisted of ophthalmologists, a pediatrician, an obstetrician & gynecologist, a public health physician, a family medicine specialist, an optometrist, an assistant medical officer and a nursing sister. There was active involvement of the Review Committee during the process of development of these guidelines.

Literature search was carried out at the following electronic databases: Guidelines International Network (G-I-N); Centre for Reviews and Dissemination (CRD); PubMed; Ovid Medline, EBM Reviews - Cochrane Database of Systemic Reviews, EBM Reviews - Health Technology Assessment, Journals full text via OVID search engine (refer to Appendix 1 for Search Terms). In addition, the reference lists of all retrieved articles were searched to identify relevant studies. Experts in the field were also contacted to identify further studies. All searches were conducted between September 2009 and January 2011. Future CPG updates will consider evidence published after this cut-off date. The details of the search strategy can be obtained upon request from the CPG Secretariat. Reference was also made to other guidelines on Diabetic Retinopathy such as The American Academy of Ophthalmology Preferred Practice Pattern Diabetic Retinopathy (2008) and National Health and Medical Research Council (NHMRC) Australia Guidelines for the Management of Diabetic Retinopathy (2008). These CPGs were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) prior to them being used as references.

The clinical questions were developed under three major subtopics and members of the Development Group were assigned individual questions within these subtopics (refer to Appendix 2 for Clinical Questions). The group members met a total of 16 times throughout the development of these guidelines. All literature retrieved was appraised by at least two members and presented in the form of evidence tables and discussed during Development Group meetings. All statements and recommendations formulated were agreed upon by both the Development Group and Review Committee. Where evidence was insufficient, the recommendations were made by consensus of both groups. These CPG are based largely on the findings of systematic reviews, meta-analyses and clinical trials, with local practices taken into consideration. SCREENING OF DIABETIC RETINOPATHY The articles were graded using the US/Canadian Preventive Services Task Force Level of Evidence (2001), while the grading of recommendation in these guidelines was modified from grades of recommendation of the Scottish Intercollegiate Guidelines Network (SIGN). The draft guidelines were posted on the MOH Malaysia official website for comment and feedback. It had also been presented to the Technical Advisory Committee for CPG and the HTA-CPG Council, MOH Malaysia for review and approval

OBJECTIVE The objective of these CPG is to provide evidence-based recommendations in the screening of Diabetic Retinopathy. This would prevent or reduce the risk of visual loss, thereby maintaining or improving vision-related quality of life.

TARGET POPULATION All patients with Diabetes Mellitus including children and pregnant women

TARGET GROUP/USER These guidelines are applicable to all healthcare professionals who are involved in the screening of Diabetic Retinopathy:

• Nurses/Assistant Medical Officers

• Family Medicine Specialists

• Optometrists

• General Practitioners/Medical Officers

• Physicians/ Pediatricians/ Obstetricians & Gynecologists/ Endocrinologists

• Diabetic Support Groups

• Ophthalmologists

HEALTHCARE SETTING Outpatient, inpatient and community settings

Rujukan seterusnya Sila Login E-Library