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

Screening for DR GuidelineScreening methodExamination interval: Patients with Diabetes, without baseline DR NICE (2005)45 degree mydriatic photography12-18 months NHMRC (2008)Dilated ophthalmoscopy Non-mydriatic photography if not available 24 months WHO (2005)Dilated two field photography12 months AAO (2008)Slit-lamp biomicroscopy12 months EvidenceSingle field 45°, non-mydriatic image is adequate to detect ‘referable’ retinopathy 24 months Further details on Poster #73

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

Acknowledgement PhD 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.