ICO Publishes New Guidelines for Diabetic Retinopathy

Tien Y. Wong, MD, PhD

The International Council of Ophthalmology (ICO) published new guidelines for the care of diabetic retinopathy, serving as an updated guide for the screening, referral and follow-up schedules, and appropriate management of vision-threatening variations of the condition.

The guidelines included recommendations for diabetic macular edema (DME) and proliferative diabetic retinopathy, tailored to a country’s needs and resources, including high-, low-, or intermediate-resource settings.

“The updated 2017 version includes incorporation of new evidence on diabetic retinopathy screening, new diagnostic technology, such as Optical Coherence Tomography, and new treatments such as [anti-vascular endothelial growth factor] therapy,” said Tien Y. Wong, MD, PhD, a professor and the medical director at the Singapore National Eye Center, and the lead author on the article in press describing the updates, but “it does not cover treatment in detail.”

Instead, he said, it focuses on a broad-based set of recommendations for screening, referrals, and principals of management. Importantly, they are not directed toward ophthalmologists, but at general physicians and public healthcare professionals. “Even if an adequate number of ophthalmologists are available, using ophthalmologists or retinal subspecialists to screen every person with [diabetes] is an inefficient use of resources,” the guidelines state.

The guidelines were first established in 2013, and the current guidelines, published in May 2018, represent the updates the group determined in 2017. Wong said that the team will continue to update them every 3 to 4 years. In addition to annual meetings, the council has regular teleconferences throughout the year, as it has grown over time. In 2013, there were 12 members; there are now 16, representing countries including the USA, Brazil, Switzerland, and Chile, among others.

One of the largest challenges informing international guidelines was determining a consensus between high resource countries and lower resource areas. While anti-vascular endothelial growth factor (VEGF) therapy is gaining popularity as the first-line option to manage diabetic retinopathy in high resource countries, its cost is prohibitive in many low-resource areas which still recommend conventional laser therapy as a first option.

“We managed to get consensus and agreement on the broader-based level of ‘minimum’ standards that all countries should agree on, leaving room for high-resource countries, such as the US and UK, to have their own specific guidelines on management,” Wong told MD Mag.

One out of every 3 patients with diabetes experiences diabetic retinopathy, which has severe implications for quality of life and wellbeing. It is the most common cause of adult blindness in most countries, and risk can often be minimized by proper blood glucose management in diabetic patients—though this does not completely eliminate the risk of retinopathy. More importantly, the article states, “designing diabetic retinopathy screening programs, with appropriate and timely referral to facilities with trained eye care professionals and using cost-effective treatment for vision-threatening levels of diabetic retinopathy can prevent vision loss.”

The new guidelines can be found online at icoph.org. They are part of an initiative by the ICO to reduce worldwide vision loss due to diabetes. Questions and comments can be emailed to info@icoph.org.

The article in press, “Guidelines on Diabetic Eye Care,” was published in Ophthalmology.