Alternatives in eye care for patients with diabetes mellitus

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The consultation strongly recommended that, i a screening and detection programme is implemented, resources be found for necessary laser treatment. From a pubic health perspective, detecting disease that cannot be treated is a poor use of resources. The participants recognized the importance of finding new methods for providing the resources necessary to deliver care within the changing international intelectual property rights regime. While education regarding the presence of retinopathy that is not sight-threatening might help to reduce the rate of progression to blindness, this has not yet been adequately demonstrated.

Al treatment should be consistent with uniform international standards. The I nternational Council of Ophthalmology guidelines for diabetic retinopathy care (52) (See Annex 4.) give detailed information about the expected performance of ophthalmologists who treat diabetic retinopathy.

The consultation came to the following conclusions:

■ An adequate level of accuracy in detecting any degree of retinopathy (screening function) is achievable by a variety of health care provders using photographic systems.

■ The current level of accuracy of health care providers in classifying the severity of diabetic retinopathy means that many alternative systems can be expected to perform at least as well and thus represent approprate alternatives.

■ Education can improve the performance of health care providers, including non-eye care professionals, although long-term data on persistence are lacking. Use of photographic standards might be an alternative that would also enhance the performance of all systems to detect and follow-up cases of diabetic retinopathy.

■ The follow-up care intervals remain a problem, both from the perspective of both the provider and the patient. While most patients are told by their provder to return within a specified interval, patients are poorly compliant (55). Further, societies necessarily differ in what they consider to be an acceptable rate of preventable vision loss in relation to the interval between follow-up, based on competing health and social needs.

Thus, the consultation considered that there are several vabe alternatives for detecting patients with diabetic retinopathy and for referral for treatment, if the society chooses to provide treatment. The choice depends on individual cultures and societies and is based on both economic and non-economic considerations.

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