Background

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Purpose of the consultation

Diabetes mellitus is an important public health problem worldwide, and more than 75% of patients who have had diabetes mellitus for more than 20 years will have some form of retinopathy. Diabetic retinopathy correlates with the duration of diabetes; thus, with increasing life expectancy, diabetic retinopathy and the ensuing blindness will tend to increase.

In view of the increasing prevalence of diabetes mellitus and diabetic retinopathy throughout most of the word, a consultation on prevention of blindness from diabetes mellitus was convened by the WHO unit of Prevention of Blindness and Deafness to review the current status of diabetic retinopathy care and to define approaches for screening, early detection and management in populations in different settings. (See agenda in Annex 1.) The consultation was held within the context of a contractual agreement between the programme for Prevention of Blindness and Deafness, WHO, and the National Eye Institute of the National Institutes of Health, Bethesda, Maryland, United States of America. The participants were drawn from all the WHO regions and represented experts in both general diabetes care and ophthalmology. (See Annex 2.) Durng the consultation, the participants sought to build on prior international collaboration and previous successful work of WHO, Member States, the International Diabetes Federation and the International Council of Ophthalmology.

Randomized clinical trals have shown the efficacy of laser photocoagulation of the retina for treating proliferative diabetic retinopathy Prevention of visual loss from diabetic retinopathy is therefore feasible and achievable with the present state of knowledge, and treatment with laser photocoagulation has been shown to be cost-effective. The Saint Vincent Declaration (1) on diabetes care, formulated under the aegis of WHO and the International Diabetes Federation, listed among its goals the reduction of blindness from diabetic retinopathy within specified dates. Although the Declaration targeted prmarily the countres of the European Region there is general consensus that the primary goals should be extended woridwide.

Detailed clinical practice guidelines for the diagnosis, treatment and evaluation of diabetic retinopathy are available from the International Council of Ophthalmology. Use of these guidelines should be extended to the developing parts of the word, with approprate adaptations for the available technology and human resources, taking into account their stage of health care system development.

The consultation considered evidence from around the word to determine a unified approach to preventing unnecessar blindness. Consensus was reached on global approaches to screening for diabetic retinopathy and treatment by eye care professionals, in an approach that can be integrated into routine diabetes care in each setting. While the work of the International Diabetes Federation formed the basis of this approach, several alternatives were identified for ensurng high-quality decisions about referral for eye care. The approach also builds on the work of the International Council of Ophthalmology and ensures a uniform approach to diabetic retinopathy care based on the best available evidence.

WHO in conjunction with the National Eye Institute and WHO collaborating centres will support Member States in assessing the resources needed for eye care for patients with diabetes. The consultation drew up a framework for making decisions about trade-offs between cost and performance in the screening and treatment of diabetes-related eye disease, and WHO and its partners will further suppor Member States in validating the models of eye care that they choose to implement.

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