Improvements to increase the cost-effectiveness of eye care for diabetes patients are a global necessity. Blindness due to diabetic retinopathy occurs in part because factors important to both patients and health care providers have not been recognized or incorporated into current diabetes education, screening and treatment programmes. Systems analyses are needed in varous cultures to understand better why patients with diabetic retinopathy go bind, particularly when the technical knowledge and services to prevent the condition exist. Operations research is needed for comprehensive, evidence-based characterzation of the contrbutions of significant factors and their interactions to blindness among patients with diabetic retinopathy. Within a standardized protocol, focus group methods can give detailed insight about bind and non-blind patients with retinopathy, members of their families or social support systems and diabetes and eye care providers, including information on the actual care provided and received.
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