ABSTRACT

Objective

To formulate guidelines for screening of diabetic retinopathy (DR) for the World Health Organization (WHO) South-East Asia Region (SEAR) aligned with the current infrastructure and human resources for health (HRH).

Design

A consultative group discussion of technical experts of the International Agency for the Prevention of Blindness (IAPB) from SEAR.

Participants

IAPB country chairs and DR technical experts from SEAR countries.

Methods

Data related to DR in SEAR was collected from published literature on available DM and DR guidelines and the participating experts. The 10 SEAR countries (the Democratic Republic of Korea was not included for lack of sufficient data) were divided into 3 resource levels (low, medium, and high) based on gross national income/per capita, cataract service indicators (cataract surgical rate and cataract surgical service), current infrastructure and available HRH. Two countries each were assigned to low (Myanmar, Timor-Leste) and high resource (India, Thailand) levels, and the remaining 6 countries (Bangladesh, Bhutan, Indonesia, Maldives, Nepal, Sri Lanka) were assigned the medium resource level. The DR care system was divided into 3 levels of care (essential, recommended, and desirable) and 3 levels of service delivery (primary, secondary, and tertiary).

Main outcome measures

Primary, secondary, and tertiary level guidelines for screening of DR

Results

Nine WHO SEAR countries participated in the formulation of the new country-specific DR screening guidelines. The DR screening recommendations were: advocacy at the community level, visual acuity measurement, and non-mydriatic fundus photography at the primary level, comprehensive eye examination and retinal laser at the secondary level, and intravitreal therapy and vitrectomy at the tertiary level. The systemic care of DM and hypertension are recommended at all levels commiserating with their care capabilities.

Conclusions

The DR guidelines for the SEAR region are the first region-specific and resource-aligned recommendations for comprehensive DR care in each country of the region. In the future, the new technological advances in retinal camera technology, teleophthalmology, and artificial intelligence should be included within the structure of the public DR care system.

中文翻译：

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利用背景、挑战和未来技术在东南亚地区制定糖尿病视网膜病变筛查指南

摘要

客观的

为世界卫生组织 (WHO) 东南亚地区 (SEAR) 制定与当前卫生基础设施和人力资源 (HRH) 相一致的糖尿病视网膜病变 (DR) 筛查指南。

设计

来自 SEAR 的国际防盲机构 (IAPB) 技术专家的协商小组讨论。

参与者

来自 SEAR 国家的 IAPB 国家主席和 DR 技术专家。

方法

SEAR 中与 DR 相关的数据是从有关现有 DM 和 DR 指南以及参与专家的已发表文献中收集的。根据人均国民总收入、白内障服务指标（白内障手术率和白内障手术服务）、现有基础设施和可用的 HRH。两个国家分别被分配到低资源水平（缅甸、东帝汶）和高资源水平（印度、泰国），其余 6 个国家（孟加拉国、不丹、印度尼西亚、马尔代夫、尼泊尔、斯里兰卡）被分配到中等资源水平。DR 护理系统分为 3 级护理（必要、推荐和可取）和 3 级服务提供（初级、二级、

主要观察指标

筛查 DR 的一级、二级和三级指南

结果

九个 WHO SEAR 国家参与了新的国家特定 DR 筛查指南的制定。DR筛查建议是：社区一级的宣传、视力测量和非散瞳眼底摄影，二级水平的综合眼科检查和视网膜激光，以及三级水平的玻璃体内治疗和玻璃体切除术。考虑到他们的护理能力，建议各级对 DM 和高血压进行全身护理。

结论

SEAR 地区的 DR 指南是针对该地区每个国家/地区的综合 DR 护理的首个针对特定地区和资源一致的建议。未来，视网膜摄像头技术、远程眼科和人工智能方面的新技术进步应纳入公共 DR 护理系统的结构中。