WHO Publishes SEAsia-specific DR Guidelines

Diabetes mellitus (DM) is increasing in the world and in countries of the South-East Asia (SEA) Region. The International Diabetes Federation (IDF) estimates that the number of people with DM in the seven countries of the SEA Region, is likely to increase from 87.6 million in 2019, to 115.1 million in 2030. The age-adjusted prevalence of DR in SEA countries is likely to increase from 11.3% in 2019, to 12.2% in 2030 (IDF).

Diabetic retinopathy (DR) is an important cause of vision impairment and blindness in South- East Asia. Diabetic retinopathy (DR) accounted for 1.07% of blindness, and 1.25% of moderate to severe visual impairment (MSVI) in 2015. Despite two decades of global efforts to reduce visual impairment, there was a 25% increase in the prevalence of DR (Crude prevalence 0.032% and 0.04% in 1990 and 2015 respectively). This disparity is explained by the increase in absolute numbers of people with diabetic retinopathy (DR), consequent to an increase in people with diabetes mellitus (DM).

There is strong evidence that good control of DM and associated systemic conditions reduces the incidence of sight-threatening retinopathy, and/or improves prognosis after standard treatment of DR.

Over the years, many country-specific and global guidelines of evidence-based diabetic retinopathy have been developed. The scopes of these guidelines are nearly similar: screening to detect sight-threatening retinopathy, referral for appropriate care, and treatment using the latest technique and technology. Many countries in the SEA Region do not have diabetic retinopathy treatment and operation guidelines, despite being home to the largest population with diabetes. The International Agency for the Prevention of Blindness (IAPB) formed a South-East Asia Diabetic Retinopathy Expert Group and sought help from the WHO SEA Regional Office in New Delhi to convene a three-day meeting in December 2019, to analyse the existing diabetic retinopathy guidelines, and formulate a guideline more specific to the Region.

This document reflects a successful collaboration between IAPB and WHO SEAR and the contribution of the South East Asia Eye Health Expert Group representing all 10 countries of the region. It is expected that these guidelines will be helpful to all programme and practitioners involve in prevention of blindness due to diabetic retinopathy in the region.