Clinical practice guidelines for the management of diabetic retinopathy (version 4.6)

Historical Significance: The report was prepared for the Clinical Outcomes and Guidelines Section of the (Australian) National Health and Medical Research Council. The first author, Professor Paul Mitchell is a well known academic ophthalmologist attached to the University of Sydney. His clinical focus was on management of age-related macular degeneration (AMD), diabetic retinopathy and other vascular retinopathies and on systemic diseases effects on the eye. He was leader of the seminal Blue Mountains epidemiological study of vision.This report lead to the NHMRC report Clinical Practice Guidelines' Management of diabetic retinopathy published in June 1997, which is now withdrawn.Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and is a significantcause of new-onset blindness. Diabetic macular changes in the form of yellowish spots and fullor partial thickness extravasations through the retina were observed for the first time by EduardJaeger In 1855. Jaegers findings were controversial until 1872, when Edward Nettleshippublished his seminal paper on oedema or cystic disease of the retina, providing the firsthistopathological proof of cystoid degeneration of the macula in patients with diabetes. Since diabetes is a common condition attention naturally focussed on developing new treatments especially in the 1980s and 1990s. At the same time there was a public health push to ensure that DR was detected as early as possible through raising awareness among referring practitioners such as GPs and optometrists. There was also a push for public screening for diabetes and DR. This report is product of this new endeavour. It was echoed in working groups in other countries beginning in the early 1990s. (See Kalantzis, G et al. Diabetic retinopathy: An historical assessment. Hormones 2006; 5: 71-74).Historically DR was a stimulating challenge for optometrists, who at the time needed to demonstrate their ability to detect DR and and have good judgement when to refer for ophthalmological treatment. Optometrists were also motivated to be accepted as key players in the public health push for early detection of eye signs of diabetes