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    Further survey of Australian ophthalmologist's diabetic retinopathy management: did practice adhere to National Health and Medical Research Council guidelines?

    Access Status
    Fulltext not available
    Authors
    Yuen, J.
    Clark, A.
    Ng, Jonathon
    Morlet, Nigel
    Keeffe, J.
    Taylor, H.
    Preen, D.
    Date
    2010
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Yuen, J. and Clark, A. and Ng, J. and Morlet, N. and Keeffe, J. and Taylor, H. and Preen, D. 2010. Further survey of Australian ophthalmologist's diabetic retinopathy management: did practice adhere to National Health and Medical Research Council guidelines?. Clinical and Experimental Ophthalmology. 38 (6): pp. 613-619.
    Source Title
    Clinical and Experimental Ophthalmology
    DOI
    10.1111/j.1442-9071.2010.02326.x
    ISSN
    1442-6404
    School
    Centre for Population Health Research
    URI
    http://hdl.handle.net/20.500.11937/46544
    Collection
    • Curtin Research Publications
    Abstract

    Background: To compare the self-reported management of diabetic retinopathy by Australian ophthalmologists with the 1997 National Health and Medical Research Council (NHMRC) guidelines. Methods: Self-reported cross-sectional survey of patterns of practice. Questionnaires were sent to all Australian ophthalmologists, comprising questions regarding professional details, diabetic retinopathy screening attitudes/practices and specific hypothetical management scenarios. Data were analysed using Chi-squared and adjusted logistic regression. Result: 480 of the 751 (64%) eligible Australian ophthalmologists participated. The majority (80%, n = 376) reported they consistently reviewed patient's glycaemic control, but only 55% and 41% regularly reviewed blood pressure and serum cholesterol control, respectively. Ophthalmologists generally adhered to NHMRC-recommended screening intervals, although only 38% agreed with the guidelines relating to screening of pre-pubertal diabetic patients. Fluorescein angiogram was used more than recommended, especially for mild non-proliferative diabetic retinopathy where 45% of respondents used this investigation. Practice duration >15 years was associated with more regular fluorescein angiogram use (OR = 3.74; 95% CI: 2.53-5.53, P < 0.001). In the clinical scenarios where clinically significant macular oedema was concurrently present with cataract or proliferative diabetic retinopathy, >26% referred to retinal subspecialists for management; 85% of the remaining ophthalmologists performed macular laser first. Respondents with practice duration >15 years were 7.8 times (P = 0.001) more likely to perform cataract surgery first. Conclusion: Diabetic retinopathy management guidelines were generally well followed by Australian ophthalmologists. However, areas of practice variation existed including frequent use of fluorescein angiogram. Significant proportion of practitioners referred diabetic patients to retinal subspecialists, who were more likely to adhere to guideline recommendations. Ophthalmologists with greater experience (>15 years) were more likely to employ practices differing from NHMRC recommendations. © 2010 The Authors. Journal compilation © 2010 Royal Australian and New Zealand College of Ophthalmologists.

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