Management of diabetic retinopathy by Australian ophthalmologists. Working Group on Evaluation of the NHMRC Retinopathy Guideline Distribution. National Health and Medical Research Council.
OBJECTIVE
To describe current management practices of diabetic retinopathy used by Australian ophthalmologists.


METHODS
Two-page self-administered questionnaire mailed to 622 ophthalmologists listed with the Royal Australian College of Ophthalmologists.


METHODS
The survey included questions about practice details such as size and location; specialty; current practice with regard to management of patients with diabetes; confidence in screening for diabetic retinopathy; and a number of patient scenarios related to screening, follow-up and treatment of diabetic retinopathy.


RESULTS
Of the 577 eligible ophthalmologists, 475 (82%) completed the questionnaire. They had been practicing ophthalmology between 1 and 50 years (median 16 years) and 89 (19%) indicated that they had a subspecialty interest either in vitreo-retinal surgery or in medical retina. For 145 (30.5%) of the ophthalmologists, at least one of their practices was located in a country area. The estimated percentage of patients with diabetes ranged from 0.1 to 60% (mean = 9.9%). Retinal specialists perform between 0 and 750 macular focal photocoagulation procedures per year (mean = 94) compared with a range of 0-350 for nonretinal specialists (mean = 10.3) (t = 6.1, P < 0.001). The ophthalmologists were presented with a hypothetical patient with cataract requiring surgery and clinically significant macular oedema that would be difficult to treat (but not impossible) because of the cataract. Seventy-seven ophthalmologists (16%) said they would delay the macular laser therapy until after the cataract surgery had been performed. In multivariate logistic regression models, nonretinal specialists were 4.44 times as likely to perform the cataract surgery first (95%CL = 1.57, 12.6) and ophthalmologists who had been in practice more than 15 years were 2.50 times as likely to perform cataract surgery first (95%CL = 1.47, 4.26). There were other examples of practice that differed from the National Health and Medical Research Council (NHMRC) guidelines in patient scenarios. The majority of ophthalmologists (60%) expressed a moderate or strong need to learn more about the management of diabetic retinopathy.


CONCLUSIONS
The variability in the management of diabetic retinopathy by Australian ophthalmologists and the desire of ophthalmologists to learn more about diabetic retinopathy provide evidence to support the need for the NHMRC Guidelines for Diabetic Retinopathy. These data will be used to evaluate changes in practice as a result of the implementation of the guidelines.
Centre for Eye Research Australia, Melbourne, Victoria. cathy@cera.unimelb.edu.au
C A
CA
McCarty
R
R
McKay
J E
JE
Keeffe
D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery*; D006302:Health Services Research / Q000706:statistics & numerical data; D006801:Humans; D017075:Laser Coagulation / Q000706:statistics & numerical data*; D009885:Ophthalmology / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014739:Victoria