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Evaluating guidelines for de-escalating care from ophthalmology to optometry in the context of diabetic retinopathy

Zyg Chapman* & Joshua Swersky

Diabetic retinopathy remains a significant common cause of preventable vision loss. Guidelines exist for the routine screening of diabetic patients, to identify the development of diabetic retinopathy, and manage the progression of the disease. While screening can be performed by optometrists, treatment of diabetic retinopathy requires management by ophthalmologists. Currently, guidelines prescribe when care should be escalated from optometry, but there is a lack of clear protocols for the de-escalation of patients from ophthalmology back to optometry. In this protocol, novel guidelines have been generated in collaboration with ophthalmologists working at Royal Melbourne Hospital, to standardize de-escalation from their care, to allied optometrists working at University of Melbourne Eyecare Clinic. In this protocol we further propose how these new guidelines might be statistically evaluated based on data generated from patients over a three-year prospective study. We hypothesise that these novel guidelines will reduce the average number of ophthalmology appointments per patient without compromising patient outcomes. These guidelines aim to reduce the clinical burden of ophthalmologists managing diabetic retinopathy, while maintaining an excellent standard of care in preventing vision loss.