Changes in management of diabetic retinopathy by Australian ophthalmologists as a result of the NHMRC clinical guidelines

Purpose: To document changes in management of diabetic retinopathy by Austr alian ophthalmologists after release of the National Health and Medical Res earch Council (NHMRC) clinical guidelines. Methods: Self-administered questionnaires were mailed to Australian ophthal mologists prior to release of the NHMRC guidelines for the management of di abetic retinopathy, and at one and 2.5 years after release of the guideline s. The questionnaires elicited information about current management practic es in relation to diabetic retinopathy. Results: The response rate for the baseline and two follow-up surveys was 8 2%, 81%, and 80%, respectively. More than 85% of the ophthalmologists respo nded that the guidelines were useful in improving management, were easy to understand, and were already part of their routine clinical practice. A rel atively small percentage (12%) felt that the guidelines made recommendation s that were not practical or feasible. Contrary to the NHMRC guidelines, at the second follow-up survey, only 50% of the ophthalmologists said that th ey would almost never perform fluorescein angiography in eyes with mild non -proliferative diabetic retinopathy. The change from baseline to the second follow-up in the percentage of ophthalmologists who would perform cataract surgery after treating clinically significant macular oedema (as advised b y the NHMRC guidelines) was statistically significant (baseline = 83.7%, 95 % confidence limit = 80.4, 87.0; second follow up = 90.4, 95% confidence li mit = 87.3, 93.5). Conclusions: Distribution of the printed NHMRC Clinical Practice Guidelines : Management of Diabetic Retinopathy and full colour Retinopathy Chart resu lted in a significant change in the recommended order of treatment of clini cally significant macular oedema. However, no significant change in the use of fluorescein angiography was documented.