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ICO issues updated Diabetic Retinopathy Guidelines

Published: 15.04.2014

The International Council of Ophthalmology (ICO) has published updated ICO Guidelines for Diabetic Eye Care. The Guidelines provide recommendations for screening and evaluating people with diabetes for potentially blinding eye problems, and treating those with diabetic retinopathy and other ocular complications of diabetes.

“The original ICO Guidelines, released in December 2013, were a technical consensus by the ICO Task Force on Diabetic Eye Care, which resulted from their extensive review of diabetic eye care guidelines from around the world,” said Dr. Tien Y. Wong, Chair, ICO Committee on Diabetic Eye Care.

“The ICO Task Force on Diabetic Eye Care did a fantastic job creating a technical consensus. In January 2014, the taskforce was re-organized as the Diabetic Eye Care Committee. We updated the ICO Guidelines based on comments received during an online peer-review process and we added new, high quality images.”

Download the ICO Guidelines for Diabetic Eye Care from the ICO website at:

The ICO Guidelines are intended to serve a supportive and educational role for ophthalmologists worldwide, with the ultimate goal of improving the quality of eye care for patients with diabetes. They offer recommendations for screening, assessing, and treating diabetic retinopathy based on available resources. The ICO Guidelines are intended to be translated and adapted for local use by ophthalmologists and others who care for those with diabetes.

The recommendations are stratified in three levels:

  • Essential or Core: for low resource settings
  • Mid-Level: for intermediate-resource settings
  • Current State-of-the-Art: for settings with abundant resources.

Diabetes is a growing global epidemic, affecting up to 30 percent of the population in some countries. Diabetic retinopathy, which is damage to the blood vessels in the back of the eye, is the leading cause of vision loss in working adult populations.

Patients with severe levels of diabetic retinopathy are reported to have poorer quality of life and reduced levels of physical, emotional, and social well-being, and they utilize more health care resources. Generally, about one in three persons with diabetes develops diabetic retinopathy, but all persons with diabetes are at risk for developing diabetic retinopathy.

Epidemiological studies and clinical trials have shown that optimal control of blood glucose, blood pressure, and blood lipids by those with diabetes can reduce the risk of developing retinopathy and slow its progression. Timely treatment with laser photocoagulation, and increasingly, the appropriate use of intraocular administration of vascular endothelial growth factor (VEGF) inhibitors can prevent almost all visual loss in vision-threatening retinopathy, particularly diabetic macular edema.

Since visual loss may not be present in the earlier stages of retinopathy, screening of persons with diabetes once a year is essential to enable early intervention and prevent blindness.

“Creating an international consensus on screening, assessing, and treating diabetic retinopathy is a major step towards reducing vision loss related to diabetes,” said Professor Hugh Taylor, ICO President and Chair of the original ICO Task Force on Diabetic Eye Care.

“Taking a resource-sensitive, adaptive approach to this worldwide issue is essential. The ICO Guidelines demonstrate the need for ophthalmologists to work with diabetologists, primary care providers, and others in the context of available clinical equipment, trained personnel, and resources.”

The ICO Guidelines are designed to be a working document and will be updated on an ongoing basis. Comments are welcome at [email protected].

Translation and adaption for non-commercial use is encouraged, but please credit the ICO. PDF and Word versions are available on the ICO website. The 2013 version of the Guidelines is also available in Vietnamese:

The ICO Guidelines are part of an ICO initiative to work with ophthalmologic societies and other partners to reduce worldwide vision loss related to diabetes. Future committee priorities include:

  • Incorporating the critical competencies for diabetic eye care into ICO curricula for ophthalmologists, subspecialists, and other eye health personnel and stimulating improved training and continuing professional development to meet public needs.
  • Developing a framework for evaluation of public health approaches and stimulating development, strengthening, and monitoring of relevant health systems.