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- A joint service of General Physicians and Ophthalmic Specialists is essentially important for comprehensive diabetes care.
- Any patient who is identified to have sight-threatening pathological change(s) with conventional non-mydriatic fundus photography at a general diabetes care unit, or if clear fundus images of the patient could not be obtained by conventional fundus photography at a general diabetes care unit, should be referred to a qualified eye care unit for mydriatic photography and ophthalmic evaluation.
- Mydriatic ETDRS 7-field standard fundus photography is the recommended choice of fundus photography at the eye care unit for the referred patient with diabetes. High resolution wide-field laser scanning photography can be used as an alternative method for the fundus photography. Macula examination by optical coherence tomography (OCT) may be applied when applicable. Contraindications for mydriasis should be evaluated by an ophthalmologist before any mydriatic agents are given to the patients.
- The photographs should be sent to a DR reading center for ETDRS grading for general diabetes care purpose. Conventional ophthalmic DR evaluation by International Standard Classification of DR may be performed by the eye care specialist for eye care purpose. Ophthalmic treatments, such as retinal laser treatments and surgical treatments may be applied for the cases in need. Systemic training for high quality ophthalmic services for DR should be emphasized. Quality control for ophthalmic service needs to be applied. This may include at least quality control of mydriatic fundus photography, indications of DR laser treatment and the quality of the laser treatment. Quality control of the indications for surgical treatment might also be needed.