Clinical practice guidelines for the treatment and management of diabetic macular oedema: a systematic review

To assess geographically global clinical practice guidelines (CPGs) for diabetic macular oedema (DMO) management.

A systematic literature review (SLR) of CPGs for DMO management was conducted using Embase and MEDLINE databases, Guideline Central, Health Technology Assessment bodies, professional ophthalmology associations, and backwards citation tracking. CPGs published between January 2010-October 2023 were included and independently assessed by four reviewers and one adjudicator using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. CPGs were qualitatively assessed for anatomical measurement (optical coherence tomography [OCT]) and visual acuity (VA) recommendations. PROSPERO identification: CRD42023473223.

14/147 identified CPGs were included. Overall AGREE II scores were 49-91 (mean [SD] = 67 [11]). Strongest domains were Scope and Purpose (85 [10.9]), Clarity of Presentation (87 [18.7]), and Editorial Independence (91 [13.7]). Stakeholder Involvement (57 [8.3]), Applicability (54 [19.4]), and Rigor of Development (41 [19.0]) scored lowest. 13/14 CPGs were "Recommended" or "Recommended with Modifications". All CPGs recommended OCT for initial diagnosis. 3/14 CPGs did not recommend VA or considered VA optional. For initial disease management, 11/14 CPGs recommended OCT. One considered OCT optional. VA was recommended by 9/14 CPGs for initial management. All CPGs recommended using VA and OCT for disease monitoring while on anti-vascular endothelial growth factor therapy. 12/14 CPGs recommended using OCT to measure anti-VEGF response to adjust treatment interval.

CPGs were aligned regarding the importance of OCT in DMO management. More rigorous methods, applicability in resource-constrained systems, and patient perspectives will improve CPG trustworthiness and transparency.