Establishing Expert Consensus on a Unified Decision Framework for Retina Patient Care

The global burden of retina care is large and increasing. Many countries have their own guidelines for diagnosis and management of the different retinal diseases, but a unified decision framework could help healthcare professionals to address capacity issues while ensuring excellent and up-to-date patient care. The purpose of this study was to explore the development of such a unified decision framework for retina care.

A modified Delphi methodology was employed. A steering committee meeting with one expert from The Ophthalmology Network was held in April 2024. An independent facilitator guided the meeting, and three main topics of focus were identified. Following discussions, 27 statements were agreed upon and an online survey containing a 4-point Likert scale to indicate level of agreement was produced and distributed to ophthalmologists. Responses to surveys were anonymous, and analysis was conducted independently. The consensus threshold was defined a priori at 75%. Results were reviewed by the steering committee of eight experts resulting in the production of recommendations.

Overall, 188 responses to the online survey were received from six regions (Europe, Asia, North America, South America, Africa, and Australia/Oceania). Twenty-six statements achieved very high consensus, and one achieved high consensus within three overarching topics of "accessing and maintaining retina care", "key principles of unified decision framework", and "benchmarking criteria". Further subgroup analysis revealed only 67% of clinicians with less than 5 years' experience agreed with the statement "Intravitreal injections should only be administered after reviewing an OCT scan". Since overall, there was a high level of agreement for all statements and stopping criteria were met, no further Delphi rounds were deemed necessary.

This consensus demonstrates that retina care experts believe that a unified decision framework would be beneficial. Their recommendations should facilitate development and implementation of such a framework.