Expert consensus on community screening of diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

 Li Xiaorong ¹ ,  Li Xiaoxin ^2,3 ,  Xu Xun ⁴

1. Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China;
2. Xiamen Eye Center of Xiamen University, Xiamen 361003, China;
3. Department of Ophthalmology, Peking University People's Hospital, Beijing 100044, China;
4. Department of Ophthalmology, Shanghai JiaoTong University, National Clinical Research Center for Eye Diseases, Shanghai 200080, China;

Corresponding author：

Li Xiaorong, Email: xiaorli@163.com; Li Xiaoxin, Email: dr_lixiaoxin@163.com; Xu Xun, Email: drxuxun@sjtu.edu.cn

Keywords：

Diabetic retinopathy; Community screening; Organization management; Expert consensus

DOI：

10.3760/cma.j.cn511434-20231219-00492

Video：

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Diabetic retinopathy is one of the microvascular complications of diabetes and a major cause of blindness in adults. Early screening is an effective way to reduce blindness caused by diabetic retinopathy. The diabetic retinopathy is one of the chronic retinal diseases highlighted in the “14th Five-Year” National Eye Health Plan (2021-2025). The establishment of effective and practical community screening model is a powerful guarantee to complete early screening. It is of great significance to standardize screening methods, screening personnel duties, equipment allocation, referral conditions and screening sustainability. Chinese fundus disease and related field experts developed the consensus through a serious, comprehensive, and complete discussion, to provide more reference for establishing a suitable community screening model of diabetic retinopathy and increasing the screening rate of diabetic retinopathy.

Citation： Li Xiaorong, Li Xiaoxin, Xu Xun. Expert consensus on community screening of diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2024, 40(2): 98-104. doi: 10.3760/cma.j.cn511434-20231219-00492 Copy

1.	Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J/OL]. Diabetes Res Clin Pract, 2022, 183: 109119[2021-12-06]. https://pubmed.ncbi.nlm.nih.gov/34879977/. DOI: 10.1016/j.diabres.2021.109119.
2.	Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
3.	Teo ZL, Tham YC, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045[J]. Ophthalmology, 2021, 128(11): 1580-1591. DOI: 10.1016/j.ophtha.2021.04.027.
4.	Song P, Yu J, Chan KY, et al. Prevalence, risk factors and burden of diabetic retinopathy in China: a systematic review and meta-analysis[J/OL]. J Glob Health, 2018, 8(1): 10803[2018-06-01]. https://pubmed.ncbi.nlm.nih.gov/29899983/. DOI: 10.7189/jogh.08.010803.
5.	邓宇轩, 叶雯青, 孙艳婷, 等. 中国糖尿病视网膜病变患病率的荟萃分析[J]. 中华医学杂志, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.Deng YX, Ye WQ, Sun YT, et al. A meta-analysis of prevalence of diabetic retinopathy in China[J]. Natl Med J China, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.
6.	Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review: global burden of diabetic eye diseases[J]. Clin Exp Ophthalmol, 2016, 44(4): 260-277. DOI: 10.1111/ceo.12696.
7.	Mazhar K, Varma R, Choudhury F, et al. Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study[J]. Ophthalmology, 2011, 118(4): 649-655. DOI: 10.1016/j.ophtha.2010.08.003.
8.	World Health Organization. The principles and practice of screening for disease[R]. Geneva, WHO, 1968: 34.
9.	Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern®[J]. Ophthalmology, 2020, 127(1): 66-145. DOI: 10.1016/j.ophtha.2019.09.025.
10.	Scanlon PH. The English National Screening programme for diabetic retinopathy 2003-2016[J]. Acta Diabetol, 2017, 54(6): 515-525. DOI: 10.1007/s00592-017-0974-1.
11.	Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
12.	Scanlon PH. The English National Screening programme for sight-threatening diabetic retinopathy[J]. J Med Screen, 2008, 15(1): 1-4. DOI: 10.1258/jms.2008.008015.
13.	Avidor D, Loewenstein A, Waisbourd M, et al. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review[J]. Cost Eff Resour Alloc, 2020, 18: 16. DOI: 10.1186/s12962-020-00211-1.
14.	白雪林, 邹海东, 应晓华, 等. 上海市北新泾街道糖尿病眼病社区防盲项目效果的卫生经济学评价[J]. 中国医药导报, 2011, 8(24): 109-111. DOI: 10.3969/j.issn.1673-7210.2011.24.050.Bai XL, Zou HD, Ying XH, et al. The health economics evaluation of community-based blindness prevention project for diabetes eye diseases in Beixinjing blocks of Shanghai City[J]. China Medical Herald, 2011, 8(24): 109-111. DOI: 10.3969/j.issn.1673-7210.2011.24.050.
15.	Ting DSW, Cheung CYL, Lim G, et al. Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes[J]. JAMA, 2017, 318(22): 2211-2223. DOI: 10.1001/jama.2017.18152.
16.	Grzybowski A, Brona P, Lim G, et al. Artificial intelligence for diabetic retinopathy screening: a review[J]. Eye, 2020, 34(3): 451-460. DOI: 10.1038/s41433-019-0566-0.
17.	Gulshan V, Peng L, Coram M, et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs[J]. JAMA, 2016, 316(22): 2402. DOI: 10.1001/jama.2016.17216.
18.	Gargeya R, Leng T. Automated identification of diabetic retinopathy using deep learning[J]. Ophthalmology, 2017, 124(7): 962-969. DOI: 10.1016/j.ophtha.2017.02.008.
19.	EGrading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group[J]. Ophthalmology, 1991, 98(5 Suppl): S786-806.
20.	Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care. The international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608-1622. DOI: 10.1016/j.ophtha.2018.04.007.
21.	中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group, Ophthalmology Society of Chinese Medical Association. Clinical diagnosis and treatment guidelines for diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
22.	中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2022年)−基于循证医学修订[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Pathology Group, Ophthalmology Branch, Chinese Medical Association, Ophthalmology Branch, Chinese Medical Doctor Association. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)[J]. Chin J Ocul Fundus Dis, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.
23.	Williams GA, Scott IU, Haller JA, et al. Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2004, 111(5): 1055-1062. DOI: 10.1016/j.ophtha.2004.02.004.
24.	中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病专业委员会. 我国糖尿病视网膜病变图像采集及阅片指南(2017年)[J]. 中华眼科杂志, 2017, 53(12): 890-896. DOI: 10.3760/cma.j.issn.0412-4081.2017.12.003.Fundus Disease Group, Ophthalmology Branch of Chinese Medical Association, and fundus disease Professional Committee of Ophthalmology branch of Chinese Medical Doctor Association. Guidelines for image acquisition and reading of diabetic retinopathy in China (2017)[J]. Chin J Ophthalmol, 2017, 53(12): 890-896. DOI: 10.3760/cma.j.issn.0412-4081.2017.12.003.

1. Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045[J/OL]. Diabetes Res Clin Pract, 2022, 183: 109119[2021-12-06]. https://pubmed.ncbi.nlm.nih.gov/34879977/. DOI: 10.1016/j.diabres.2021.109119.
2. Yau JW, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy[J]. Diabetes Care, 2012, 35(3): 556-564. DOI: 10.2337/dc11-1909.
3. Teo ZL, Tham YC, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045[J]. Ophthalmology, 2021, 128(11): 1580-1591. DOI: 10.1016/j.ophtha.2021.04.027.
4. Song P, Yu J, Chan KY, et al. Prevalence, risk factors and burden of diabetic retinopathy in China: a systematic review and meta-analysis[J/OL]. J Glob Health, 2018, 8(1): 10803[2018-06-01]. https://pubmed.ncbi.nlm.nih.gov/29899983/. DOI: 10.7189/jogh.08.010803.
5. 邓宇轩, 叶雯青, 孙艳婷, 等. 中国糖尿病视网膜病变患病率的荟萃分析[J]. 中华医学杂志, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.Deng YX, Ye WQ, Sun YT, et al. A meta-analysis of prevalence of diabetic retinopathy in China[J]. Natl Med J China, 2020, 100(48): 3846-3852. DOI: 10.3760/cma.j.cn112137-20200925-02720.
6. Ting DS, Cheung GC, Wong TY. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review: global burden of diabetic eye diseases[J]. Clin Exp Ophthalmol, 2016, 44(4): 260-277. DOI: 10.1111/ceo.12696.
7. Mazhar K, Varma R, Choudhury F, et al. Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study[J]. Ophthalmology, 2011, 118(4): 649-655. DOI: 10.1016/j.ophtha.2010.08.003.
8. World Health Organization. The principles and practice of screening for disease[R]. Geneva, WHO, 1968: 34.
9. Flaxel CJ, Adelman RA, Bailey ST, et al. Diabetic retinopathy preferred practice pattern®[J]. Ophthalmology, 2020, 127(1): 66-145. DOI: 10.1016/j.ophtha.2019.09.025.
10. Scanlon PH. The English National Screening programme for diabetic retinopathy 2003-2016[J]. Acta Diabetol, 2017, 54(6): 515-525. DOI: 10.1007/s00592-017-0974-1.
11. Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
12. Scanlon PH. The English National Screening programme for sight-threatening diabetic retinopathy[J]. J Med Screen, 2008, 15(1): 1-4. DOI: 10.1258/jms.2008.008015.
13. Avidor D, Loewenstein A, Waisbourd M, et al. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review[J]. Cost Eff Resour Alloc, 2020, 18: 16. DOI: 10.1186/s12962-020-00211-1.
14. 白雪林, 邹海东, 应晓华, 等. 上海市北新泾街道糖尿病眼病社区防盲项目效果的卫生经济学评价[J]. 中国医药导报, 2011, 8(24): 109-111. DOI: 10.3969/j.issn.1673-7210.2011.24.050.Bai XL, Zou HD, Ying XH, et al. The health economics evaluation of community-based blindness prevention project for diabetes eye diseases in Beixinjing blocks of Shanghai City[J]. China Medical Herald, 2011, 8(24): 109-111. DOI: 10.3969/j.issn.1673-7210.2011.24.050.
15. Ting DSW, Cheung CYL, Lim G, et al. Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes[J]. JAMA, 2017, 318(22): 2211-2223. DOI: 10.1001/jama.2017.18152.
16. Grzybowski A, Brona P, Lim G, et al. Artificial intelligence for diabetic retinopathy screening: a review[J]. Eye, 2020, 34(3): 451-460. DOI: 10.1038/s41433-019-0566-0.
17. Gulshan V, Peng L, Coram M, et al. Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs[J]. JAMA, 2016, 316(22): 2402. DOI: 10.1001/jama.2016.17216.
18. Gargeya R, Leng T. Automated identification of diabetic retinopathy using deep learning[J]. Ophthalmology, 2017, 124(7): 962-969. DOI: 10.1016/j.ophtha.2017.02.008.
19. EGrading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group[J]. Ophthalmology, 1991, 98(5 Suppl): S786-806.
20. Wong TY, Sun J, Kawasaki R, et al. Guidelines on diabetic eye care. The international council of ophthalmology recommendations for screening, follow-up, referral, and treatment based on resource settings[J]. Ophthalmology, 2018, 125(10): 1608-1622. DOI: 10.1016/j.ophtha.2018.04.007.
21. 中华医学会眼科学会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2014年)[J]. 中华眼科杂志, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.Fundus Disease Group, Ophthalmology Society of Chinese Medical Association. Clinical diagnosis and treatment guidelines for diabetic retinopathy in China (2014)[J]. Chin J Ophthalmol, 2014, 50(11): 851-865. DOI: 10.3760/cma.j.issn.0412-4081.2014.11.014.
22. 中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病学组. 我国糖尿病视网膜病变临床诊疗指南(2022年)−基于循证医学修订[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Pathology Group, Ophthalmology Branch, Chinese Medical Association, Ophthalmology Branch, Chinese Medical Doctor Association. Evidence-based guidelines for diagnosis and treatment of diabetic retinopathy in China (2022)[J]. Chin J Ocul Fundus Dis, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.
23. Williams GA, Scott IU, Haller JA, et al. Single-field fundus photography for diabetic retinopathy screening: a report by the American Academy of Ophthalmology[J]. Ophthalmology, 2004, 111(5): 1055-1062. DOI: 10.1016/j.ophtha.2004.02.004.
24. 中华医学会眼科学分会眼底病学组, 中国医师协会眼科医师分会眼底病专业委员会. 我国糖尿病视网膜病变图像采集及阅片指南(2017年)[J]. 中华眼科杂志, 2017, 53(12): 890-896. DOI: 10.3760/cma.j.issn.0412-4081.2017.12.003.Fundus Disease Group, Ophthalmology Branch of Chinese Medical Association, and fundus disease Professional Committee of Ophthalmology branch of Chinese Medical Doctor Association. Guidelines for image acquisition and reading of diabetic retinopathy in China (2017)[J]. Chin J Ophthalmol, 2017, 53(12): 890-896. DOI: 10.3760/cma.j.issn.0412-4081.2017.12.003.

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