Interpretation of <i>Expert consensus on community screening of diabetic retinopathy</i>_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Juping ¹ , Xu Xun ² ,  Li Xiaorong ¹

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. Department of Ophthalmology, Shanghai JiaoTong University, National Clinical Research Center for Eye Diseases, Shanghai 200080, China;

Corresponding author：

Li Xiaorong, Email: xiaorli@163.com

Keywords：

Diabetic retinopathy; Community screening; Sustainability; Interpretation of expert consensus

DOI：

10.3760/cma.j.cn511434-20240119-00039

Video：

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Diabetes retinopathy (DR) is listed as one of the chronic diseases that should be focused on in the “14th Five-Year” National Eye Health Plan (2021-2025). Early screening is one of the effective measures to reduce blindness caused by DR. Establishing an efficient and practical community screening model is a powerful guarantee for completing early screening. The Ocular Fundus Diseases Group of the Ophthalmology Branch of the Chinese Medical Association has led the development of Expert consensus on community screening of diabetic retinopathy among DR community screening experts that is suitable for the current national situation, in order to guide and promote the further improvement of DR community screening work in China. This Expert Consensus provides detailed specifications on the current domestic trend of DR, the necessity of screening, the role of artificial intelligence grading, screening process, and quality control. This interpretation further emphasizes the importance of DR community screening, while emphasizing the responsibilities of different departments in the screening process. Finally, recommendations are provided for the sustainability of DR community screening. It is hoped that the screening rate of DR in China can be improved and blindness can be reduced by DR through Expert consensus on community screening of diabetic retinopathy and interpretation of the content.

Citation： Liu Juping, Xu Xun, Li Xiaorong. Interpretation of Expert consensus on community screening of diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2024, 40(2): 105-108. doi: 10.3760/cma.j.cn511434-20240119-00039 Copy

1.	Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, et al. Diabetic macular edema pathophysiology: vasogenic versus inflammatory[J/OL]. J Diabetes Res, 2016, 2016: 2156273[2016-09-28]. https://pubmed.ncbi.nlm.nih.gov/27761468/. DOI: 10.1155/2016/2156273.
2.	Wang W, Lo ACY. Diabetic retinopathy: pathophysiology and treatments[J]. Int J Mol Sci, 2018, 19(6): 1816. DOI: 10.3390/ijms19061816.
3.	Wilson J, Jungner G. The principles and practice of screening for disease. Public Health Papers 34[R]. Geneva: WHO, 1968.
4.	Balooch Hasankhani M, Mirzaei H, Karamoozian A. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019[J/OL]. Sci Rep, 2023, 13(1): 21908[2023-12-11]. https://pubmed.ncbi.nlm.nih.gov/38081899/. DOI: 10.1038/s41598-023-49249-0.
5.	IDF Diabetes Atlas[DB/OL]. International Diabetes Federation, 2023[2024-01-19]. https://diabetesatlas.org/atlas-reports.
6.	Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: 997. DOI: 10.1136/bmj.m997.
7.	Hou X, Wang L, Zhu D, et al. Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China[J]. Nat Commun, 2023, 14(1): 4296. DOI: 10.1038/s41467-023-39864-w.
8.	Tan H, Wang X, Ye K, et al. Prevalence and risk factors of diabetic retinopathy among Chinese adults with type 2 diabetes in a suburb of Shanghai, China[J/OL]. PLoS One, 2022, 17(10): e0275617[2022-10-04]. https://pubmed.ncbi.nlm.nih.gov/36194621/. DOI: 10.1371/journal.pone.0275617.
9.	Xu X, Yang W, Deng Y, et al. Association of socioeconomic status with glycated haemoglobin level and risk factors for diabetic retinopathy: a cross-sectional study in Sichuan, western China [J/OL]. BMJ Open, 2023, 13(2): e067475[2023-02-16]. https://europepmc.org/article/MED/36797020. DOI: 10.1136/bmjopen-2022-067475.
10.	Zhou C, Li S, Ye L, et al. Visual impairment and blindness caused by retinal diseases: a nationwide register-based study[J/OL]. J Glob Health, 2023, 13: 04126[2023-11-03]. https://pubmed.ncbi.nlm.nih.gov/37921040/. DOI: 10.7189/jogh.13.04126.
11.	Ogurtsova K, Guariguata L, Barengo NC, et al. IDF diabetes Atlas: global estimates of undiagnosed diabetes in adults for 2021[J/OL]. Diabetes Res Clin Pract, 2022, 183: 109118[2021-12-06]. https://pubmed.ncbi.nlm.nih.gov/34883189/. DOI: 10.1016/j.diabres.2021.109118.
12.	He J, Cao T, Xu F, et al. Artificial intelligence-based screening for diabetic retinopathy at community hospital[J]. Eye (Lond), 2020, 34(3): 572-576. DOI: 10.1038/s41433-019-0562-4.
13.	Zang B, Rong S, Li D, et al. Undiagnosed diabetic retinopathy in Northeast China: prevalence and determinants[J/OL]. Front Endocrinol (Lausanne), 2023, 14: 1263508[2023-11-29]. https://pubmed.ncbi.nlm.nih.gov/38093961/. DOI: 10.3389/fendo.2023.1263508.
14.	Sheppler CR, Lambert WE, Gardiner SK, et al. Predicting adherence to diabetic eye examinations: development of the compliance with annual diabetic eye exams survey[J]. Ophthalmology, 2014, 121(6): 1212-1219. DOI: 10.1016/j.ophtha.2013.12.016.
15.	Keenum Z, McGwin G Jr, Witherspoon CD, et al. Patients' adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use[J]. JAMA Ophthalmol, 2016, 134(11): 1221-1228. DOI: 10.1001/jamaophthalmol.2016.3081.
16.	Matthews DR, Stratton IM, Aldington SJ, et al. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69[J]. Arch Ophthalmol, 2004, 122(11): 1631-1640. DOI: 10.1001/archopht.122.11.1631.
17.	van Leiden HA, Dekker JM, Moll AC, et al. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study[J]. Arch Ophthalmol, 2003, 121(2): 245-251. DOI: 10.1001/archopht.121.2.245.
18.	Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9[J]. Ophthalmology, 1991, 98(5 Suppl): S766-785.
19.	Fu P, Huang Y, Wan X, et al. Efficacy and safety of pan retinal photocoagulation combined with intravitreal anti-VEGF agents for high-risk proliferative diabetic retinopathy: a systematic review and meta-analysis[J/OL]. Medicine (Baltimore), 2023, 102(39): e34856[2023-09-29]. https://pubmed.ncbi.nlm.nih.gov/37773800/. DOI: 10.1097/MD.0000000000034856.
20.	Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 376(9735): 124-136. DOI: 10.1016/S0140-6736(09)62124-3.
21.	Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review[J]. JAMA, 2007, 298(8): 902-916. DOI: 10.1001/jama.298.8.902.
22.	Li H, Zhang L, Wang X, et al. Direct medical cost and medications for patient of diabetes retinopathy in Beijing, China, 2016-2018[J/OL]. Diabetes Res Clin Pract, 2023, 202: 110796[2023-06-22]. https://pubmed.ncbi.nlm.nih.gov/37355099/. DOI: 10.1016/j.diabres.2023.110796.
23.	Alzaid A, Ladron de Guevara P, Beillat M, et al. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses[J]. Expert Rev Pharmacoecon Outcomes Res, 2021, 21(4): 785-798. DOI: 10.1080/14737167.2020.1782748.
24.	Ahsan S, Basit A, Ahmed KR, et al. Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard[J]. Diabetes Metab Syndr, 2014, 8(2): 96-101. DOI: 10.1016/j.dsx.2014.04.015.
25.	Lairson DR, Pugh JA, Kapadia AS, et al. Cost-effectiveness of alternative methods for diabetic retinopathy screening[J]. Diabetes Care, 1992, 15(10): 1369-1377. DOI: 10.2337/diacare.15.10.1369.
26.	Chawla H, Uhr JH, Williams JS, et al. Economic evaluation of artificial intelligence systems versus manual screening for diabetic retinopathy in the United States[J]. Ophthalmic Surg Lasers Imaging Retina, 2023, 54(5): 272-280. DOI: 10.3928/23258160-20230406-01.
27.	Li H, Li G, Li N, et al. Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model[J/OL]. PLoS One, 2023, 18(11): e0291390[2023-11-16]. https://pubmed.ncbi.nlm.nih.gov/37971984/. DOI: 10.1371/journal.pone.0291390.
28.	Hao S, Liu C, Li N, et al. Clinical evaluation of AI-assisted screening for diabetic retinopathy in rural areas of midwest China[J/OL]. PLoS One, 2022, 17(10): e0275983[2022-10-13]. https://pubmed.ncbi.nlm.nih.gov/36227905/. DOI: 10.1371/journal.pone.0275983.
29.	Tan CH, Kyaw BM, Smith H, et al. Use of smartphones to detect diabetic retinopathy: scoping review and meta-analysis of diagnostic test accuracy studies[J/OL]. J Med Internet Res, 2020, 22(5): e16658[2020-05-15]. https://pubmed.ncbi.nlm.nih.gov/32347810/. DOI: 10.2196/16658.

1. Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, et al. Diabetic macular edema pathophysiology: vasogenic versus inflammatory[J/OL]. J Diabetes Res, 2016, 2016: 2156273[2016-09-28]. https://pubmed.ncbi.nlm.nih.gov/27761468/. DOI: 10.1155/2016/2156273.
2. Wang W, Lo ACY. Diabetic retinopathy: pathophysiology and treatments[J]. Int J Mol Sci, 2018, 19(6): 1816. DOI: 10.3390/ijms19061816.
3. Wilson J, Jungner G. The principles and practice of screening for disease. Public Health Papers 34[R]. Geneva: WHO, 1968.
4. Balooch Hasankhani M, Mirzaei H, Karamoozian A. Global trend analysis of diabetes mellitus incidence, mortality, and mortality-to-incidence ratio from 1990 to 2019[J/OL]. Sci Rep, 2023, 13(1): 21908[2023-12-11]. https://pubmed.ncbi.nlm.nih.gov/38081899/. DOI: 10.1038/s41598-023-49249-0.
5. IDF Diabetes Atlas[DB/OL]. International Diabetes Federation, 2023[2024-01-19]. https://diabetesatlas.org/atlas-reports.
6. Li Y, Teng D, Shi X, et al. Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study[J]. BMJ, 2020, 369: 997. DOI: 10.1136/bmj.m997.
7. Hou X, Wang L, Zhu D, et al. Prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy in adults with diabetes in China[J]. Nat Commun, 2023, 14(1): 4296. DOI: 10.1038/s41467-023-39864-w.
8. Tan H, Wang X, Ye K, et al. Prevalence and risk factors of diabetic retinopathy among Chinese adults with type 2 diabetes in a suburb of Shanghai, China[J/OL]. PLoS One, 2022, 17(10): e0275617[2022-10-04]. https://pubmed.ncbi.nlm.nih.gov/36194621/. DOI: 10.1371/journal.pone.0275617.
9. Xu X, Yang W, Deng Y, et al. Association of socioeconomic status with glycated haemoglobin level and risk factors for diabetic retinopathy: a cross-sectional study in Sichuan, western China [J/OL]. BMJ Open, 2023, 13(2): e067475[2023-02-16]. https://europepmc.org/article/MED/36797020. DOI: 10.1136/bmjopen-2022-067475.
10. Zhou C, Li S, Ye L, et al. Visual impairment and blindness caused by retinal diseases: a nationwide register-based study[J/OL]. J Glob Health, 2023, 13: 04126[2023-11-03]. https://pubmed.ncbi.nlm.nih.gov/37921040/. DOI: 10.7189/jogh.13.04126.
11. Ogurtsova K, Guariguata L, Barengo NC, et al. IDF diabetes Atlas: global estimates of undiagnosed diabetes in adults for 2021[J/OL]. Diabetes Res Clin Pract, 2022, 183: 109118[2021-12-06]. https://pubmed.ncbi.nlm.nih.gov/34883189/. DOI: 10.1016/j.diabres.2021.109118.
12. He J, Cao T, Xu F, et al. Artificial intelligence-based screening for diabetic retinopathy at community hospital[J]. Eye (Lond), 2020, 34(3): 572-576. DOI: 10.1038/s41433-019-0562-4.
13. Zang B, Rong S, Li D, et al. Undiagnosed diabetic retinopathy in Northeast China: prevalence and determinants[J/OL]. Front Endocrinol (Lausanne), 2023, 14: 1263508[2023-11-29]. https://pubmed.ncbi.nlm.nih.gov/38093961/. DOI: 10.3389/fendo.2023.1263508.
14. Sheppler CR, Lambert WE, Gardiner SK, et al. Predicting adherence to diabetic eye examinations: development of the compliance with annual diabetic eye exams survey[J]. Ophthalmology, 2014, 121(6): 1212-1219. DOI: 10.1016/j.ophtha.2013.12.016.
15. Keenum Z, McGwin G Jr, Witherspoon CD, et al. Patients' adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use[J]. JAMA Ophthalmol, 2016, 134(11): 1221-1228. DOI: 10.1001/jamaophthalmol.2016.3081.
16. Matthews DR, Stratton IM, Aldington SJ, et al. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69[J]. Arch Ophthalmol, 2004, 122(11): 1631-1640. DOI: 10.1001/archopht.122.11.1631.
17. van Leiden HA, Dekker JM, Moll AC, et al. Risk factors for incident retinopathy in a diabetic and nondiabetic population: the Hoorn study[J]. Arch Ophthalmol, 2003, 121(2): 245-251. DOI: 10.1001/archopht.121.2.245.
18. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9[J]. Ophthalmology, 1991, 98(5 Suppl): S766-785.
19. Fu P, Huang Y, Wan X, et al. Efficacy and safety of pan retinal photocoagulation combined with intravitreal anti-VEGF agents for high-risk proliferative diabetic retinopathy: a systematic review and meta-analysis[J/OL]. Medicine (Baltimore), 2023, 102(39): e34856[2023-09-29]. https://pubmed.ncbi.nlm.nih.gov/37773800/. DOI: 10.1097/MD.0000000000034856.
20. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy[J]. Lancet, 2010, 376(9735): 124-136. DOI: 10.1016/S0140-6736(09)62124-3.
21. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review[J]. JAMA, 2007, 298(8): 902-916. DOI: 10.1001/jama.298.8.902.
22. Li H, Zhang L, Wang X, et al. Direct medical cost and medications for patient of diabetes retinopathy in Beijing, China, 2016-2018[J/OL]. Diabetes Res Clin Pract, 2023, 202: 110796[2023-06-22]. https://pubmed.ncbi.nlm.nih.gov/37355099/. DOI: 10.1016/j.diabres.2023.110796.
23. Alzaid A, Ladron de Guevara P, Beillat M, et al. Burden of disease and costs associated with type 2 diabetes in emerging and established markets: systematic review analyses[J]. Expert Rev Pharmacoecon Outcomes Res, 2021, 21(4): 785-798. DOI: 10.1080/14737167.2020.1782748.
24. Ahsan S, Basit A, Ahmed KR, et al. Diagnostic accuracy of direct ophthalmoscopy for detection of diabetic retinopathy using fundus photographs as a reference standard[J]. Diabetes Metab Syndr, 2014, 8(2): 96-101. DOI: 10.1016/j.dsx.2014.04.015.
25. Lairson DR, Pugh JA, Kapadia AS, et al. Cost-effectiveness of alternative methods for diabetic retinopathy screening[J]. Diabetes Care, 1992, 15(10): 1369-1377. DOI: 10.2337/diacare.15.10.1369.
26. Chawla H, Uhr JH, Williams JS, et al. Economic evaluation of artificial intelligence systems versus manual screening for diabetic retinopathy in the United States[J]. Ophthalmic Surg Lasers Imaging Retina, 2023, 54(5): 272-280. DOI: 10.3928/23258160-20230406-01.
27. Li H, Li G, Li N, et al. Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model[J/OL]. PLoS One, 2023, 18(11): e0291390[2023-11-16]. https://pubmed.ncbi.nlm.nih.gov/37971984/. DOI: 10.1371/journal.pone.0291390.
28. Hao S, Liu C, Li N, et al. Clinical evaluation of AI-assisted screening for diabetic retinopathy in rural areas of midwest China[J/OL]. PLoS One, 2022, 17(10): e0275983[2022-10-13]. https://pubmed.ncbi.nlm.nih.gov/36227905/. DOI: 10.1371/journal.pone.0275983.
29. Tan CH, Kyaw BM, Smith H, et al. Use of smartphones to detect diabetic retinopathy: scoping review and meta-analysis of diagnostic test accuracy studies[J/OL]. J Med Internet Res, 2020, 22(5): e16658[2020-05-15]. https://pubmed.ncbi.nlm.nih.gov/32347810/. DOI: 10.2196/16658.

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Interpretation of Expert consensus on community screening of diabetic retinopathy

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