Interpretation of <i>National consensus on the management of major chronic fundus diseases in China: a modified Delphi approach</i>_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Kun , Chen Chong ,  Xu Xun

Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, National Clinical Research Center for Eye Diseases, Shanghai 200080, China;

Corresponding author：

Xu Xun, Email: drxuxun@sjtu.edu.cn

Keywords：

Chronic Fundus disease management; Pathways for clinical diagnosis and treatment; Interpretation of expert consensus

DOI：

10.3760/cma.j.cn511434-20240328-00126

Video：

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Abstract Full text Figures/Tables Video References Cited by

Based on the current situation of patients with retinal diseases in China and the clear requirements of the "14th Five-Year Plan for Eye Health (2021-2025)" to strengthen the construction of the prevention and control system for retinal diseases, experts in the field of retinal diseases in China have conducted in-depth and comprehensive thematic discussions, and used the modified Delphi method for collective decision-making and opinion solicitation, ultimately forming consensus and consistent guidance suggestions for the management of chronic diseases of retinal diseases that are in line with China's national conditions. This consensus includes key content such as definitions, treatment plans, and follow-up frequency for the management of chronic diseases of the fundus. It clearly proposes relevant measures to improve the management process of chronic diseases of the fundus, and elaborates on the advantages and feasibility of establishing an online remote platform for the management of chronic diseases of the fundus, in order to assist doctors in formulating personalized treatment plans and ensure that patients receive standardized treatment and follow-up. This consensus will provide guidance and reference for the management of chronic diseases and long-term standardized diagnosis and treatment of major fundus diseases in China.

Citation： Liu Kun, Chen Chong, Xu Xun. Interpretation of National consensus on the management of major chronic fundus diseases in China: a modified Delphi approach. Chinese Journal of Ocular Fundus Diseases, 2024, 40(5): 342-346. doi: 10.3760/cma.j.cn511434-20240328-00126 Copy

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4.	Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis[J/OL]. Lancet Glob Health, 2014, 2(2): e106-e116[2014-01-03]. https://pubmed.ncbi.nlm.nih.gov/25104651/. DOI: 10.1016/S2214-109X(13)70145-1.
5.	Ye H, Zhang Q, Liu X, et al. Prevalence of age-related macular degeneration in an elderly urban chinese population in China: the Jiangning Eye Study[J]. Invest Ophthalmol Vis Sci, 2014, 55(10): 6374-6380. DOI: 10.1167/iovs.14-14899.
6.	Teo ZL, Tham YC, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis[J]. Ophthalmology, 2021, 128(11): 1580-1591. DOI: 10.1016/j.ophtha.2021.04.027.
7.	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.
8.	Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042. DOI: 10.1016/j.ophtha.2016.01.006.
9.	Baird PN, Saw SM, Lanca C, et al. Myopia[J]. Nat Rev Dis Primers, 2020, 6(1): 99. DOI: 10.1038/s41572-020-00231-4.
10.	Scott IU, Campochiaro PA, Newman NJ, et al. Retinal vascular occlusions[J]. Lancet, 2020, 396(10266): 1927-1940. DOI: 10.1016/S0140-6736(20)31559-2.
11.	Lau JT, Lee V, Fan D, et al. Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population[J]. Br J Ophthalmol, 2002, 86(10): 1080-1084. DOI: 10.1136/bjo.86.10.1080.
12.	Zhang CX, Zhang GM, Ma N, et al Awareness of age-related macular degeneration and its risk factors among Beijing residents in China[J]. Chin Med J (Engl), 2017, 130(2): 155-159. DOI: 10.4103/0366-6999.197994.
13.	周芬, 谢红莉, 瞿佳. 眼科资源现状及服务能力调查[J]. 中国医院, 2008, 12(4): 14-16. DOI: 10.3969/j.issn.1671-0592.2008.04.006.Zhou F, Xie HL, Qu J. Investigation on ophthalmology resource and service skill[J]. Chinese Hospitals, 2008, 12(4): 14-16. DOI: 10.3969/j.issn.1671-0592.2008.04.006.
14.	Polack S, Yorston D, López-Ramos A, et al. Rapid assessment of avoidable blindness and diabetic retinopathy in Chiapas, Mexico[J]. Ophthalmology, 2012, 119(5): 1033-1040. DOI: 10.1016/j.ophtha.2011.11.002.
15.	邹海东, 张晳, 许迅, 等. 上海市静安区曹家渡街道年龄相关性黄斑变性的患病率调查[J]. 中华眼科杂志, 2005, 41(1): 15-19. DOI: 10.3760/j:issn:0412-4081.2005.01.005.Zou HD, Zhang X, Xu X, et al. Prevalence study of age-related macular degeneration in Caojiadu blocks, Shanghai[J]. Chin J Ophthalmol, 2005, 41(1): 15-19. DOI: 10.3760/j:issn:0412-4081.2005.01.005.
16.	Gonder JR, Walker VM, Barbeau M, et al. Costs and quality of life in diabetic macular edema: Canadian burden of diabetic macular edema observational study (C-REALITY)[J/OL]. J Ophthalmol, 2014, 2014: 939315[2014-03-26]. https://pubmed.ncbi.nlm.nih.gov/24795818/. DOI: 10.1155/2014/939315.
17.	单侯乾, 潘蓓, 左丽倩, 等. 兰州市糖尿病视网膜病变患者住院费用分析[J]. 中国初级卫生保健, 2019, 33(7): 51-54. DOI: 10.3969/j.issn.1001-568X.2019.07.0017.Shan HQ, Pan B, Zuo LQ, et al. Analysis on the hospitalization expenses of patients with diabetic retinopathy in Lanzhou[J]. Chinese Primary Health Care, 2019, 33(7): 51-54. DOI: 10.3969/j.issn.1001-568X.2019.07.0017.
18.	Rees G, Xie J, Fenwick EK, et al. Association between diabetes-related eye complications and symptoms of anxiety and depression[J]. JAMA Ophthalmol, 2016, 134(9): 1007-1014. DOI: 10.1001/jamaophthalmol.2016.2213.
19.	陈有信. 对年龄相关性黄斑变性的公众认知度亟待提高[J]. 中华眼科杂志, 2009, 45(5): 389-392. DOI: 10.3760/cma.j.issn.0412-4081.2009.05.002.Chen YX. Urgent action needed to raise public awareness of age-related macular degeneration in China[J]. Chin J Ophthalmol, 2009, 45(5): 389-392. DOI: 10.3760/cma.j.issn.0412-4081.2009.05.002.
20.	Meads C, Hyde C. What is the cost of blindness?[J]. Br J Ophthalmol, 2003, 87(10): 1201-1204. DOI: 10.1136/bjo.87.10.1201.
21.	Holz FG, Minnella AM, Tuli R, et al. Ranibizumab treatment patterns in prior ranibizumab-treated neovascular age-related macular degeneration patients: real-world outcomes from the LUMINOUS study[J/OL]. PLoS One, 2020, 15(12): e0244183[2020-12-30]. https://pubmed.ncbi.nlm.nih.gov/33378369/. DOI: 10.1371/journal.pone.0244183.
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. 我国主要眼底病慢病管理专家共识——基于改良版德尔菲法制订[J]. 中华眼底病杂志, 2024, 40(4): 253-263. DOI: 10.3760/cma.j.cn511434-20240220-00076.Fundus Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. National consensus on the management of major chronic fundus diseases in China: a modified Delphi approach[J]. Chin J Ocul Fundus Dis, 2024, 40(4): 253-263. DOI: 10.3760/cma.j.cn511434-20240220-00076.
23.	García Layana A, Adán A, Ascaso FJ, et al. Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: expert recommendations using a Delphi approach[J]. Eur J Ophthalmol, 2020, 30(5): 1042-1052. DOI: 10.1177/1120672119861623.
24.	Kodjikian L, Baillif S, Couturier A, et al. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: a national Delphi consensus study[J]. Eur J Ophthalmol, 2022, 32(5): 2845-2856. DOI: 10.1177/112067 21211052852.
25.	Özen S, Sag E, Ben-Chetrit E, et al. Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach[J]. Rheumatology (Oxford), 2021, 60(8): 3799-3808. DOI: 10.1093/rheumatology/keaa863.
26.	陶洋旭, 李建军. 医疗共识制订方法: 德尔菲法和名义小组法[J]. 国际眼科纵览, 2021, 45(5): 369-373. DOI: 10.3760/cma.j.issn.1673-5803.2021.05.001.Tao YX, Li JJ. Delphi method and nominal group method for medical consensus formation[J]. Int Rev Ophthalmol, 2021, 45(5): 369-373. DOI: 10.3760/cma.j.issn.1673-5803.2021.05.001.
27.	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. 中国年龄相关性黄斑变性临床诊疗指南(2023年)[J]. 中华眼科杂志, 2023, 59(5): 347-366. DOI: 10.3760/cma.j.cn112142-20221222-00649.Chinese Vitreo-Retina Society of Chinese Medical Association, Fundus Disease Group of Chinese Ophthalmologist Association. Evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China (2023)[J]. Chin J Ophthalmol, 2023, 59(5): 347-366. DOI: 10.3760/cma.j.cn112142-20221222-00649.
28.	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)[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of 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.
29.	苗恒, 黎晓新, 赵明威. 《中国视网膜静脉阻塞临床诊疗路径专家共识》解读[J]. 中华眼底病杂志, 2024, 40(3): 186-189. DOI: 10.3760/cma.j.cn511434-20240218-00071.Miao H, Li XX, Zhao MW. Interpretation of Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China[J]. Chin J Ocul Fundus Dis, 2024, 40(3): 186-189. DOI: 10.3760/cma.j.cn511434-20240218-00071.

1. 国家卫生健康委. “十四五”全国眼健康规划(2021-2025年)[EB/OL]. [2022-01-04]. http://www.nhc.gov.cn/yzygj/s7653/202201/d607d24b6b1c4bd9b827eedf41eff820.shtml.National Health Commission. 14th Five-Year Plan for Eye Health(2021-2025)[EB/OL]. [2022-01-04]. http://www.nhc.gov.cn/yzygj/s7653/202201/d607d24b6b1c4bd9b827eedf41eff820.shtml.
2. 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: 4126[2023-11-03]. https://pubmed.ncbi.nlm.nih.gov/37921040/. DOI: 10.7189/jogh.13.04126.
3. Song P, Du Y, Chan KY, et al. The national and subnational prevalence and burden of age-related macular degeneration in China[J/OL]. J Glob Health, 2017, 7(2): 20703[2017-12-02]. https://pubmed.ncbi.nlm.nih.gov/29302323/. DOI: 10.7189/jogh.07.020703.
4. Wong WL, Su X, Li X, et al. Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis[J/OL]. Lancet Glob Health, 2014, 2(2): e106-e116[2014-01-03]. https://pubmed.ncbi.nlm.nih.gov/25104651/. DOI: 10.1016/S2214-109X(13)70145-1.
5. Ye H, Zhang Q, Liu X, et al. Prevalence of age-related macular degeneration in an elderly urban chinese population in China: the Jiangning Eye Study[J]. Invest Ophthalmol Vis Sci, 2014, 55(10): 6374-6380. DOI: 10.1167/iovs.14-14899.
6. Teo ZL, Tham YC, Yu M, et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: systematic review and meta-analysis[J]. Ophthalmology, 2021, 128(11): 1580-1591. DOI: 10.1016/j.ophtha.2021.04.027.
7. 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.
8. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042. DOI: 10.1016/j.ophtha.2016.01.006.
9. Baird PN, Saw SM, Lanca C, et al. Myopia[J]. Nat Rev Dis Primers, 2020, 6(1): 99. DOI: 10.1038/s41572-020-00231-4.
10. Scott IU, Campochiaro PA, Newman NJ, et al. Retinal vascular occlusions[J]. Lancet, 2020, 396(10266): 1927-1940. DOI: 10.1016/S0140-6736(20)31559-2.
11. Lau JT, Lee V, Fan D, et al. Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population[J]. Br J Ophthalmol, 2002, 86(10): 1080-1084. DOI: 10.1136/bjo.86.10.1080.
12. Zhang CX, Zhang GM, Ma N, et al Awareness of age-related macular degeneration and its risk factors among Beijing residents in China[J]. Chin Med J (Engl), 2017, 130(2): 155-159. DOI: 10.4103/0366-6999.197994.
13. 周芬, 谢红莉, 瞿佳. 眼科资源现状及服务能力调查[J]. 中国医院, 2008, 12(4): 14-16. DOI: 10.3969/j.issn.1671-0592.2008.04.006.Zhou F, Xie HL, Qu J. Investigation on ophthalmology resource and service skill[J]. Chinese Hospitals, 2008, 12(4): 14-16. DOI: 10.3969/j.issn.1671-0592.2008.04.006.
14. Polack S, Yorston D, López-Ramos A, et al. Rapid assessment of avoidable blindness and diabetic retinopathy in Chiapas, Mexico[J]. Ophthalmology, 2012, 119(5): 1033-1040. DOI: 10.1016/j.ophtha.2011.11.002.
15. 邹海东, 张晳, 许迅, 等. 上海市静安区曹家渡街道年龄相关性黄斑变性的患病率调查[J]. 中华眼科杂志, 2005, 41(1): 15-19. DOI: 10.3760/j:issn:0412-4081.2005.01.005.Zou HD, Zhang X, Xu X, et al. Prevalence study of age-related macular degeneration in Caojiadu blocks, Shanghai[J]. Chin J Ophthalmol, 2005, 41(1): 15-19. DOI: 10.3760/j:issn:0412-4081.2005.01.005.
16. Gonder JR, Walker VM, Barbeau M, et al. Costs and quality of life in diabetic macular edema: Canadian burden of diabetic macular edema observational study (C-REALITY)[J/OL]. J Ophthalmol, 2014, 2014: 939315[2014-03-26]. https://pubmed.ncbi.nlm.nih.gov/24795818/. DOI: 10.1155/2014/939315.
17. 单侯乾, 潘蓓, 左丽倩, 等. 兰州市糖尿病视网膜病变患者住院费用分析[J]. 中国初级卫生保健, 2019, 33(7): 51-54. DOI: 10.3969/j.issn.1001-568X.2019.07.0017.Shan HQ, Pan B, Zuo LQ, et al. Analysis on the hospitalization expenses of patients with diabetic retinopathy in Lanzhou[J]. Chinese Primary Health Care, 2019, 33(7): 51-54. DOI: 10.3969/j.issn.1001-568X.2019.07.0017.
18. Rees G, Xie J, Fenwick EK, et al. Association between diabetes-related eye complications and symptoms of anxiety and depression[J]. JAMA Ophthalmol, 2016, 134(9): 1007-1014. DOI: 10.1001/jamaophthalmol.2016.2213.
19. 陈有信. 对年龄相关性黄斑变性的公众认知度亟待提高[J]. 中华眼科杂志, 2009, 45(5): 389-392. DOI: 10.3760/cma.j.issn.0412-4081.2009.05.002.Chen YX. Urgent action needed to raise public awareness of age-related macular degeneration in China[J]. Chin J Ophthalmol, 2009, 45(5): 389-392. DOI: 10.3760/cma.j.issn.0412-4081.2009.05.002.
20. Meads C, Hyde C. What is the cost of blindness?[J]. Br J Ophthalmol, 2003, 87(10): 1201-1204. DOI: 10.1136/bjo.87.10.1201.
21. Holz FG, Minnella AM, Tuli R, et al. Ranibizumab treatment patterns in prior ranibizumab-treated neovascular age-related macular degeneration patients: real-world outcomes from the LUMINOUS study[J/OL]. PLoS One, 2020, 15(12): e0244183[2020-12-30]. https://pubmed.ncbi.nlm.nih.gov/33378369/. DOI: 10.1371/journal.pone.0244183.
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. 我国主要眼底病慢病管理专家共识——基于改良版德尔菲法制订[J]. 中华眼底病杂志, 2024, 40(4): 253-263. DOI: 10.3760/cma.j.cn511434-20240220-00076.Fundus Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association. National consensus on the management of major chronic fundus diseases in China: a modified Delphi approach[J]. Chin J Ocul Fundus Dis, 2024, 40(4): 253-263. DOI: 10.3760/cma.j.cn511434-20240220-00076.
23. García Layana A, Adán A, Ascaso FJ, et al. Use of intravitreal dexamethasone implants in the treatment of diabetic macular edema: expert recommendations using a Delphi approach[J]. Eur J Ophthalmol, 2020, 30(5): 1042-1052. DOI: 10.1177/1120672119861623.
24. Kodjikian L, Baillif S, Couturier A, et al. Recommendations for the management of diabetic macular oedema with intravitreal dexamethasone implant: a national Delphi consensus study[J]. Eur J Ophthalmol, 2022, 32(5): 2845-2856. DOI: 10.1177/112067 21211052852.
25. Özen S, Sag E, Ben-Chetrit E, et al. Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach[J]. Rheumatology (Oxford), 2021, 60(8): 3799-3808. DOI: 10.1093/rheumatology/keaa863.
26. 陶洋旭, 李建军. 医疗共识制订方法: 德尔菲法和名义小组法[J]. 国际眼科纵览, 2021, 45(5): 369-373. DOI: 10.3760/cma.j.issn.1673-5803.2021.05.001.Tao YX, Li JJ. Delphi method and nominal group method for medical consensus formation[J]. Int Rev Ophthalmol, 2021, 45(5): 369-373. DOI: 10.3760/cma.j.issn.1673-5803.2021.05.001.
27. 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. 中国年龄相关性黄斑变性临床诊疗指南(2023年)[J]. 中华眼科杂志, 2023, 59(5): 347-366. DOI: 10.3760/cma.j.cn112142-20221222-00649.Chinese Vitreo-Retina Society of Chinese Medical Association, Fundus Disease Group of Chinese Ophthalmologist Association. Evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China (2023)[J]. Chin J Ophthalmol, 2023, 59(5): 347-366. DOI: 10.3760/cma.j.cn112142-20221222-00649.
28. 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)[J]. 中华眼底病杂志, 2023, 39(2): 99-124. DOI: 10.3760/cma.j.cn511434-20230110-00018.Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of 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.
29. 苗恒, 黎晓新, 赵明威. 《中国视网膜静脉阻塞临床诊疗路径专家共识》解读[J]. 中华眼底病杂志, 2024, 40(3): 186-189. DOI: 10.3760/cma.j.cn511434-20240218-00071.Miao H, Li XX, Zhao MW. Interpretation of Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China[J]. Chin J Ocul Fundus Dis, 2024, 40(3): 186-189. DOI: 10.3760/cma.j.cn511434-20240218-00071.

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Interpretation of National consensus on the management of major chronic fundus diseases in China: a modified Delphi approach

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