With the deepening understanding of the pathogenesis of retinopathy of prematurity (ROP) and the continuous development of new drugs, intravitreal injection of anti-vascular endothelial growth factor (VEGF) drugs has gradually become an important treatment of ROP. Therefore, it is of great significance to standardize the operation of ROP intravitreal injection in order to make sure that infants receive safe and effective treatment. Based on the actual situation of the diagnosis and treatment of ROP in China, and after careful, comprehensive and full discussion on the indications and contraindications, injection requirements, operation precautions and post-treatment precautions of intravitreal injection of anti-VEGF drugs in the treatment of ROP, Pediatric Retinology Group of Ophthalmology Professional Committee of Cross-Strait Medical and Health Exchange Association form an expert consensus, and it is reviewed and modified by Fundus Disease Group of Chinese Medical Association Ophthalmology Branch for ophthalmologists' reference in clinical work.
Inherited retinal diseases (IRDs) are a group of severe retinal degenerative diseases leading to permanent visual impairment. IRDs are the major cause of irreversible blindness in children and working age groups. Gene therapy is a new clinical treatment method and currently the only clear and effective treatment for IRDs, while, there are still risks in clinical research and application. How to standardize perioperative management and reduce the potential risks of treatment is one of the keys to ensure the safety and effectiveness of treatment. However, there is no systematic and standardized guidance on the perioperative management for IRDs gene therapy. Therefore, in order to standardize the perioperative management, the Fundus Disease Group of Ophthalmology Society of Chinese Medical Association and Chinese Medical Doctor Association organized domestic experts to put forward standardized opinions on the perioperative management of IRDs gene therapy in China after repeated discussion and combined with domestic and foreign research experience, so as to provide clinicians with reference and application in clinical research and practice.
Rapid development of recently emerging precision medicine techniques represented by gene therapy has brought hope for the treatment of rare blinding eye diseases such as inherited retinal diseases (IRDs) for which there was no effective treatment previously. Although the globally growth of clinical trials for IRDs has increased rapidly over the past decade, due to the highly genetic and clinical phenotypic heterogeneity, as well as limited data on epidemiology and natural history of the disease, along with severe loss of vision function of majority patients for which the established measurements may not be appropriate, such studies lack standard outcome measurements and endpoints to asses clinical meaningful effectiveness, posing great challenges in terms of study design and evaluation of treatment efficacy, as well as clinical practice application. At present, there is no systematic nor standardized guidance on safety measures, clinical outcomes and endpoints of visual function for clinical trial design in IRDs. Therefore, in order to standardize the validated evaluation of IRDs clinical efficacy outcome measurements and endpoints, the Fundus Disease Group of Chinese Medical Association Ophthalmology Branch and Fundus Disease Committee of Chinese Medical Doctor Association Ophthalmology Branch organized domestic experts to put forward consensus and recommendations on standardizing outcome measurements and endpoints for clinical study design in IRDs, aiming to advance the study design of IRDs natural history research and clinical trials and to effectively evaluate disease progression and intervention efficacy. Along with the development of medical science and clinical trials, relevant content will be improved and updated accordingly.
With the popularity and development of artificial intelligence (AI), disease screening systems based on AI algorithms are gradually emerging in the medical field. Such systems can be used for primary screening of diseases to relieve the pressure on primary health care. In recent years, AI algorithms have demonstrated good performance in the analysis and identification of lesion signs in the macular region of fundus color photography, and a screening system for fundus lesion signs applicable to primary screening is bound to emerge in the future. Therefore, to standardize the design and clinical application of the macular region lesion sign screening systems based on AI algorithms, the Ocular Fundus Diseases Group of Chinese Ophthalmological Society, in collaboration with relevant experts, has developed this guideline after investigating issues, discussing production evidence, and holding guideline workshops. This guideline aims to establish uniform standards for the definition of the macular region and lesion signs, AI adoption scenarios, algorithm model construction, datasets establishment and labeling, architecture and functions design, and image data acquisition for the screening system to guide the implementation of the screening work.
Retinopathy of prematurity (ROP) is a blinding eye disease of neonates. Early screening and regular follow-up can prevent the disease from leading to serious functional impairment. Rop is classified by the World Health Organization as the prevention target of avoidable blindness in neonates. Since the National Health Commission of the People's Republic of China issued "Guidelines for the treatment of oxygen and the prevention and treatment of retinopathy in prematurity" in 2004, the Ophthalmology Group of the Chinese Academy of Ophthalmology has actively promoted the screening and treatment of ROP, and updated "Guidelines for screening retinopathy of prematurity" in China in 2014. After nearly 20 years of hard work, the disease of stage 5 ROP in China has basically disappeared. In order to reasonably grasp the classification criteria of ROP and the indications of drug treatment, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association organize experts in related fields to reach consensus opinions through serious, comprehensive and full discussion, and update the classification of ROP in China and the Chinese translation of new terms with reference to international standard terms. The standard of anti-vascular endothelial growth factor drug treatment indication is also added to provide reference for clinicians in clinical practice.
The population of various fundus diseases in China is vast, and the number of patients is continuously increasing due to the aging population. In contrast, fundus disease awareness among the general public in China is low, and grassroots screening needs urgent improvement. At the same time, the diagnosis and treatment rate are quite low, and the treatment methods for late-stage diseases are limited, resulting in poor prognosis of visual function and high blindness rate. Chronic fundus diseases require long-term, standardized treatment and long-term follow-up, which can be burdensome for patients, leading to high missed visit rates and reduced therapeutic effects. The "14th Five-Year Plan for Eye Health (2021-2025)" clearly put forward the requirements of strengthening the construction of the fundus disease prevention and control system. We urgently need to develop a management model for chronic diseases of fundus diseases tailored to China's national conditions. This will require establishing corresponding management platforms, improving personnel allocation, and enhancing compliance in the treatment of fundus diseases, to improve treatment effectiveness and fundamentally reduce blindness rates. After China's authoritative experts in the field of fundus diseases through the organization of in-depth and comprehensive thematic discussion, and the use of the improved version of Delphi method for collective decision-making and opinion consultation, a series of consensus guidance and suggestions were finally formed. These valuable professional insights will strongly promote the establishment of an appropriate chronic fundus disease management system in China, ensure that patients with fundus disease get long-term, standardized medical services, and lay a solid foundation for improving the overall prevention and treatment of fundus diseases.
Retinal vein occlusion (RVO) is a common clinical disease in ophthalmology. In recent years, with the emergence of drugs such as anti-vascular endothelial growth factor drugs and sustained release of intraocular glucocorticoids, the therapeutic effect and prognosis of RVO patients have been significantly improved. Nevertheless, in different regions and hospitals at all levels in China, the diagnosis and treatment strategies for RVO are mostly based on their own accumulated experience, and there is still room for improvement in the awareness of ophthalmologists on early intervention of RVO and the popularity of related knowledge, and a set of standardized clinical diagnosis and treatment paths is urgently needed. To this end, Fundus Diseases Group in Ophthalmology Branch of Chinese Medical Association, Professional Committee of Fundus Diseases in Ophthalmology Branch of Chinese Medical Doctor Association through systematic and in-depth literature research and analysis of the latest clinical research results, and combined with the current social and economic development of China, jointly drafted the draft of Expert consensus on clinical diagnosis and treatment path of retinal vein occlusion in China. After several reviews and revisions by the core expert group, the consensus was finalized. This consensus is elaborated in terms of the definition and classification of RVO, etiology and pathogenesis, initial diagnosis and treatment path consensus, and follow-up diagnosis and treatment assessment and follow-up management, aiming to provide easy to understand and grasp practical guidance for ophthalmic specialists and general ophthalmology practitioners. This consensus strictly follows the basic principles of evidence-based medicine, fully considers China's national conditions and existing diagnosis and treatment conditions, and puts forward principled recommendations with general guiding significance for the clinical diagnosis and treatment practice of RVO, aiming to meet the diagnosis and treatment needs of most patients. When applying this consensus to guide practice, clinicians should take into account the specific disease characteristics of patients, combined with various factors such as available treatment means and patients' economic status, and implement individualized comprehensive treatment plans, so as to meet the diversified diagnosis and treatment needs of the majority of RVO patients.
Proliferative diabetic retinopathy (PDR) is more advanced stage in diabetic retinopathy (DR), often with vitreous hemorrhages and traction retinal detachment which seriously affects patients' vision and even leads to severe visual impairment. Pars plana vitrectomy is an effective treatment for PDR. However, the operation procedure is quite complexed. Inadequate management can negatively impact postoperative vision or even lead to complications. Therefore, it is very important to clarify the surgical indications and standardize the operating procedures of PDR. To this end, Fundus Disease Group of Ophthalmological Society of Chinese Medical Association, Fundus Disease Group of Ophthalmologist Branch of Chinese Medical Doctor Association, Expert Group of Expert consensus for pars plana vitrectomy treatment of type 2 diabetic retinopathy focus on 9 key clinical issues, based on the latest evidence-based medical evidence, combined with international guidelines and China's social and economic development. Recommendations were made on the selection of DR Surgery timing, perioperative blood glucose management, surgical mode selection, formulation of surgical operation plan, drug combination or laser therapy, etc., which formed China's expert consensus on pars plana vitrectomy in the treatment of type 2 DR. This consensus is applicable to Chinese doctors specializing in fundus diseases and doctors engaged in fundus diseases, aiming to provide scientific guidance for vitreous surgery treatment of PDR patients, assist clinical decision-making, and further improve the level of surgical treatment of DR in China.