Centre universitaire d'ophtalmologie (CUO)-Hôpital Maisonneuve-Rosemont, Département d'ophtalmologie, Université de Montréal, Montréal, Qué.
Hamilton Regional Eye Institute, St. Joseph's Healthcare Hamilton, Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ont.; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont.
Can J Ophthalmol. 2020 Feb;55(1 Suppl 1):14-24. doi: 10.1016/j.jcjo.2020.01.001.
The purpose of this report is to develop a consensus for Canadian national guidelines specific to a tele-medicine approach to screening for diabetic retinopathy (DR) using evidence-based and clinical data.
Canadian Tele-Screening Grading Scales for DR and diabetic macular edema (DME) were created primarily based on severity grading scales outlined by the International Clinical Diabetic Retinopathy Disease Severity Scale (ICDR) and the Scottish DR Grading Scheme 2007. Other grading scales used in international screening programs and the clinical expertise of the Canadian Retina Research Network members and retina specialists nationwide were also used in the creation of the guidelines.
National Tele-Screening Guidelines for DR and DME with and without optical coherence tomography (OCT) images are proposed. These outline a diagnosis and management algorithm for patients presenting with different stages of DR and/or DME. General guidelines detailing the requirements for imaged retina fields, image quality, quality control, and follow-up care and the role of visual acuity, pupil dilation, OCT, ultra-wide-field imaging, and artificial intelligence are discussed.
Tele-retina screening can help to address the need for timely and effective screening for DR, whose prevalence continues to rise. A standardized and evidence-based national approach to DR tele-screening has been proposed, based on DR/DME grading using two 45° image fields or a single widefield or ultra-wide-field image, preferable use of OCT imaging, and a focus on local quality control measures.
本报告旨在根据循证和临床数据，制定加拿大国家指南，以制定使用远程医疗方法筛查糖尿病视网膜病变（DR）的共识。
加拿大的 DR 和糖尿病性黄斑水肿（DME）远程筛查分级量表主要基于国际临床糖尿病视网膜病变疾病严重程度分级量表（ICDR）和 2007 年苏格兰 DR 分级方案中概述的严重程度分级量表制定。国际筛查项目中使用的其他分级量表以及加拿大视网膜研究网络成员和全国视网膜专家的临床专业知识也用于指南的制定。
提出了有和没有光学相干断层扫描（OCT）图像的 DR 和 DME 国家远程筛查指南。这些指南概述了不同阶段的 DR 和/或 DME 患者的诊断和管理算法。详细介绍了视网膜成像领域、图像质量、质量控制、随访护理以及视力、瞳孔扩张、OCT、超广角成像和人工智能的作用等一般指南。
远程视网膜筛查有助于解决及时有效筛查 DR 的需求，因为 DR 的患病率仍在上升。已经提出了一种基于使用两个 45°图像场或单个宽场或超广角图像、优选使用 OCT 成像以及关注本地质量控制措施的 DR 远程筛查的标准化和基于证据的国家方法。
