Kárason Kolbeinn Tumi, Vo Diana, Grauslund Jakob, Rasmussen Malin Lundberg
Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Acta Ophthalmol. 2022 Mar;100(2):127-135. doi: 10.1111/aos.14767. Epub 2021 Feb 2.
Screening for diabetic retinopathy (DR) is recommended to detect sight-threatening complications prior to visual loss. Early Treatment Diabetic Retinopathy Study (ETDRS) seven standard field (7SF) retinal imaging has traditionally been regarded the gold standard for DR classification, but other methods are often preferred clinically. The purpose of this systematic review was to determine whether 7SF is the most optimal screening method for DR grading, or if similar results can be achieved by other methods using a smaller field of view (<7SF) or ultra-wide field (UWF) imaging.
Based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, two independent reviewers initially identified 7167 publications in PubMed, Cochrane and Embase databases. Of these, 16 publications were included based on predefined inclusion criteria.
7SF was used as reference standard in 12 studies (compared with < 7SF in five studies and UWF in seven studies), and four studies compared other reference standards. Compared to 7SF, studies using < 7SF and UWF images both reported of similar agreement. A lower rate of ungradable images was reported for mydriatic and non-mydriatic UWF as compared to non-mydriatic < 7SF modalities.
Retinal imaging of <7SF and UWF both provide acceptable performance compared to 7SF. Given the time-consuming nature of the latter, these methods could be reasonable options in DR screening, even though a high number of ungradable images in non-mydriatic < 7SF may pose a clinical challenge.
建议对糖尿病视网膜病变（DR）进行筛查，以便在视力丧失之前检测出有视力威胁的并发症。早期糖尿病视网膜病变研究（ETDRS）的七标准视野（7SF）视网膜成像传统上被视为DR分类的金标准，但临床上通常更倾向于其他方法。本系统评价的目的是确定7SF是否是DR分级的最佳筛查方法，或者使用较小视野（<7SF）或超广角（UWF）成像的其他方法是否能取得类似结果。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南，两名独立的评审员最初在PubMed、Cochrane和Embase数据库中识别出7167篇出版物。其中，根据预定义的纳入标准纳入了16篇出版物。
12项研究将7SF用作参考标准（5项研究与<7SF比较，7项研究与UWF比较），4项研究比较了其他参考标准。与7SF相比，使用<7SF和UWF图像的研究均报告了相似的一致性。与非散瞳<7SF模式相比，散瞳和非散瞳UWF的不可分级图像率较低。
与7SF相比，<7SF和UWF的视网膜成像均具有可接受的性能。鉴于7SF耗时的特性，这些方法在DR筛查中可能是合理的选择，尽管非散瞳<7SF中大量不可分级的图像可能带来临床挑战。
