Harvard Medical School, 1 Joslin Place, Boston, USA.
Alexandria Faculty of Medicine, Champilion Street, Azarita, Raml Station, Alexandria, Egypt.
Indian J Ophthalmol. 2022 Oct;70(10):3579-3583. doi: 10.4103/ijo.IJO_641_22.
To evaluate current practice patterns for Egyptian ophthalmologists in the diagnosis of diabetic retinopathy (DR) and explore potential implications of these approaches on management.
Cross-sectional survey conducted in Egypt amongst practicing ophthalmologists.
The study had 203 responses (~6% of all Egyptian ophthalmologists). A majority of respondents were general ophthalmologists (78.2%), practicing for five to ten years (41.9%). In patients with DR and no diabetic macular edema (DME), 33.0% of respondents would use FA in patients with mild DR, 44.3% in patients with moderate DR and 51.2% in patients with severe non-proliferative diabetic retinopathy (NPDR). Color imaging (CI) was used by less than 1% as the sole imaging modality for any level of DR. Approximately 70% of respondents used fluorescein angiography (FA) to grade and base treatment decisions for DR, either alone or in conjunction with dilated eye exams and/or CI. Given the known more severe appearance of DR on FA than on standard color imaging upon which treatment guidelines are based, use of FA as the primary modality over a one-year period could result in PRP that would otherwise not be suggested in approximately 78,820 eyes at an additional cost of $10.1 million US dollars. These numbers are projected to double by 2045.
Given that FA detects significantly greater pathology than CI, and that treatment and follow-up recommendations are based on CI, its use as the primary imaging modality in DR grading may result in apparently significantly higher DR severity, with subsequently increased procedures and associated costs.
评估埃及眼科医生在诊断糖尿病视网膜病变（DR）方面的当前实践模式，并探讨这些方法对管理的潜在影响。
在埃及对执业眼科医生进行横断面调查。
该研究共有 203 名受访者（约占埃及眼科医生的 6%）。大多数受访者为普通眼科医生（78.2%），从业时间为 5 至 10 年（41.9%）。在 DR 且无糖尿病性黄斑水肿（DME）的患者中，33.0%的受访者会在轻度 DR 患者中使用 FA，44.3%在中度 DR 患者中使用，51.2%在严重非增生性糖尿病视网膜病变（NPDR）患者中使用。彩色成像（CI）作为任何程度 DR 的唯一成像方式的使用不到 1%。大约 70%的受访者使用荧光素血管造影（FA）对 DR 进行分级并根据治疗决策，单独或与散瞳眼部检查和/或 CI 一起使用。鉴于 FA 检测到的 DR 病变程度明显高于治疗指南所依据的标准彩色成像，在一年的时间内，将 FA 作为主要成像方式使用可能会导致原本不会建议进行光凝治疗的约 78820 只眼睛接受光凝治疗，费用额外增加 1010 万美元。这些数字预计到 2045 年将翻一番。
鉴于 FA 检测到的病变明显多于 CI，并且治疗和随访建议基于 CI，因此将其作为 DR 分级的主要成像方式可能会导致 DR 严重程度明显升高，随后会增加手术次数和相关费用。
