Omar Amer, Williams R Geoff, Whelan James, Noble Jason, Brent Michael H, Giunta Michel, Olivier Sébastien, Lhor Mustapha
Medical Retina Institute of Montreal, 2170 René-Lévesque Blvd Ouest, Bureau 101, Montréal, QC, H3H 2T8, Canada.
Calgary Retina Consultants, University of Calgary, Calgary, AB, Canada.
Ophthalmol Ther. 2024 May;13(5):1071-1102. doi: 10.1007/s40123-024-00923-0. Epub 2024 Mar 23.
Despite advances in systemic care, diabetic disease of the eye (DDE) remains the leading cause of blindness worldwide. There is a critical gap of up-to-date, evidence-based guidance for ophthalmologists in Canada that includes evidence from recent randomized controlled trials. Previous guidance has not always given special consideration to applying treatments and managing DDE in the context of the healthcare system. This consensus statement aims to assist practitioners in the field by providing a spectrum of acceptable opinions on DDE treatment and management from recognized experts in the field. In compiling evidence and generating consensus, a working group of retinal specialists in Canada addressed clinical questions surrounding the four themes of disease, patient, management, and collaboration. The working group reviewed literature representing the highest level of evidence on DDE and shared their opinions on topics surrounding the epidemiology and pathophysiology of diabetic retinopathy and diabetic macular edema; diagnosis and monitoring; considerations around diabetes medication use; strategic considerations for management given systemic comorbidities, ocular comorbidities, and pregnancy; treatment goals and modalities for diabetic macular edema, non-proliferative and proliferative diabetic retinopathy, and retinal detachment; and interdisciplinary collaboration. Ultimately, this work highlighted that the retinal examination in DDE not only informs the treating ophthalmologist but can serve as a global index for disease progression across many tissues of the body. It highlighted further that DDE can be treated regardless of diabetic control, that a systemic approach to patient care will result in the best health outcomes, and prevention of visual complications requires a multidisciplinary management approach. Ophthalmologists must tailor their clinical approach to the needs and circumstances of individual patients and work within the realities of their healthcare setting.
尽管全身治疗取得了进展，但糖尿病眼病（DDE）仍是全球失明的主要原因。在加拿大，眼科医生缺乏最新的、基于证据的指导意见，其中包括来自近期随机对照试验的证据。以往的指导意见在医疗系统背景下应用治疗方法和管理糖尿病眼病方面，并非总是给予特别考虑。本共识声明旨在通过提供该领域公认专家对糖尿病眼病治疗和管理的一系列可接受意见，来帮助该领域的从业者。在收集证据并达成共识的过程中，加拿大的一个视网膜专家工作组探讨了围绕疾病、患者、管理和协作这四个主题的临床问题。该工作组回顾了代表糖尿病眼病最高证据水平的文献，并就糖尿病视网膜病变和糖尿病性黄斑水肿的流行病学和病理生理学、诊断和监测、糖尿病药物使用的注意事项、考虑到全身合并症、眼部合并症和妊娠的管理策略、糖尿病性黄斑水肿、非增殖性和增殖性糖尿病视网膜病变以及视网膜脱离的治疗目标和方式，以及跨学科协作等主题分享了他们的意见。最终，这项工作强调，糖尿病眼病的视网膜检查不仅能为治疗眼科医生提供信息，还可作为身体许多组织疾病进展的总体指标。它进一步强调，无论糖尿病控制情况如何，糖尿病眼病都可以得到治疗，采用全身治疗方法将带来最佳的健康结果，预防视觉并发症需要多学科管理方法。眼科医生必须根据个体患者的需求和情况调整其临床方法，并在其医疗环境的实际情况下开展工作。
