Jakob Grauslund1,2,3, Nis Andersen1,4, Jens Andresen1,4, Per Flesner1,4, Per Haamann1,4, Steffen Heegaard1,5, Michael Larsen1,5, Caroline Schmidt Laugesen1,6, Katja Schielke1,7, Jesper Skov1,4, Toke Bek1,8. 1. Danish Ophthalmological Society, Copenhagen, Denmark. 2. Department of Ophthalmology, Odense University Hospital, Odense, Denmark. 3. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 4. Organization of Danish Ophthalmologists, Copenhagen, Denmark. 5. Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark. 6. Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark. 7. Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark. 8. Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Abstract
PURPOSE: Diabetic retinopathy (DR) is among the leading causes of visual loss in the working-age population. It is generally accepted that screening of DR is cost-effective and can detect DR before it becomes sight-threatening to allow timely treatment. METHODS: A group of retinal specialists was formed by the Danish Ophthalmological Society with the aim to formulate contemporary evidence-based guidelines for screening of DR in order to implement these in the Danish screening system. RESULTS: We hereby present evidence for DR-screening regarding (1) classification of DR, (2) examination techniques, (3) screening intervals and (4) automated screening. It is our recommendation that the International Clinical Retinopathy Disease Severity Scale should be used to classify DR. As a minimum, mydriatic two-field disc- and macular-centred images are required. In the case of suspected clinically significant diabetic macular oedema, supplementary optical coherence tomography can increase the diagnostic accuracy. There is solid evidence to support a flexible, individualized screening regimen. In particular, it is possible to prolong screening intervals to 24-48 months for patients with no or mild nonproliferative diabetic retinopathy (NPDR), but it is also possible to use extended intervals of 12-24 months for patients with moderate NPDR given that these are well-regulated regarding glycaemic control (HbA1c ≤ 53 mmol/mol) and blood pressure (≤130/80 mmHg). Automated screening of DR is encouraging but is not ready for implementation at present. CONCLUSION: Danish evidenced-based guidelines for screening of DR support high-quality imaging and allow flexible, individualized screening intervals with a potential for extension to patients with low risk of DR progression.
PURPOSE:Diabetic retinopathy (DR) is among the leading causes of visual loss in the working-age population. It is generally accepted that screening of DR is cost-effective and can detect DR before it becomes sight-threatening to allow timely treatment. METHODS: A group of retinal specialists was formed by the Danish Ophthalmological Society with the aim to formulate contemporary evidence-based guidelines for screening of DR in order to implement these in the Danish screening system. RESULTS: We hereby present evidence for DR-screening regarding (1) classification of DR, (2) examination techniques, (3) screening intervals and (4) automated screening. It is our recommendation that the International Clinical Retinopathy Disease Severity Scale should be used to classify DR. As a minimum, mydriatic two-field disc- and macular-centred images are required. In the case of suspected clinically significant diabetic macular oedema, supplementary optical coherence tomography can increase the diagnostic accuracy. There is solid evidence to support a flexible, individualized screening regimen. In particular, it is possible to prolong screening intervals to 24-48 months for patients with no or mild nonproliferative diabetic retinopathy (NPDR), but it is also possible to use extended intervals of 12-24 months for patients with moderate NPDR given that these are well-regulated regarding glycaemic control (HbA1c ≤ 53 mmol/mol) and blood pressure (≤130/80 mmHg). Automated screening of DR is encouraging but is not ready for implementation at present. CONCLUSION: Danish evidenced-based guidelines for screening of DR support high-quality imaging and allow flexible, individualized screening intervals with a potential for extension to patients with low risk of DR progression.
Authors: Jakob K H Andersen; Martin S Hubel; Malin L Rasmussen; Jakob Grauslund; Thiusius R Savarimuthu Journal: Transl Vis Sci Technol Date: 2022-06-01 Impact factor: 3.048
Authors: Deborah M Broadbent; Amu Wang; Christopher P Cheyne; Marilyn James; James Lathe; Irene M Stratton; John Roberts; Tracy Moitt; Jiten P Vora; Mark Gabbay; Marta García-Fiñana; Simon P Harding Journal: Diabetologia Date: 2020-11-04 Impact factor: 10.122