Grading and disease management in national screening for diabetic retinopathy in England and Wales
Grading and disease management in national screening for diabetic retinopathy in England and Wales
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DOI：
10.1111/j.1464-5491.2003.01077.x
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发表时间：
2003-12-01
影响因子：
3.5
通讯作者：
Leese, G
中科院分区：
文献类型：
--
作者：
Harding, S;Greenwood, R;Leese, G
AIMS英国正在制定一项全国性的糖尿病眼病筛查计划。我们提出了一种分级和早期疾病管理方案来检测威胁视力的糖尿病视网膜病变和任何视网膜病变，这将允许在所有步骤进行精确的质量保证，同时将转诊到医院眼科服务的假阳性降至最低。方法专家小组在2000至2002年间组织讨论，回顾现有证据和分级分类。该方案的建议原则包括：对视网膜病变和黄斑病变进行单独分级，最少步骤，与中央监测兼容，可扩展到已建立的更复杂的系统和用于研究，无损伤计数，无‘可疑’损伤，尝试检测局灶性渗出性、弥漫性和缺血性黄斑病变，并快速跟踪初级或二级分级人员的转诊。威胁视力的糖尿病视网膜病变被定义为：增殖性前期或更严重的视网膜病变，威胁视力的黄斑病变和/或存在光凝。在中央报道的最小数据集中，视网膜病变分为四个级别：无(R0)，背景(R1)，增殖前期(R2)，增殖性(R3)。黄斑病变和光凝被分级为无(M0，P0)或存在(M1，P1)。讨论糖尿病视网膜病变分级和疾病管理工作组制定的方案代表了一种新的共识，可以作为国家指南的基础，从而引入对糖尿病患者的质量保证筛查。
Aims A National Screening Programme for diabetic eye disease in the UK is in development. We propose a grading and early disease management protocol to detect sight-threatening diabetic retinopathy and any retinopathy, which will allow precise quality assurance at all steps while minimizing false-positive referral to the hospital eye service.Methods Expert panel structured discussions between 2000 and 2002 with review of existing evidence and grading classifications.Proposals Principles of the protocol include: separate grading of retinopathy and maculopathy, minimum number of steps, compatible with central monitoring, expandable for established more complex systems and for research, no lesion counting, no 'questionable' lesions, attempt to detect focal exudative, diffuse and ischaemic maculopathy and fast track referral from primary or secondary graders. Sight-threatening diabetic retinopathy is defined as: preproliferative retinopathy or worse, sight-threatening maculopathy and/or the presence of photocoagulation. In the centrally reported minimum data set retinopathy is graded into four levels: none (R0), background (R1), preproliferative (R2), proliferative (R3). Maculopathy and photocoagulation are graded as absent (M0, P0) or present (M1, P1).Discussion The protocol developed by the Diabetic Retinopathy Grading and Disease Management Working Party represents a new consensus upon which national guidelines can be based leading to the introduction of quality-assured screening for people with diabetes.