Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales
Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales
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DOI：
10.1016/s0161-6420(03)00475-5
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发表时间：
2003-09-01
期刊：
影响因子：
13.7
通讯作者：
Verdaguer, JT
中科院分区：
文献类型：
--
作者：
Wilkinson, CP;Ferris, FL;Verdaguer, JT
目的：就糖尿病视网膜病变和糖尿病黄斑水肿的临床疾病严重程度分类系统达成共识，可在全球范围内使用，并改善护理糖尿病患者的医生之间的沟通和协调。设计：制定糖尿病视网膜病变疾病严重程度量表。参与者：来自16个国家的31人，代表综合眼科、视网膜亚专科、内分泌学和流行病学。方法：基于早期治疗糖尿病视网膜病变研究和威斯康星糖尿病视网膜病变流行病学研究出版物的初步临床分类系统，在研讨会之前分发给小组。每个成员都用电子邮件审查，并使用改进的德尔菲系统对回复进行分层。在后来的研讨会上，开发了糖尿病视网膜病变和黄斑水肿的单独系统。然后由小组成员重新评估这些结果，并再次使用改进的德尔菲系统来测量一致程度。主要结果测量：对具体分类系统达成共识。结果：糖尿病视网膜病变的疾病严重程度分为五个阶段，包括低风险的三个阶段，严重非增殖性视网膜病变的第四个阶段和增殖性视网膜病变的第五个阶段。糖尿病性黄斑水肿分为明显存在和明显不存在。如果训练和设备允许筛选者做出有效的决定，黄斑水肿进一步分类为其与中央黄斑距离的函数。结论：对于糖尿病视网膜病变和糖尿病黄斑水肿，似乎确实需要有确凿证据支持的一致的国际临床分类系统。提出的临床分类系统提供了一种适当分类糖尿病视网膜病变和黄斑水肿的方法。希望这些系统在改善糖尿病患者的筛查以及护理这些患者的个人之间的沟通和讨论方面具有价值。(C) 2003年由美国眼科学会出版。
Purpose: To develop consensus regarding clinical disease severity classification systems for diabetic retinopathy and diabetic macular edema that can be used around the world, and to improve communication and coordination of care among physicians who care for patients with diabetes.Design: Report regarding the development of clinical diabetic retinopathy disease severity scales.Participants: A group of 31 individuals from 16 countries, representing comprehensive ophthalmology, retina subspecialties, endocrinology, and epidemiology.Methods: An initial clinical classification system, based on the Early Treatment Diabetic Retinopathy Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy publications, was circulated to the group in advance of a workshop. Each member reviewed this using e-mail, and a modified Delphi system was used to stratify responses. At a later workshop, separate systems for diabetic retinopathy and macular edema were developed. These were then reevaluated by group members, and the modified Delphi system was again used to measure degrees' of agreement.Main Outcome Measures: Consensus regarding specific classification systems was achieved.Results: A five-stage disease severity classification for diabetic retinopathy includes three stages of low risk, a fourth stage of severe nonproliferative retinopathy, and a fifth stage of proliferative retinopathy. Diabetic macular edema is classified as apparently present or apparently absent. If training and equipment allow the screener to make a valid decision, macular edema is further categorized as a function of its distance from the central macula.Conclusions: There seems to be a genuine need for consistent international clinical classification systems for diabetic retinopathy and diabetic macular edema that are supported with solid evidence. The proposed clinical classification systems provide a means of appropriately categorizing diabetic retinopathy and macular edema. It is hoped that these systems will be valuable in improving both screening of individuals with diabetes and communication and discussion among individuals caring for these patients. (C) 2003 by the American Academy of Ophthalmology.