Evidence-based Danish guidelines for screening of diabetic retinopathy

Jakob Grauslund; Nis Andersen; Jens Andresen; Per Flesner; Per Haamann; Steffen Heegaard; Michael Larsen; Caroline Schmidt Laugesen; Katja Schielke; Jesper Skov; Toke Bek

doi:10.1111/aos.13936

Evidence-based Danish guidelines for screening of diabetic retinopathy

Jakob Grauslund, Nis Andersen, Jens Andresen, Per Flesner, Per Haamann, Steffen Heegaard, Michael Larsen, Caroline Schmidt Laugesen, Katja Schielke, Jesper Skov, Toke Bek

Institut for Klinisk Medicin

13 Citationer (Scopus)

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.

Originalsprog	Engelsk
Tidsskrift	Acta Ophthalmologica
Vol/bind	96
Udgave nummer	8
Sider (fra-til)	763-769
Antal sider	7
ISSN	1755-375X
DOI	https://doi.org/10.1111/aos.13936
Status	Udgivet - dec. 2018

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10.1111/aos.13936

aos.13936Forlagets udgivne version, 177 KB

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title = "Evidence-based Danish guidelines for screening of diabetic retinopathy",

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.",

keywords = "Denmark/epidemiology, Diabetic Retinopathy/epidemiology, Humans, Mass Screening/standards, Morbidity/trends, Ophthalmology, Practice Guidelines as Topic, Societies, Medical",

author = "Jakob Grauslund and Nis Andersen and Jens Andresen and Per Flesner and Per Haamann and Steffen Heegaard and Michael Larsen and Laugesen, {Caroline Schmidt} and Katja Schielke and Jesper Skov and Toke Bek",

note = "{\textcopyright} 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.",

year = "2018",

month = dec,

doi = "10.1111/aos.13936",

language = "English",

volume = "96",

pages = "763--769",

journal = "Acta Ophthalmologica",

issn = "1755-375X",

publisher = "Wiley-Blackwell",

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TY - JOUR

T1 - Evidence-based Danish guidelines for screening of diabetic retinopathy

AU - Grauslund, Jakob

AU - Andersen, Nis

AU - Andresen, Jens

AU - Flesner, Per

AU - Haamann, Per

AU - Heegaard, Steffen

AU - Larsen, Michael

AU - Laugesen, Caroline Schmidt

AU - Schielke, Katja

AU - Skov, Jesper

AU - Bek, Toke

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

KW - Denmark/epidemiology

KW - Diabetic Retinopathy/epidemiology

KW - Humans

KW - Mass Screening/standards

KW - Morbidity/trends

KW - Ophthalmology

KW - Practice Guidelines as Topic

KW - Societies, Medical

U2 - 10.1111/aos.13936

DO - 10.1111/aos.13936

M3 - Journal article

C2 - 30311394

SN - 1755-375X

VL - 96

SP - 763

EP - 769

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

IS - 8

ER -

Evidence-based Danish guidelines for screening of diabetic retinopathy

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