Abstract
Objective
The purpose of this report is to develop a consensus for Canadian national guidelines
specific to a tele-medicine approach to screening for diabetic retinopathy (DR) using
evidence-based and clinical data.
Methods
Canadian Tele-Screening Grading Scales for DR and diabetic macular edema (DME) were
created primarily based on severity grading scales outlined by the International Clinical
Diabetic Retinopathy Disease Severity Scale (ICDR) and the Scottish DR Grading Scheme
2007. Other grading scales used in international screening programs and the clinical
expertise of the Canadian Retina Research Network members and retina specialists nationwide
were also used in the creation of the guidelines.
Results
National Tele-Screening Guidelines for DR and DME with and without optical coherence
tomography (OCT) images are proposed. These outline a diagnosis and management algorithm
for patients presenting with different stages of DR and/or DME. General guidelines
detailing the requirements for imaged retina fields, image quality, quality control,
and follow-up care and the role of visual acuity, pupil dilation, OCT, ultra-wide-field
imaging, and artificial intelligence are discussed.
Conclusions
Tele-retina screening can help to address the need for timely and effective screening
for DR, whose prevalence continues to rise. A standardized and evidence-based national
approach to DR tele-screening has been proposed, based on DR/DME grading using two
45° image fields or a single widefield or ultra-wide-field image, preferable use of
OCT imaging, and a focus on local quality control measures.
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Article info
Publication history
Accepted:
January 2,
2020
Received in revised form:
December 27,
2019
Received:
December 5,
2019
Identification
Copyright
© 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
