Современные тенденции скрининга диабетической ретинопатии

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Заболеваемость сахарным диабетом в мире неуклонно растет, а вместе с ней — и число случаев снижения и потери зрения в результате диабетической ретинопатии (ДР). Данная патология на начальных стадиях протекает бессимптомно, при этом только своевременное лечение может быть эффективным. В связи с этим скрининг ДР является важной и актуальной проблемой. В данном литературном обзоре рассмотрены принципы, критерии и проблемы существующих программ скрининга ДР, основывающихся на цифровом фотографировании глазного дна. Особое внимание уделено отображаемым биомаркерам и их роли в скрининге ДР. Описаны различные методы исследования, такие как флюоресцентная ангиография, оптическая когерентная томография, оптическая когерентная томография-ангиография, лазерная сканирующая офтальмоскопия. При помощи этих методов можно визуализировать патологические изменения сетчатки, связанные с ДР. Данные изменения рассмотрены как потенциальные скрининговые биомаркеры ДР. В обзоре отражены новые направления скрининга, основанные на применении телемедицинских технологий, искусственного интеллекта, мобильных фоторегистрирующих устройств.

Ключевые слова:

диабетическая ретинопатия

скрининг

биомаркер

диабетический макулярный отек

оптическая когерентная томография-ангиография

Авторы:

Павлов В.Г.

ФГБНУ «Научно-исследовательский институт глазных болезней»

Сидамонидзе А.Л.

ФГБНУ «Научно-исследовательский институт глазных болезней»

Петрачков Д.В.

ФГБНУ «Научно-исследовательский институт глазных болезней»

Даты поступления:

31.05.2020

Даты принятия в печать:

20.06.2020

Список литературы:

Dedov I, Shestakova M, Benedetti MM, Simon D, Pakhomov I, Galstyan G. Prevalence of type 2 diabetes mellitus (T2DM) in the adult Russian population (NATION study). Diabetes Research and Clinical Practice. 2016;115: 90-95. https://doi.org/10.1016/j.diabres.2016.02.010
UK National Screening Committee (UK NSC). Population screening programmes — guidance. NHS population screening explained. 2013. Accessed June 18, 2020. https://www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc
Cheung N, Mitchell P, Wong TY. Diabetic Retinopathy. Lancet. 2010; 376(9735):124-146. https://doi.org/10.1016/S0140-6736(09)62124-3
Fong DS, Gottlieb J, Ferris FL Iii, Klein R. Understanding the value of diabetic retinopathy screening. Archives of Ophthalmology. 2001;119(5):758-760. https://doi.org/10.1001/archopht.119.5.758
Sinclair SH, Delvecchio C. The internist’s role in managing diabetic retinopathy: screening for early detection. Cleveland Clinic Journal of Medicine. 2004;71(2):151-159. https://doi.org/10.3949/ccjm.71.2.151
Vujosevic S, Aldington SJ, Silva P, Hernández C, Scanlon P, Peto T, Simó R. Screening for diabetic retinopathy: new perspectives and challenges. Lancet Diabetes and Endocrinology. 2020;8(4):337-347. https://doi.org/10.1016/S2213-8587(19)30411-5
Пядушкина Е.А., Авксентьева М.В., Омельяновский В.В. Зарубежные рекомендации по раннему выявлению хронических неинфекционных заболеваний: опыт Великобритании и США. Медицинские технологии. Оценка и выбор. 2016;3(25):20-33.
Gubitosi-Klug RA, Bebu I, White NH, Malone J, Miller R, Lorenzi GM, Hainsworth DP, Trapani VR, Lachin JM, Tamborlane WV; Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. Screening eye exams in youth with type 1 diabetes under 18 years of age: once may be enough? Pediatric Diabetes. 2019;20(6):743-749. https://doi.org/10.1111/pedi.12877
Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. Дедова И.И., Шестаковой М.В., Майорова А.Ю. 9-й выпуск. Сахарный диабет. 2019; 22(1-1):1-144. https://doi.org/10.14341/DM221S1
Barsegian A, Kotlyar B, Lee J, Salifu MO, McFarlane SI. Diabetic retinopathy: focus on minority populations. International Journal of Clinical Endocrinology and Metabolism. 2017;3(1):34-45. https://doi.org/10.17352/ijcem.000027
Мирошниченко И.И., Птицина С.Н. Биомаркеры в современной медико-биологической практике. Биомедицинская химия. 2009;55(4): 425-440.
Будзинская М.В., Липатов Д.В., Павлов В.Г., Петрачков Д.В. Биомаркеры при диабетической ретинопатии. Сахарный диабет. 2020;23(1): 88-94. https://doi.org/10.14341/DM10045
Caliumi C, Balducci S, Petramala L, Cotesta D, Zinnamosca L, Cianci R, Di Donato D, Vingolo EM, Fallucca F, Letizia C. Plasma levels of adrenomedullin, a vasoactive peptide, in type 2 diabetic patients with and without retinopathy. Minerva Endocrinologica. 2007;32(2):73-78.
Sharma S, Purohit S, Sharma A, Hopkins D, Steed L, Bode B, Anderson SW, Caldwell R, She JX. Elevated serum levels of soluble TNF receptors and adhesion molecules are associated with diabetic retinopathy in patients with type-1 diabetes. Mediators of Inflammation. 2015;279393. https://doi.org/10.1155/2015/279393
Tayyari F, Khuu LA, Sivak JM, Flanagan JG, Singer S, Brent MH, Hudson C. Retinal blood oxygen saturation and aqueous humour biomarkers in early diabetic retinopathy. Acta Ophthalmologica Scandinavica Foundation. 2019;97(5):673-679. https://doi.org/10.1111/aos.14016
Gangula A, Ghoshdastidar S, Kannan R, Upendran A. Diabetic Retinopathy Screening Using a Gold Nanoparticle-Based Paper Strip Assay for the At-Home Detection of the Urinary Biomarker 8-Hydroxy-2’-Deoxyguanosine. American Journal of Ophthalmology. 2020;213:306‐319. https://doi.org/10.1016/j.ajo.2020.01.032
Nishida N, Arizumi T, Takita M, Kitai S, Yada N, Hagiwara S, Inoue T, Minami Y, Ueshima K, Sakurai T, Kudo M. Reactive oxygen species induce epigenetic instability through the formation of 8-hydroxydeoxyguanosine in human hepatocarcinogenesis. Digestive Diseases (Basel, Switzerland). 2013; 31(5-6):459-466. https://doi.org/10.1159/000355245
Шадричев Ф.Е., Шкляров, Е.Б., Григорьева Н.Н. Скрининг диабетической ретинопатии: от офтальмоскопии к цифровому фотографированию. Офтальмологические ведомости. 2009;2(4):19-30.
Abramoff MD, Folk JC, Han DP, Automated analysis of retinal images for detection of referable diabetic retinopathy. JAMA Ophthalmology. 2013;131(3): 351-357. https://doi.org/10.1001/jamaophthalmol.2013.1743
Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 suppl):823-833.
Stefansson E, Bek T, Porta M, Larsen N, Kristinsson JK, Agardh E. Screening and prevention of diabetic blindness. Acta Ophthalmologica Scandinavica. 2000;78(4):374-385. https://doi.org/10.1034/j.1600-0420.2000.078004374.x
Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26(9):2653-2664. https://doi.org/10.2337/diacare.26.9.2653
Shiba T, Yamamoto T, Seki U, Utsugi N, Fujita K, Sato Y, Terada H, Sekihara H, Hagura R. Screening and follow-up of diabetic retinopathy using a new mosaic 9-field fundus photography system. Diabetes Research and Clinical Practice. 2002;55(1):49-59. https://doi.org/10.1016/s0168-8227(01)00285-6
Csutak A, Lengyel I, Jonasson F, Leung I, Geirsdottir A, Xing W, Peto T. Agreement between image grading of conventional (45°) and ultra wide-angle (200°) digital images in the macula in the Reykjavik eye study. Eye (London, England). 2010;24(10):1568-1575. https://doi.org/10.1038/eye.2010.85
Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, Dills D, Kampik A, Pararajasegaram R, Verdaguer JT; Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9): 1677-1682. https://doi.org/10.1016/S0161-6420(03)00475-5
Vujosevic S, Benetti E, Massignan F, Pilotto E, Varano M, Cavarzeran F, Avogaro A, Midena E. Screening for diabetic retinopathy: 1 and 3 nonmydriatic 45-degree digital fundus photographs vs 7 standard early treatment diabetic retinopathy study fields. American Journal of Ophthalmology. 2009; 148(1):111-118. https://doi.org/10.1016/j.ajo.2009.02.031
Silva PS, Cavallerano JD, Sun JK, Noble J, Aiello LM, Aiello LP. Nonmydriatic ultrawide field retinal imaging compared with dilated standard 7-field 35-mm photography and retinal specialist examination for evaluation of diabetic retinopathy. American Journal of Ophthalmology. 2012;154(3):549-559. https://doi.org/10.1016/j.ajo.2012.03.019
Silva PS, Cavallerano JD, Tolson AM, Rodriguez J, Rodriguez S, Ajlan R, Tolls D, Patel B, Sehizadeh M, Thakore K, Sun JK, Aiello LP. Real-time ultrawide field image evaluation of retinopathy in a diabetes telemedicine program. Diabetes Care. 2015;38(9):1643-1649. https://doi.org/10.2337/dc15-0161
Шкляров Е.Б., Григорьева Н.Н., Шадричев Ф.Е., Астахов Ю.С. Новые технологии визуализации диабетических изменений сетчатки. Сахарный диабет. 2008;11(3):28-29. https://doi.org/10.14341/2072-0351-5356
Diabetes Control and Complications Trial Research Group (1987). Color photography versus fluorescein angiography in the detection of diabetic retinopathy in the Diabetes Control and Complications Trial. Archives of Ophthalmology. 1987;105(10):1344-1351. https://doi.org/10.1001/archopht.1987.01060100046022
Sanborn GE, Wroblewski JJ. Evaluation of a combination digital retinal camera with spectral-domain optical coherence tomography (SD-OCT) that might be used for the screening of diabetic retinopathy with telemedicine: A pilot study. Journal of Diabetes and Its Complications. 2018;32(11):1046-1050. https://doi.org/10.1016/j.jdiacomp.2018.08.010
Hirano T, Hoshiyama K, Hirabayashi K, Wakabayashi M, Toriyama Y, Tokimitsu M, Murata T. Vitreoretinal Interface Slab in OCT Angiography for Detecting Diabetic Retinal Neovascularization. Ophthalmology Retina. 2020; 6:588-594. https://doi.org/10.1016/j.oret.2020.01.004
Gildea D. The diagnostic value of optical coherence tomography angiography indiabetic retinopathy: a systematic review. International Ophthalmology. 2019;39(10):2413-2433. https://doi.org/:10.1007/s10792-018-1034-8
Hirano T, Kitahara J, Toriyama Y, Kasamatsu H, Murata T, Sadda S. Quantifying vascular density and morphology using different swept-source optical coherence tomography angiographic scan patterns in diabetic retinopathy. British Journal of Ophthalmology. 2019;103(2):216-221. https://doi.org/10.1136/bjophthalmol-2018-311942
Sambhav K, Abu-Amero KK, Chalam KV. Deep Capillary Macular Perfusion Indices Obtained with OCT Angiography Correlate with Degree of Nonproliferative Diabetic Retinopathy. European Journal of Ophthalmology. 2017; 27(6):716-729. https://doi.org/10.5301/ejo.5000948
Нероев В.В., Охоцимская Т.Д., Фадеева В.А. Оценка микрососудистых изменений сетчатки при сахарном диабете методом ОКТ-ангиографии. Российский офтальмологический журнал. 2017;10(2):40-45. https://doi.org/10.21516/2072-0076-2017-10-2-40-45
Choi W, Waheed NK, Moult EM, Adhi M, Lee B, De Carlo T, Jayaraman V, Baumal CR, Duker JS, Fujimoto JG. Ultrahigh speed swept source optical coherence tomography angiography of retinal and choriocapillaris alterations in diabetic patients with and without retinopathy. Retina. 2017;37(1):11-21. https://doi.org/10.1097/IAE.0000000000001250
Alam M, Zhang Y, Lim JI, Chan RVP, Yang M, Yao X. Quantitative optical coherence tomography angiography features for objective classification and staging of diabetic retinopathy. Retina. 2018;40(2):322-332. https://doi.org/10.1097/IAE.0000000000002373
Conti FF, Qin VL, Rodrigues EB, Sharma S, Rachitskaya AV, Ehlers JP, Singh RP. Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography. British Journal of Ophthalmology. 2019; 103(4):452-456. https://doi.org/10.1136/bjophthalmol-2018-311903
Alibhai AY, De Pretto LR, Moult EM, Or C, Arya M, McGowan M, Carrasco-Zevallos O, Lee B, Chen S, Baumal CR, Witkin AJ, Reichel E, de Freitas AZ, Duker JS, Fujimoto JG, Waheed NK. Quantification of retinal capillary nonperfusion in diabetics using wide-field optical coherence tomography angiography. Retina. 2020;40(3):412-420. https://doi.org/10.1097/IAE.0000000000002403
Spaide RF. Volume-rendered optical coherence tomography of diabetic retinopathy pilot study. American Journal of Ophthalmology. 2015;160(6):1200-1210. https://doi.org/10.1016/j.ajo.2015.09.010
Ben ÂJ, Neyeloff JL, De Souza CF, Rosses APO, De Araujo AL, Szortika A, Locatelli F, de Carvalho G, Neumann CR. Cost-utility analysis of opportunistic and systematic diabetic retinopathy screening strategies from the perspective of the Brazilian public healthcare system key points for decision-makers. Applied Health Economics and Health Policy. 2020;18(1):57-68. https://doi.org/10.1007/s4025 8-019-00528-w
Stanimirovic A, Francis T, Shahid N, Sutakovic O, Merritt R, Brent MH, Rac VE.Tele-retina screening of diabetic retinopathy among at-risk populations: an economic analysis. Canadian Journal of Ophthalmology. 2019; 55(1S1):8-13. https://doi.org/10.1016/j.jcjo.2019.06.008
Maberley D, Walker H, Koushik A, Cruess A. Screening for diabetic retinopathy in James Bay, Ontario: a cost-effectiveness analysis. Canadian Medical Association. 2003;168(2):160-164.
Naik S, Wykoff CC, Ou WC, Stevenson J, Gupta S, Shah AR. Identification of Factors to Increase Efficacy of Telemedicine Screening for Diabetic Retinopathy in Endocrinology Practices using the Intelligent Retinal Imaging System (IRIS) Platform. Diabetes Research and Clinical Practice. 2018;140:265-270. https://doi.org/10.1016/j.diabres.2018.04.011
Борщук Е.Л., Чупров А.Д., Лосицкий А.О., Фирсов А.С. Организация скрининга диабетической ретинопатии с применением телемедицинских технологий. Практическая медицина. 2018;16(4):68-70. https://doi.org/1032000/2072-1757-2018-16-4-68-70
Afshar AR, Oldenburg CE, Stewart JM. A novel hybrid fixed and mobile ultrawide field imaging program for diabetic tele-retinopathy screening. Ophthalmology Retina. 2019;3(7):576-579. https://doi.org/10.1016/j.oret.2019.03.007
Avidor D, Loewenstein A, Waisbourd M, Nutman A. Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review. Cost Effectiveness and Resource Allocation: C/E. 2020;18:16. https://doi.org/10.1186/s12962-020-00211-1
Чупров А.Д., Лосицкий А.О., Фирсов А.С. Социально-экономические аспекты скрининга диабетической ретинопатии с использованием телемедицинских технологий. Современные технологии в офтальмологии. 2019;2:20-22. https://doi.org/10.25276/2312-4911-2019-2-20-22
Carin L, Pencina MJ. On deep learning for medical image analysis. JAMA. 2018;320(11):1192-1193. https://doi.org/10.1001/jama.2018.13316
LeCun Y, Bengio Y, Hinton G. Deep learning. Nature. 2015;521(7553): 436-444. https://doi.org/10.1038/ nature14539
Wong TY, Bressler NM. Artificial intelligence with deep learning technology looks into diabetic retinopathy screening. JAMA. 2016;316(22): 2366-2367. https://doi.org/10.1001/jama.2016.17563
Abramoff MD, Lavin PT, Birch M, Shah N, Folk JC. Pivotal trial of an autonomous AI-based diagnostic system for detection of diabetic retinopathy in primary care offices. NPJ Digital Medicine. 2018;1:39. https://doi.org/10.1038/s41746-018-0040-6
Russo A, Morescalchi F, Costagliola C, Delcassi L, Semeraro F. Comparison of smartphone ophthalmoscopy with slit-lamp biomicroscopy for grading diabetic retinopathy. American Journal of Ophthalmology. 2015;159(2): 360-364. https://doi.org/10.1016/j.ajo.2014.11.008
Rajalakshmi R, Arulmalar S, Usha M, Prathiba V, Kareemuddin KS, Anjana RM, Mohan V. Validation of smartphone based retinal photography for diabetic retinopathy screening. PLoS One. 2015;10(9):e0138285. https://doi.org/10.1371/journal.pone.0138285

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