Chinese Ophthalmological Society Research Articles

Chinese expert consensus on the diagnosis and treatment of asthenopia (2024)

Asthenopia is a group of eye discomfort syndromes with complex clinical manifestations, accompanied with systemic symptoms or not. It is caused by diverse influencing factors and occurs upon overuse of the eyes. Over the past decade, significant changes have appeared in the etiology, clinical manifestation and treatment of asthenopia with great changes in the society and lifestyles. The Chinese Optometric Association of Chinese Ophthalmological Society and the Optometry Group of Chinese Ophthalmologist Association have organized nationwide experts in the field to thoroughly discuss the latest researches on asthenopia. Consensus opinions have been formed on the causes, influencing factors, clinical manifestations, diagnosis and treatment of asthenopia, following the definition of asthenopia in the International Classification of Diseases, so as to provide guidance for the clinical diagnosis and treatment of asthenopia.

The standardized design and application guidelines: A primary-oriented artificial intelligence screening system of the lesion sign in the macular region based on fundus color photography

With the popularity and development of artificial intelligence (AI), disease screening systems based on AI algorithms are gradually emerging in the medical field. Such systems can be used for primary screening of diseases to relieve the pressure on primary health care. In recent years, AI algorithms have demonstrated good performance in the analysis and identification of lesion signs in the macular region of fundus color photography, and a screening system for fundus lesion signs applicable to primary screening is bound to emerge in the future. Therefore, to standardize the design and clinical application of macular region lesion sign screening systems based on AI algorithms, the Ocular Fundus Diseases Group of Chinese Ophthalmological Society, in collaboration with relevant experts, developed this guideline after investigating issues, discussing production evidence, and holding guideline workshops. It aimed to establish uniform standards for the definition of the macular region and lesion signs, AI adoption scenarios, algorithm model construction, dataset establishment and labeling, architecture and function design, and image data acquisition for the screening system to guide the implementation of the screening work.

Chinese guideline on the diagnosis and treatment of thyroid-associated ophthalmopathy (2022)

Thyroid-associated ophthalmopathy (TAO) is an orbital disease closely related to thyroid diseases. TAO has a prolonged course and possibility of blindness and disability. Its diagnosis and treatment can be complex with multiple disciplines involved. To improve the standardized diagnosis and treatment of TAO in China, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association and the Thyroid Group of Chinese Society of Endocrinology of Chinese Medical Association have jointly drawn up this first clinical guideline in China for TAO by complying with the principles, methods and steps of guideline formation. In this guideline, there are 24 recommendations for the major clinical problems in the diagnosis and treatment of TAO, including the clinical diagnostic criteria, disease staging and grading methods, novel treatment based on the pathogenesis, multi-disciplinary treatment, risk factor control, individualized selection of treatment such as drugs, radiation and surgery, therapeutic efficacy evaluation and critical illness management. This guideline provides instructions for clinicians to carry out relevant clinical and research work.

Chinese expert consensus on diagnosis and treatment of uveal melanoma (2021)

Uveal melanoma (UM) is the most common primary intraocular malignant tumor in adults that seriously endangers the life and visual function of patients. After repeated discussions by domestic experts from the Ophthalmological Society of China Medicine Education Association, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association, and the Ocular Oncology Committee of China Anti-Cancer Association, we put forward consensus opinions on the standardization of UM diagnosis and treatment, hoping to provide references for ophthalmologists and relevant professional clinicians in their work practice, so as to improve the level of clinical diagnosis and treatment of UM. (Chin J Ophthalmol, 2021, 57:886-897).

Chinese expert consensus on diagnosis and treatment of congenital nasolacrimal duct obstruction (2021)

Congenital nasolacrimal duct obstruction is a common ophthalmic disease in children with a high incidence. The main clinical manifestation is persistent epiphora soon after birth, sometimes accompanied by an abscess. At present, the treatment methods used include conservative treatment and surgical treatment, but there exist some problems, such as improper surgical indications and non-standard surgical operation. In view of this, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association has reached a consensus after full discussion, in order to standardize the clinical diagnosis and treatment of congenital nasolacrimal duct obstruction in China. (Chin J Ophthalmol, 2021, 57: 814-818).

Chinese expert consensus on the diagnosis and treatment of orbital foreign bodies (2021)

In addition to mechanical injury and secondary infection, long-term retention of orbital foreign bodies can cause inflammation, foreign body granuloma and fistula formation, affecting the appearance and visual function of patients. Trans-orbital craniocerebral foreign bodies can cause severe complications such as craniocerebral injury and intracranial infection. The Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society of Chinese Medical Association has formed the expert consensus on tissue injury, imaging examinations, diagnosis and treatment of orbital foreign bodies, hoping to provide the reference for clinical work and to standardize and improve the diagnosis and treatment of intraorbital foreign bodies. (Chin J Ophthalmol, 2021, 57: 743-748).

Expert consensus on the diagnosis and treatment of dry eye during perioperative period of corneal refractive surgery in China (2021)

The number of corneal refractive surgery in China is increasing year by year, and the quality of surgery is also improved with the trend of diversification and standardization. Dry eye is still one of the common problems associated with corneal refractive surgery. The standardized diagnosis and treatment of dry eye during the perioperative period of corneal refractive surgery is of great significance to improve the postoperative visual quality and satisfaction of patients, and it is also an important part of medical quality control and standardized management in ophthalmology. Therefore, Chinese Optometric Association of Chinese Ophthalmological Society, and the Refractive Surgery Group and the Optometry Group of Chinese Ophthalmologist Association have worked together to address the pathogenesis of dry eye, its evaluation and management before corneal refractive surgery and postoperative nursing care and treatment. The domestic and foreign research findings and the actual clinical situation in China have been considered fully to form this experts' consensus, which could be used as a reference for medical personnel in clinical practice. (Chin J Ophthalmol, 2021, 57: 644-650).

Chinese expert consensus on the diagnosis and treatment of epithelial tumors of the lacrimal gland (2021)

Orbital tumors frequently occur in the regions where the lacrimal gland is located. Lacrimal gland tumors account for about 10% of orbital space-occupying lesions. Among them, 20% to 50% were epithelial tumors, with benign tumors accounting for 55% and malignant tumors accounting for 45%. Epithelial lacrimal gland tumors usually have a special location with relatively distinctive manifestations, and the treatment principle is different from other orbital space-occupying lesions. Improper treatment often leads to recurrence and even malignant transformation, which compromise the prognosis and life quality of patients. In view of this, the Oculoplastic and Orbital Disease Group of Chinese Ophthalmological Society has put forward the expert consensus on the diagnosis and treatment of epithelial lacrimal gland tumors after serious discussion, in order to improve the level of diagnosis and treatment of this disease in China. (Chin J Ophthalmol, 2021, 57: 658-662).

Expert consensus on the clinical diagnosis and treatment of eye burns in China (2021)

Eye burns, which are usually caused by chemicals such as acidic, alkaline and heat-related substances, are true medical emergencies. These substances can lead to potential permanent damage to the eyelids, cornea, ocular surface and intraocular tissues. In severe cases, eye burns may result in blindness. Currently, there is a lack of uniform and standardized guidelines for the diagnosis and treatment of eye burns. As a result, a considerable number of patients have a poor prognosis. Therefore, the Cornea Group of Chinese Ophthalmological Society has developed this consensus statement after thorough discussions, hoping to provide guiding opinions on the clinical diagnosis and treatment of eye burns. (Chin J Ophthalmol, 2021, 57:254-260).

Consensus of experts on diagnosis and treatment of neurotrophic keratitis in China (2021)

Neurotrophic keratitis is a degenerative disease of the cornea caused by impairment in the trigeminal nerve, which can lead to dry eyes, corneal epithelial defects and corneal ulcers. The common causes include herpes virus infection, craniocerebral and ophthalmic surgery injury, and diabetes. Due to the reduced or lack of corneal sensitivity, patients' symptoms are mild, while severe corneal stroma melting or even perforation may occur. And the conventional symptomatic treatment is not effective. In view of the current lack of clinical understanding of this disease, there are a large number of problems of misdiagnosis and mistreatment. To improve the level of diagnosis and treatment, the consensus of experts on diagnosis and treatment of neurotrophic keratitis, which can be used as a reference for ophthalmologists in clinical work, is formulated by the Cornea Group of Chinese Ophthalmological Society. (Chin J Ophthalmol, 2021, 57:90-94).

Cautious about the indication expansion of intraocular refractive surgery

Myopic refractive surgery has developed vigorously in China during the past 30 years, and the number of surgeries is increasing year by year. Since intraocular refractive surgery has a wide range of correction, no need to cut the corneal tissue and a stable visual quality, it has been gradually promoted in clinical practice. Specialists from the Optometry Group of Chinese Ophthalmological Society have given guidance on the ocular indications, age, diopters and other aspects for the posterior chamber intraocular lens implantation. In this article, the authors expound that intraocular refractive surgery should not be recommended for low and moderate myopic eyes, neither for some special occupations at present. The complications of intraocular refractive surgery and the countermeasures are also discussed. The authors also put forward the principles of customized myopic refractive surgery and emphasize that the clinicians should be more cautious about the diopter range selection, occupational need evaluation, individual differences and complications of intraocular refractive surgery. (Chin J Ophthalmol, 2020, 56: 89-92).

Pioneer of Chinese Ophthalmology--130th Anniversary of Beijing Tongren Hospital.

Much has been achieved in clinical and scientific research in the past 130 years by Beijing Tongren Hospital, which has evolved from an eye clinic to a comprehensive hospital with an ophthalmology department known as one of the best in China. This article presents the most historic moments and events in the development of a hospital with the largest eye care service volume. In addition, given the leading position of Tongren, the development of ophthalmology in Tongren is also the epitome of the development of modern ophthalmology in China. Beijing Institute of Ophthalmology (BIO) was established in 1959 as an affiliated institution under Tongren, aiming at carrying out applied science and basic science research, and directors of BIO have thus far served 4 terms as president of the Chinese Ophthalmological Society. In 2002, Beijing Tongren Eye Center (hereafter referred to as the Eye Center) was established to combine all the ophthalmic resources within Tongren. In 2017, the Eye Center alone had a surgical volume of 78,223, with surgeries for cataract, refractive errors, fundus, glaucoma, and corneal disease being the 5 most common, and 902,409 outpatient visits. Equipped with the leading experts and equipment, Tongren is dedicated to the battle against major eye diseases by carrying out large population-based epidemiological surveys and basic science research on pathogenesis and effective treatments, thereby making contributions to the development of the science of ophthalmology along with the delivery of eye care services in China and beyond.

A survey of Chinese ophthalmologists' cognition and practice of evidence-based medicine

Background Evidence-based medicine (EBM) has been widely applied to solve clinical issues internationally,however,the awareness of oculists in China still is dissatisfied,and the relevant issue survey can offer the training guidance.Objective This study was to survey the status of the cognition and practice of EBM in ophthalmologists in China and analyze the problems in their EBM practice.Methods Two hundred and thirty-three ophthalmologists were enrolled in the 18th Congress of Chinese Ophthalmological Society in August,2013.A survey about EBM was performed by self-made questionnaire,including general data from the surveyors,the way and channel of understanding EBM,the attitude toward EBM,clinical practice of EBM and influencing factors.The educational background,professional qualifications,ranked distribution of hospitals which surveyors came from,size of the citys and attribute of hospitals were stratified and analyzed.SPSS 17.0 software was used for statistical analysis.Results A total of 233 questionnaires were distributed,and 233 were regained with the response rate 100％,and 214 valid questionnaires were included,with the effective rate 91.8％.50.5％ of the respondents (104/206) knew EBM in university.The proportion of those believe EBM initially as medical students was 41.8％,and 49.1％ (102/208) were aware of EBM in recent 8 years.And 47.7％ (101/211) believed that EBM should be given priority in clinic,and 7.5％ (16/211) were indifferent to EBM.Only 3.8％ (8/211) surveyors thought EBM to be little important.The proportion of the respondents choosing ‘ know’ or ‘ moderately-know’ were 69.1％ (148/214),35.0％ (75/ 213),21.5％ (46/213) and 57.4％ (121/211) respectively in EBM,Meta analysis,Cochrane as well as Preferred Practice Patterns (PPPs) with a higher receiving degree in well-educated individuals (P =0.000,0.000,0.001,0.000).EBM was well practiced in 11.7％ (25/211) oculists,with a higher using frequency in senior ophthalmologists,and 17.8％ (89/495,frequency) oculists consulted the EBM literature to resolve problems in clinic,with a significant difference in the using frequency of EBM among the different educational background subjects (x2=13.406,P=0.037).The top three barriers which affected the application of EBM in clinical practices were lack of time and the limited energy,feeling it difficult to evaluate the evidence correctly as well as the absence of cases proving the efficacy to treat based EBM.The type of EBM evidence mostly used by respondents was medical database (36.7％),and CNKI (33.5％) and PubMed (38.4％) were the mostly used Chinese and English database,respectively.Respondents who have never searched the Chinese or English database occupied up to 7.3％ and 17.2％,respectively.Conclusions The cognition degree and applying frequency are still lower in ophthalmologists in China.The training of EBM should be strengthened in medical students.The guidance measurement should be taken to encourage eye doctors to apply EBM. Key words: Evidence-based medicine; Ophthalmologist; Cognition; Practice; Attitude; Cross-sectional study ; Questionnaire

Prevalence and influence of diabetic retinopathy in populations at the age of ≥ 40 years in Luzhou City, Sichuan Province in 2011

To estimate the prevalence rate and risk factors of diabetic retinopathy(DR) in residents at the age of ≥ 40 years in Luzhou, Sichuan Province. A multistage, stratified cluster random sampling method was used to select 7 communities of 8002 permanent residents ( ≥ 40 years old) for diabetes screened from May to December 2011 in Luzhou, Sichuan Province.Reference to the diagnostic criteria for diabetes recommended by World Health Organization in 1999, to the 1374 diabetes screening out patients with questionnaire, physical examination, fasting plasma glucose, 2-hours postprandial plasma glucose, glycosylated hemoglobin(HbAlc) and visual acuity, ocular diseases, fundus examination, etc.Some patients with fundus fluorescein angiography to the DR diagnosis, diagnostic criteria with reference to the diagnosis standard made by Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association in 1984. Rates between the groups were compared using χ(2) test, trend χ(2) test or Fisher exact test, using multivariate analysis of risk factors associated with DR screening. A total of 8002 people were chosen and invited to take part in the project, 7478 persons completed the study, the overall response rate was 93.48%.One thousand three hundreds and seventy-four persons were diagnosed as diabetic patients, which took the proportion of 18.37% of the selected population, while 214 DR patients were found with the DR prevalence of 15.57%, occupying 2.86% of the total.Of 214 patients, 194 cases were non-proliferative diabetic retinopathy, making up 90.65% of DR patients, while 7 cases were found to be proliferative diabetic retinopathy, constitute 9.35% of DR patients. Multi-factor analysis manifest that there were close relationship between diabetic duration (trend χ(2) = 189.21, P < 0.01) , the level of HbAlc (χ(2) = 30.021, P < 0.01) , coronary heart disease (χ(2) = 4.075, P = 0.044) and DR prevalence. The prevalence of DR is high in the diabetic residents in Luzhou, Sichuan Province. Diabetic duration, the level of HbAlc and coronary heart disease are the significant factors to influence DR development. These results indicate that the changes of the level of HbAlc are closely related to the genesis and development of DR among the diabetic patients.

The clinical significance of C-peptide for assessing the prognosis of non-proliferative diabetic retinopathy

Background Diabetiretinopathy(DR) icommon ophthalmivasculadisease which can lead to blindness,and itpathogenesiicomplex.C-peptide iby-producin insulin synthesis,and loof studieindicate thaC-peptide iclosely related with diabetimicrovasculacomplications.Objective Thistudy wato explore the clinical significance of the detection of C-peptide to assesthe prognosiof non-proliferative DR(NPDR).Methodretrospective case-observational study wadesigned.The clinical datof 205 casewith NPDwere collected in Wuhan Puren Hospital from January 1,2009 to January 1,2010.The patientwere diagnosed by fundufluorescein angiography (FFA) and the stageof theidiseasewere determined based on the Dstaging developed by the Chinese Ophthalmological Society fundustudy group.Twenty-seven-month follow-up waperformed fothe patientto record the parameterof theiblood biochemistry,changein theiphysical conditions,and changein theiblood pressure and DM.The patientwere assigned to the PDgroup and NPDgroup athe end of the follow-up.The independenrisk factofoNPDwaanalyzed using the univariate analysis,and multivariate logistiregression analysiwaused to evaluate the correlation of varioufactorwith pooprognosiof NPDR.Receiveoperating characteristi(ROC) curve wadrawn to assesthe prediction efficiency of C-peptide fothe prognosiof NPDR.ResultThe clinical datof 205 patientwith NPDwere reviewed,and 15 patientfailed to show up fovisitarate of 7.3％.One hundred and ninety patientwith NPDfinished follow-up with mean age of (41.54± 8.15)years.Of the 190 patients,69 patient(36.3％) advanced to PDR,and 121 patient(63.7％) were NPDduring the follow-up.Significandifferencewere seen in age,hypertension history,smoking history,DM course and C-peptide levelbetween the PDgroup and PDgroup (age:=13.78,P＜0.05 ; hypertension history:x2 =21.57,P＜0.05 ;smocking history:x2 =26.96,P＜0.05;DM course:t=6.89,P＜0.05;C-peptide:t=20.50,P＜0.05).pooprognosiwacorrelated with age (OR:1.04,95％ CI:1.01-1.07),hypertension history (OR:1.05,95％ CI:1.02-1.08),smokinghistory (OR:1.07,95％CI:1.04-1.11),DM course (0R:1.18,95％CI:1.13-1.25) oC-peptide conten(0R:1.09,95％ CI:1.06-1.12).The areundethe ROcurve wa0.835 (P＜0.05,95％ CI:0.818-0.843) when the C-peptide waincluded,buwalarge than 0.769 (P ＜ 0.05,95％ CI:0.754-0.780) when Cpeptide waexcluded.ConclusionThe levelof blood C-peptide are lowein the PDpatientthan those in the NPDpatients,and the lowelevel of blood C-peptide in the NPDpopulation increasetheirisk of developing PDR.Testing foblood C-peptide level can benefithe prognosiof NPDR. Key words: Diabetes mellitus/complication; Retina; Diabetic retinopathy; C-peptide; Prognosis

Investigation of eye bank status quo in China

Explore the status quo of eye bank in each province in China. Design questionnaires according to the eye bank permit standard. Questionnaires were sent to members of Chinese Medical Association Chinese Ophthalmological Society's Cornea Group, large eye hospital and department of ophthalmology in provincial hospital, from February to September 2009. The content involved institution set-up condition of eye bank, request of ground and equipment, personnel, quality management, and propaganda. Subjective questions were also raised about the difficulty and solution. 81 questionnaires were sent out and 59 were replied, in which 18 had no eye bank, and the other 41 had eye banks. More than 35 eye banks equipped with the essential equipment of eye bank; more than 37 (90.2%) did safe detection through blood; 34 (82.9%) eye banks' supply was unable to meet the demand; 32 eye banks (78.0%) in iteratively promoted cornea donation. 24 eye banks reflected that the most important difficulty was unsound of the law, and legislation was to petition; 17 reflected the insufficient of funds; 14 reflected the lack of the unified standard; and 12 advocated the consciousness of contribution. Most of the eye banks in China have the essential hardware equipment and the quality management, but the unbalanced development and the lack of the unified management. The supply of cornea donator is unable to meet the demand.

Eoidemiologic studay on the prevalence rate and risk factors of diabetic retinopathy in eastern countryside of Changzhi

Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Changzhi. Methods With the help of an established resident health data, a epidemiology study was performed on 63 409 residents (≥15 years old) in the rural area of Changzhi; while the standard of diagnosis of diabetes was in accordance with the standard made by WHO in 1997. Diabetes was diagnosed in 2632 residents, and these patients underwent the investigation and examination including the disease history, glycosylated hemoglobin (HbAlc), fasting blood glucose, visual acuity, ocular diseases and intraocular pressure. The standard of DR was drawn according to the diagnosis standard made by Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association in 1985. The data was statistically analyzed by SPSS 13.0 software. Results A total of 57 500 residents underwent the examination with the participating rate of 90.68% ; 2632(4. 58%) were diagnosed as with diabetes, in whom 986 were with DR (with DR prevalence of 37.46%). The duration of diabetes was the independent risk factor of DR (r=0. 210,P<0. 001). The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The visual acuity in residents with or without DR differed significantly(P<0.01). The level of HbA1c was positively related to DR. Conclusions The incidence of DR is high in residents with diabetes in eastern countryside area of Changzhi. The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The level of HbAlc may be the important indicator which can monitor the occurrence and development of DR in patients with diabetes. Key words: Diabetic retinopathy/epidemiology; Diabetic retinopathy/diagnosis; Epidemiologic methods

World Ophthalmology Congress 2008 in Hong Kong

The World Ophthalmology Congress 2008 was sponsored by the International Council of Ophthalmology, hosted by the College of Ophthalmologists of Hong Kong and the Hong Kong Ophthalmological Society, and co-hosted by the Asia Pacific Academy of Ophthalmology and the Chinese Ophthalmological Society. The World Ophthalmology Congress 2008 was held in conjunction with the 31st International Congress of Ophthalmology, the 23rd Congress of Asia Pacific Academy of Ophthalmology, the 13th Congress of Chinese Ophthalmological Society and the 20th Hong Kong Ophthalmological Symposium. World Ophthalmology Congress 2008 was attended by over 13,300 delegates and exhibitors from more than 100 countries, with over 3000 participants coming from the People’s Republic of China. The Congress was supported by over 150 corporate partners from more than 22 countries. The strength of any scientific congress lies in the quality of the scientific program. The Scientific Program Committee of the World Ophthalmology Congress 2008 was chaired by Steve Ryan. Under his able leadership, a 5-day scientific program in 18 subspecialty areas was staged, with over 1100 prominent, international speakers presenting in 319 scientific sessions, many of them organized by more than 40 international, supranational, national and subspecialty ophthalmologic societies. In addition, there were also three subspecialty day programs in Cataract and Refractive Surgery, Glaucoma and Retina, a World Ophthalmic Education Colloquium and a Chinese program organized by the Chinese Ophthalmological Society. The submitted scientific program included over 170 free paper presentations, over 3700 poster presentations and more than 100 video presentations.

Free Papers

World Ophthalmology Congress 2008 was held in conjunction with the 31st International Congress of Ophthalmology, the 23rd Congress of Asia Pacific Academy of Ophthalmology, the 13th Congress of Chinese Ophthalmological Society and the 20th Hong Kong Ophthalmological Symposium

To strengthen the academic morality standard for promoting the further development of ophthalmology

It is imperative and urgent to strength the academic ethic construction in ophthalmology in China. In the rapid development of ophthalmology in recent years, there exit some manifests of academic ethic anomy and unhealthy climate. We should adopt some effective measures to standardize the academic behavior, and clean and create the favourable academic behavior, in order to promote the academic activities in ophthalmology. The rule on the academic ethic standard by Chinese Ophthalmological Society published in this journal is an important measure for strengthening the academic ethic construction in ophthalmology, and deserve to be noted and practiced by all of ophthalmologists and visual researchers.