Diabetic Retinopathy Cases Research Articles

A Review on Recent Techniques For grading the Severity of Diabetic Retinopathy in Retinal Colour Fundus Images

Diabetic retinopathy (DR) is an eye disease, which is caused by the development of retinal microvascularization following diabetes. It is a problem of diabetes mellitus, which produces lesions in the surface of the retina due to which eye vision gets affected. Severe, uncontrolled cases of diabetic retinopathy will result in blindness. Since DR cannot be reversed, it can lead to blindness, and only early treatment maintains vision. Early diagnosis and treatment of DR can significantly reduce The risk of losing the vision. Fundus images are manually examined for morphological changes in retinal lesions such as micro aneurysms, exudates, blood vessels, hemorrhages. They are a tedious and time-consuming job. It is often easily accomplished with the help of a computer-assisted system. The identification and classification of the severity of diabetic retinopathy requires adequate segmentation of the retinal lesions. In this article, various techniques for detecting retinal lesions are discussed for the final detection and classification of nonproliferative diabetic retinopathy. Blood vessel detection techniques for diagnosing proliferative diabetic retinopathy are also discussed. In addition, the available datasets for the fundus colored retina were also examined. This work will be useful for researchers and technicians who wish to use ongoing research in this area. Several challenging topics are also discussed that require further investigation.

Efficacy of artificial intelligence-based screening for diabetic retinopathy in type 2 diabetes mellitus patients

AimTo explore the efficacy of artificial intelligence (AI)-based screening for diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients. MethodsData were obtained from 549 T2DM patients who visited the Fundus Disease Center at Henan Provincial People’s Hospital from 2018/10–2020/09. DR identification and grading were conducted by two retina specialists, EyeWisdom®DSS and EyeWisdom®MCS, with ophthalmologist grading as reference standard, efficacy of EyeWisdom was evaluated according to sensitivity, specificity, positive predictive value, and negative predictive value. ResultsOphthalmologists detected 324 DR cases. Among them, there were 43 of mild non-proliferative DR (NPDR), 79 of moderate NPDR, 61 of severe NPDR, and 141 of proliferative DR (PDR). EyeWisdom®DSS detected 337 DR and EyeWisdom®MCS detected 264 DR. Sensitivity and specificity of EyeWisdom®DSS were 91.0%(95 %CI: 87.3%–93.8%) and 81.3% (95 %CI: 75.5%–86.1%), while EyeWisdom®MCS correctly identified 76.2%(95 %CI: 71.1%–80.7%) of patients with DR and 92.4%(95 %CI: 87.9%–95.4%) of patients without DR. EyeWisdom®DSS showed 76.5%(95 %CI: 69.6%–82.3%) sensitivity and 78.4%(95 %CI: 73.7%–82.5%) specificity for detecting NPDR and 64.5%(95 %CI: 56.0%–72.3%) sensitivity and 93.1%(95 %CI: 90.1%–95.3%) specificity for diagnosing PDR. ConclusionEyeWisdom®DSS is effective in screening for DR, and the accuracy of EyeWisdom®MCS was higher for identifying patients without DR. It is valuable to carry out AI-based DR screening in poorer regions.

Plasma Levels and Diagnostic Significance of miR-335-3p and EGFR in Diabetic Retinopathy.

Diabetic retinopathy (DR) is the common complication of diabetes, accounting for most blindness cases worldwide. MicroRNAs (miRs) are small non-coding RNAs and participate in the pathogenesis and develop-ment of various diseases, including DR. The present study aimed to investigate miR-335-3p and vascular endothelial growth factor (EGFR) roles in DR diagnosis and development. A total of 104 healthy volunteers, 96 type 2 diabetes mellitus (T2DM) patients, and 102 DR cases were enrolled in this study. The clinicopathological information of all subjects were collected and analyzed using chisquared test. After collecting plasma from each participant, a ROC assay was conducted to determine the dis-criminative value of miR-335-3p and EGFR in DR diagnosis. The targeted relationship between miR-335-3p and EGFR was examined by dual-luciferase reporter assay and correlation analysis. After exposing APRE-19 cells to different concentrations of high glucose (HG), the DR in vitro cell model was constructed. The expression levels of miR-335-3p and EGFR were detected using RT-qPCR. The effects of miR-335-3p and EGFR on HG-treated APRE-19 cell viability were determined by CCK-8 assay. Clinicopathological information presented that BMI index, fasting blood glucose (FBP), 2h-BG, HbA1c, miR-335-3p, and EGFR levels were strongly associated with DR pathogenesis. MiR-335-3p was significantly decreased while EGFR was increased in DR patients and HG-treated APRE-19 cells. MiR-335-3p and EGFR presented high accuracy, sensitivity, and specificity in differentiating DR from healthy cases and T2DM patients; moreover, miR-335-3p and EGFR could also discriminate proliferative DR (PDR) cases from healthy controls. After confirming that miR-335-3p was negatively correlated with its target EGFR, we found miR-335-3p could increase the viability in HG-treated APRE-19 cells while silencing of EGFR could also reverse the inhibitory effects of HG conditions on APRE-19 cell viability. We concluded that plasma miR-335-3p and EGFR may be utilized as non-invasive biomarkers for screening DR cases, contributing to DR diagnosis and treatment.

Awareness about Eye Health in Kerala

Awareness about Eye Health in Kerala

Анти-VEGF-терапия диабетического макулярного отека: актуальные подходы к ведению пациентов с высокими и низкими исходными функциональными параметрами

Diabetic macular edema (DME) is a serious complication of diabetes mellitus (DM) and a vision-threatening condition which can lead to irreversible blindness. Its prevalence correlates with the number of cases of DM and diabetic retinopathy and demonstrates a stable upward trend. Though modern medicine has made tremendous strides and developed several options for DME treatment which comply with the efficacy and safety criteria from a perspective of evidence-based medicine, DME remains a challenge in the clinical practice. There is no doubt that the key role is played by anti-angiogenic (anti-VEGF) therapy which has become the gold standard treatment for DME and is supported by a strong evidence base. However, some aspects of this method application are understudied. Thus, most of the randomized clinical studies (RCSs) of anti-VEGF therapy included patients with the "averaged" baseline values of visual acuity (within the range of 23–79 letters using ETDRS chart / 0.06–0.7 in decimal system). But in real clinical practice ophthalmologists often observe atypical DME cases where the baseline visual acuity values fall outside the range described in RCSs. The present literature review is aimed at considering tactics of the rational management of patients with atypically low and high baseline visual functions and provides analysis of the recent publications in which the outcomes of anti-VEGF therapy are discussed in the context of this problem. Keywords: macular edema, anti-VEGF therapy, diabetic retinopathy, diabetes, diabetic macular edema, high visual acuity, low visual acuity. For citation: Bobykin E.V. Anti-VEGF therapy for diabetic macular edema: up-to-date approaches to the management of patients with high and low baseline functional parameters. Russian Journal of Clinical Ophthalmology. 2022;22(3):181–186 (in Russ.). DOI: 10.32364/2311-7729- 2022-22-3-181-186.

Glycemic Variability and Other Risk Factors for Diabetic Retinopathy

Background: Hyperglycemia is a known risk factor for diabetic retinopathy (DR) but the association between glycemic variability and DR is unclear. We aim to evaluate the glycemic variability in DR through retrospective continuous glucose monitoring (CGM) and assess its effect on the clinical profile of participants with or without DR. Material and Methods: Retrospective observational hospital-based case-control study. We collected anthropometric and clinical data of 74 people with type 2 diabetes from our ophthalmology database whose retrospective CGM data were available. Among them, 37 had DR (cases) and 37 did not have DR (controls). The data were analyzed using SPSS version 27. Results: Duration of diabetes and glycosylated hemoglobin (HbA1c) was significantly higher and the estimated glomerular filtration rate (eGFR) was significantly lower in the cases compared to the controls. CGM markers, like time-above-range, average glucose, glucose management indicator, were higher while time-in-range was lower in the cases compared to the controls (P = ns). Time-below-range targets in people >65 years were met in a lower proportion (p < 0.05) of people in the cases (50%) compared to the controls (92%). Conclusion: Duration of diabetes, low eGFR, and high HbA1c showed significant association with retinopathy in type 2 diabetes. Although markers of glycemic variability did not show a statistically significant difference in cases compared to controls, all indices of glycemic variability were numerically higher in people with DR. Hypoglycemia in elderly participants with DR and its implications on achieving targets requires more research.

ResNet-34/DR: A Residual Convolutional Neural Network for the Diagnosis of Diabetic Retinopathy

Diabetic retinopathy (DR) is an eye complication associated with diabetes, resulting in blurred vision or blindness. The early diagnosis and treatment of DR can decrease the risk of vision loss dramatically. However, such diagnosis is a tedious and complicated task due to the variability of retinal changes across the stages of the diseases, and due to the high number of undiagnosed and untreated DR cases. In this paper, we develop a computationally efficient and scalable deep learning model using convolutional neural networks (CNN), for diagnosing DR automatically. Various preprocessing algorithms are utilized to improve accuracy, and a transfer learning strategy is adopted to speed up the process. Our experiment used the fundus image set available on online Kaggle datasets. As an ultimate conclusion of applicable performance metrics, our computational simulation achieved a relatively-high F1 score of 93.2% for stage-based DR classification.

Chemerin/CMKLR1 Axis Promotes the Progression of Proliferative Diabetic Retinopathy.

Background Diabetic retinopathy (DR) is a prevalent microvascular complication of diabetes, and the levels of chemerin were associated with the severity of DR. However, there is no research on chemerin in the development of proliferative diabetic retinopathy (PDR). Therefore, our study aimed to explore the relationship between chemerin and PDR. Methods The levels of chemerin/chemokine-like receptor (CMKLR1), proinflammatory cytokines, and vascular endothelial growth factor (VEGF) in 90 cases of PDR and nonproliferative diabetic retinopathy (NPDR) patients and in high glucose (HG) stimulated human retinal pigment epithelium cells (ARPE-19) were evaluated by ELISA. Moreover, chemerin was added into HG-induced ARPE-19 cells to assess its effect on proinflammatory cytokines and VEGF. Results The levels of chemerin/CMKLR1 were higher in PDR patients than NPDR ones, and chemerin was positively correlated with CMKLR1 in PDR patients. Compared to NPDR, the secretions of proinflammatory cytokines and VEGF were increased in PDR patients and positively correlated with chemerin/CMKLR1. Additionally, chemerin activated CMKLR1 and aggravated HG-induced cell injury, inflammatory responses, and VEGF expressions in ARPE-19 cells. Conclusion Our study demonstrated that chemerin/CMKLR1 axis aggravated the progression of PDR, which suggested that inhibition of chemerin might serve as a new therapeutic approach to treat PDR.

The rs2442598 polymorphism in the ANGPT-2 gene is associated with risk for diabetic retinopathy in patients with type 1 diabetes mellitus in a Brazilian population.

As studies have reported the involvement of angiopoietin-2 (ANGPT-2) in the pathogenesis of diabetic retinopathy (DR), the aim of this study was to investigate the association between the ANGPT-2 rs2442598 polymorphism and DR. This case-control study comprised 107 patients with type 1 diabetes mellitus (T1DM) and DR (cases) and 129 patients with T1DM without DR (controls) and with ≥ 10 years of DM. The ANGPT-2 rs2442598 (G/A) polymorphism was genotyped by real-time PCR using TaqMan MGB probes. Genotype distributions of this polymorphism were consistent with the Hardy-Weinberg equilibrium. The frequency of the rs2442598 A allele was higher in cases compared to controls (p = 0.011). Moreover, the A/A genotype was more frequent in cases than in controls (p = 0.017) and was associated with risk for DR after adjustments for duration of DM, HbA1c, triglycerides, estimated glomerular filtration rate, and hypertension (odds ratio [OR] = 5.19, 95% confidence interval [CI] 1.21-22.27). This association was maintained under recessive (OR = 4.78, 95% CI 1.14-19.99) and additive (OR = 6.861, 95% CI 1.45-32.38) inheritance models. Our data demonstrated, for the first time, an association between the ANGPT-2 rs2442598 A allele and risk for DR in T1DM patients from southern Brazil. Additional studies are necessary to replicate this association in other populations.

Association of Generalized and Abdominal Obesity with Diabetic Retinopathy in Chinese Type 2 Diabetic Patients.

Obesity has been proposed to promote the progression of diabetic retinopathy (DR), but previous studies have not shown consistent results. We aimed to explore the association between generalized and abdominal obesity and DR risk, and to assess the joint effect of these two different types of obesity on DR development. A nested case-control study within a large prospective study on type 2 diabetes was conducted in communities in Huai'an City, Jiangsu Province, China. Cases were individuals who had diagnoses of DR during the 6-year follow-up. A total number of 1544 DR cases and 1:1 matched controls were included. Binomial and multinomial logistic regression models were used to investigate the effects of obesity on DR occurrence and DR severity. Compared with individuals in the first tertile of the baseline waist-to-hip ratio (WHR), subjects in the third tertile at baseline had significantly higher risk of DR (OR 1.44, 95% CI 1.17-1.78) during the follow-up period. Conversely, body mass index (BMI) (continuous) had an adjusted OR of 0.97 (95% CI 0.95-0.99) of developing DR. Individuals with low BMI and high WHR levels were identified as a high-risk population with a higher likelihood of developing DR (OR 1.65, 95% CI 1.17-2.33) than those in the lowest BMI category and simultaneously in the first WHR tertile. Type 2 diabetic individuals with low BMI levels and high WHR levels had a significantly increased risk of developing DR which indicated that isolated abdominal obesity might be involved in the pathogenesis of DR.

Screening Diabetic Retinopathy Using an Automated Retinal Image Analysis System in Independent and Assistive Use Cases in Mexico: Randomized Controlled Trial.

BackgroundThe automated screening of patients at risk of developing diabetic retinopathy represents an opportunity to improve their midterm outcome and lower the public expenditure associated with direct and indirect costs of common sight-threatening complications of diabetes.ObjectiveThis study aimed to develop and evaluate the performance of an automated deep learning–based system to classify retinal fundus images as referable and nonreferable diabetic retinopathy cases, from international and Mexican patients. In particular, we aimed to evaluate the performance of the automated retina image analysis (ARIA) system under an independent scheme (ie, only ARIA screening) and 2 assistive schemes (ie, hybrid ARIA plus ophthalmologist screening), using a web-based platform for remote image analysis to determine and compare the sensibility and specificity of the 3 schemes.MethodsA randomized controlled experiment was performed where 17 ophthalmologists were asked to classify a series of retinal fundus images under 3 different conditions. The conditions were to (1) screen the fundus image by themselves (solo); (2) screen the fundus image after exposure to the retina image classification of the ARIA system (ARIA answer); and (3) screen the fundus image after exposure to the classification of the ARIA system, as well as its level of confidence and an attention map highlighting the most important areas of interest in the image according to the ARIA system (ARIA explanation). The ophthalmologists’ classification in each condition and the result from the ARIA system were compared against a gold standard generated by consulting and aggregating the opinion of 3 retina specialists for each fundus image.ResultsThe ARIA system was able to classify referable vs nonreferable cases with an area under the receiver operating characteristic curve of 98%, a sensitivity of 95.1%, and a specificity of 91.5% for international patient cases. There was an area under the receiver operating characteristic curve of 98.3%, a sensitivity of 95.2%, and a specificity of 90% for Mexican patient cases. The ARIA system performance was more successful than the average performance of the 17 ophthalmologists enrolled in the study. Additionally, the results suggest that the ARIA system can be useful as an assistive tool, as sensitivity was significantly higher in the experimental condition where ophthalmologists were exposed to the ARIA system’s answer prior to their own classification (93.3%), compared with the sensitivity of the condition where participants assessed the images independently (87.3%; P=.05).ConclusionsThese results demonstrate that both independent and assistive use cases of the ARIA system present, for Latin American countries such as Mexico, a substantial opportunity toward expanding the monitoring capacity for the early detection of diabetes-related blindness.

Increased serum cortisol is associated with alterations in cross-sectional and topographic OCT parameters in diabetic retinopathy: a preliminary study.

Cortisol, a steroid hormone, plays an essential role in metabolic processes of diabetes mellitus. This study for the first time evaluated the association of serum cortisol with spectral domain optical coherence tomography (SD-OCT)-based cross-sectional and topographic parameters with severity of diabetic retinopathy (DR). A tertiary care center-based preliminary study was undertaken. Fourteen consecutive cases of DR and fifteen healthy controls were included. Cases were graded according to ETDRS classification: non-proliferative DR (NPDR, n = 8) and proliferative DR (PDR, n = 6). All study subjects underwent complete ophthalmological evaluation. Serum cortisol was analyzed using chemiluminescence microparticle assay method. Central subfield thickness (CST), cube average thickness (CAT), cube volume (CV), retinal nerve fiber layer (RNFL) thickness, disorganization of inner retinal layers (DRIL), grade of retinal photoreceptor ellipsoid zone (EZ) disruption and grade of retinal pigment epithelium (RPE) alterations were evaluated using SD-OCT. Statistical analysis was done using ANOVA and Pearson's correlation analysis. Mean serum cortisol levels (µg/dL) were NPDR = 11.59 ± 0.42, PDR = 14.50 ± 0.26 and controls = 8.22 ± 0.77. With increasing severity of DR, mean CST, CAT, CV showed positive correlation, whereas mean RNFL thickness showed negative correlation with serum cortisol levels (p < 0.01). DRIL, EZ disruption and RPE alterations showed positive correlation with serum cortisol levels (p < 0.001). Serum cortisol levels are significantly associated with severity of DR and correlate positively with CST, CAT, CV, DRIL, EZ disruption and RPE alterations and negatively with RNFL thickness.

Outcome of cataract surgery in eyes with diabetic retinopathy: a Swedish national cataract register report.

To analyse if patients with diabetic retinopathy (DR) subjected to cataract surgery differ in outcome compared to patients without DR with regard to best-corrected visual acuity (BCVA), deviation from target refraction, intraoperative difficulties and risk of complications. A register-based study from the Swedish National Cataract Register (NCR) during the years 2015-2017 including 358 040 cataract procedures. Patients with other ocular pathology than cataract and DR were omitted from outcome analyses. Diabetic retinopathy was reported in 13 724 of all eyes (3.8%). Preoperative BCVA was significantly worse in DR patients than in patients without DR, 0.54 ± 0.33 compared to 0.40 ± 0.27 (logMAR, mean ± SD, p < 0.001). The same was evident for postoperative BCVA, 0.15 ± 0.25 for DR patients versus 0.06 ± 0.13 (p < 0.001). The improvement in BCVA was slightly better in DR than in non-DR, -0.40 ± 0.32 (logMAR; mean ± SD) versus -0.35 ± 0.27, p < 0.001. The absolute mean biometry prediction error was 0.42 ± 0.50 diopters (D) in DR and 0.43 ± 0.71 D in non-DR patients, p = 0.768. One or more intraoperative difficulties, including mechanical pupil dilation, capsular stain, hooks at capsulorhexis margin or capsular tension ring, had an adjusted odds ratio (OR) of 1.75 (95% confidence interval [CI] 1.61-1.90, p < 0.001) in DR versus non-DR cases and the rate of posterior capsular tears (PCR) had an adjusted OR of 1.76 (95% CI 1.40-2.20, p < 0.001). Eyes with DR have inferior pre- and postoperative BCVA compared to non-DR eyes. There is little difference in improvement of BCVA and no difference in absolute mean biometry prediction error. Importantly, intraoperative difficulties and PCRs are almost twice as common in DR patients, strongly indicating that these patients should be managed by experienced surgeons.

Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India.

Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.

The rs2442598 Polymorphism in ANGPT-2 Gene Is Associated With Risk for Diabetic Retinopathy in Patients With Type 1 Diabetes Mellitus From a Brazilian Population

Introduction: Angiopoietin-2 (ANGPT-2) is a member of a growth factor family that binds to the endothelial receptor tyrosine kinase 2 and regulates vascular development and function. Under hyperglycemic conditions, ANGPT-2 is upregulated and leads to vascular destabilization, pericyte dropout, and aggravation of inflammation. In this context, studies have reported the involvement of ANGPT-2 in the pathogenesis of diabetic retinopathy (DR). Thus, polymorphisms in ANGPT-2 gene may be of interest in this field. Objective: To investigate the association between the rs2442598 polymorphism in the ANGPT-2 gene and DR. Methods: This case-control study comprised 107 patients with type 1 diabetes mellitus (T1DM) and DR (cases) and 129 patients with T1DM without DR (controls) and with ≥10 years of DM. The ANGPT-2 rs2442598 (G/A) polymorphism was genotyped by real-time PCR using TaqMan MGB probes. Results: Genotype distributions of this polymorphism were consistent with Hardy-Weinberg Equilibrium. Frequency of the rs2442598 A allele was higher in cases compared to controls (P= 0.011). Moreover, the A/A genotype was higher in cases than controls (P= 0.017) and was associated with risk for DR after adjustment for duration of DM, HbA1c, triglycerides, estimated glomerular filtration rate, and presence of hypertension (OR= 5.19, IC95% 1.21 - 22.27). This association was maintained under the recessive (OR= 4.78, IC95% 1.14 - 19.99) and additive (OR= 6.861, IC95% 1.45 - 32.38) inheritance models. Conclusion: Our data demonstrate, for the first time, the association of the ANGPT-2 rs2442598 A allele with risk for DR in T1DM patients from Southern Brazil.

Plasma miR-26a-5p is a biomarker for retinal neurodegeneration of early diabetic retinopathy.

Retinal neurodegeneration is an early pathological change in diabetic retinopathy (DR). Early-stage retinal neurodegeneration is usually asymptomatic. This study aims to identify circulating microRNAs (miRNAs) as sensitive biomarkers for early retinal neurodegeneration. We profiled the plasma miRNA expression in three mild nonproliferative diabetic retinopathy (NPDR) cases and three matched non-DR patients using RNA sequencing. The differential miRNAs were validated with qRT-PCR. The retinal nerve fibre layer (RNFL) thickness of the eyes was measured using spectral-domain Optical coherence tomography (SD-OCT). The association between differential miRNAs and RNFL thickness was analysed using the Pearson correlation analysis. Bioinformatics tools were used to predict potential targets of miRNA associated with RNFL thickness and investigate the functions of the potential target genes. RNA sequencing identified 69 differential miRNAs and eight of them were reported to be associated with DR. The qRT-PCR for these eight miRNAs validated the down-regulation of circulating miR-26a-5p and miR-126-5p in a larger validating cohort. A positive correlation between plasma miR-26a-5p level and the RNFL thickness of the superior quadrant of both eyes was identified in another cohort, including 33 mild NPDR cases, 33 matched non-DR patients and 20 healthy controls. Furthermore, 367 candidate targets of miR-26a-5p were predicted. The functional studies revealed that these target genes are profoundly involved in various cellular functions and signalling pathways. Circulating miR-26a-5p is a potential biomarker for early-stage retinal neurodegeneration and it may be involved in the development of DR via profoundly influencing the functions of retinal cells.

Influence of serum lipids on clinically significant macular edema in type 2 diabetic retinopathy cases

Background: Diabetic retinopathy (DR), a paramount microvascular complication of diabetes mellitus (DM), has a significant impact on the world’s health system. Up to 30 percent of patients with clinically significant macular oedema (CSME) will develop moderate visual loss. Other than diabetes, several systemic factors like dyslipidemia play an important role in the pathogenesis of DME. Thus, addressing these additional risk factors, in addition to adequate control of blood glucose helps to prevent and reverse maculopathy to some extent, thereby preserving their vision. Materials and Methods: This study was done on 150 patients with type 2 diabetes mellitus, presenting to the outpatient department of ophthalmology of a tertiary care hospital, with CSME in either or both eye(s). A detailed history of each of these patients was taken and a comprehensive ophthalmic evaluation of anterior and posterior segments was done. Following Biochemical tests were carried out: 1. fasting blood glucose and post prandial blood glucose, 2. fasting lipid profile (serum total cholesterol, serum triglycerides, LDL-cholesterol, HDL-cholesterol, and VLDL-cholesterol). Dyslipidaemia was defined by using national cholesterol education program–adult treatment panel III (NCEP ATP III) guidelines. Accordingly, dyslipidemia was identified, when at least one of the Fasting lipid profile parameters crossed the desirable range. Statistical Analysis: Data obtained from Diabetic Retinopathy cases was analysed using chi-square test. Results: A total of 150 patients of either gender, between the age groups 30-70 years, were enrolled into the study after applying inclusion and exclusion criterias. Dyslipidemia was present in 101/150 (67.3%) patients. LDL-cholesterol level was significantly high, whereas Total Cholesterol, Triglycerides and VLDL showed borderline high values. Further, the occurrence of CSME showed a statistically significant correlation with LDL in majority of

Association of Erythropoietin Gene Polymorphisms With Type 2 Diabetic Retinopathy in Adult Patients From Northern India

ObjectivesOur aim in this study was to determine the association of erythropoietin (EPO) gene polymorphisms with diabetic retinopathy in patients with type 2 diabetes from northern India. MethodsIn this case-control study, we recruited 614 participants, consisting of 302 diabetic retinopathy cases and 312 individuals with confirmed type 2 diabetes without retinopathy as controls. EPO polymorphism analysis was performed in all participants using polymerase chain reaction and direct DNA sequence analysis. ResultsThe genotype distribution and allele frequency of the c.246+265G>A (rs507392) polymorphism differed significantly (p<0.05) between the retinopathy and control groups. For the −1306C>A (rs1617640) polymorphism, genotype distribution among the 2 groups analyzed differed significantly (p=0.047), but the distribution of allele frequency was not found to be statistically significant (p=0.07). For the c.∗772G>T (rs551238) variant, genotype distribution did not differ significantly when comparing the 2 groups (p=0.062), but allele frequency distribution did differ significantly (p=0.045). For the polymorphisms analyzed, namely rs507392 and rs1617640, a statistically significant association with retinopathy was observed (dominant model: adjusted odds ratio [OR], 2.23; 95% confidence interval [CI], 1.36 to 3.35; p<0.01; codominant model: adjusted OR, 1.45; 95% CI, 1.00 to 2.09; p=0.048). However, no significant association between c.∗772G>T (rs551238) polymorphism and diabetic retinopathy was found. ConclusionsOur findings show 2 polymorphisms (c.246+265G>A [rs507392] and −1306C>A [rs1617640]) in EPO to be risk factors for type 2 diabetic retinopathy in a northern Indian cohort. To our knowledge, this is the first report from India to demonstrate an association between EPO gene polymorphisms and retinopathy.

Automated feature-based grading and progression analysis of diabetic retinopathy

BackgroundIn diabetic retinopathy (DR) screening programmes feature-based grading guidelines are used by human graders. However, recent deep learning approaches have focused on end to end learning, based on labelled data at the whole image level. Most predictions from such software offer a direct grading output without information about the retinal features responsible for the grade. In this work, we demonstrate a feature based retinal image analysis system, which aims to support flexible grading and monitor progression.MethodsThe system was evaluated against images that had been graded according to two different grading systems; The International Clinical Diabetic Retinopathy and Diabetic Macular Oedema Severity Scale and the UK’s National Screening Committee guidelines.ResultsExternal evaluation on large datasets collected from three nations (Kenya, Saudi Arabia and China) was carried out. On a DR referable level, sensitivity did not vary significantly between different DR grading schemes (91.2–94.2.0%) and there were excellent specificity values above 93% in all image sets. More importantly, no cases of severe non-proliferative DR, proliferative DR or DMO were missed.ConclusionsWe demonstrate the potential of an AI feature-based DR grading system that is not constrained to any specific grading scheme.

Comparison of Ocular Lens Thickness of Type-2 Diabetic Retinopathy Patients with Non-diabetic Control, Measured by High Resolution Ultrasonography

Background &amp; objective: The aim of this study was to verify whether the ocular lens of type-2 diabetic retinopathy patients was thicker (measured by high resolution Ultrasonography) than those of non-diabetic individuals.The study also evaluated the differences in lens thickness (LT) between right and left eyes of diabetic retinopathy patients, and the differences in LT between proliferative and background retinopathy cases.&#x0D; Methods: This case-control study was conducted on 68 subjects (34 cases and 34 controls) aged 20-60 years in the Department of Radiology and Imaging, BIRDEM Hospital from March 2015 to February 2016. Adult patients suffering from type-2 diabetic retinopathy confirmed by slit-lamp examination were selected as cases, while apparently healthy subjects were taken as control. Patients with history of heart failure, ocular surgery, acute eye conditions, such as, conjunctivitis, scleritis, cataract or any other co-morbidities were excluded. Ocular mean lens thickness was measured by high resolution ultrasonography and was compared between case and control groups by Un-paired t-Test.&#x0D; Results: The study showed that type 2 diabetic patients had significantly thicker lenses than their non-diabetic counterparts (in right eye:case 4.1 ± 0.3 mm versus control 3.7±0.1 mm, p&lt;0.001 and in left eye:case 4.2 ± 0.3 mm vs. control 3.7±0.1 mm, p&lt;0.001). The study also revealed that proliferative retinopathy cases had thicker lenses than any other diabetic retinopathy groups (p &lt; 0.05) and there was also statistically significant difference of HbA1c level between proliferative and background type II diabetic retinopathy cases (p&lt;0.05)&#x0D; Conclusion: The study concluded that lens thickness is increased in type-2 diabetic retinopathy patients than that in non-diabetic healthy controls.The proliferative diabetic retinopathy cases possess thicker lens than the background retinopathy cases.&#x0D; Ibrahim Card Med J 2020; 10 (1&amp;2): 40-44