Diabetic Eye Research Articles

Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening

IntroductionRural versus urban disparities have been observed in diabetic eye screening, but whether the level of disadvantage in rural versus urban areas is related to these disparities is unclear. Our...

Impact of Artificial Intelligence Assessment of Diabetic Retinopathy on Referral Service Uptake in a Low-Resource Setting: The RAIDERS Randomized Trial.

This trial was designed to determine if artificial intelligence (AI)-supported diabetic retinopathy (DR) screening improved referral uptake in Rwanda. The Rwanda Artificial Intelligence for Diabetic Retinopathy Screening (RAIDERS) study was an investigator-masked, parallel-group randomized controlled trial. Patients ≥ 18 years of age with known diabetes who required referral for DR based on AI interpretation. The RAIDERS study screened for DR using retinal imaging with AI interpretation implemented at 4 facilities from March 2021 through July 2021. Eligible participants were assigned randomly (1:1) to immediate feedback of AI grading (intervention) or communication of referral advice after human grading was completed 3 to 5 days after the initial screening (control). Difference between study groups in the rate of presentation for referral services within 30 days of being informed of the need for a referral visit. Of the 823 clinic patients who met inclusion criteria, 275 participants (33.4%) showed positive findings for referable DR based on AI screening and were randomized for inclusion in the trial. Study participants (mean age, 50.7 years; 58.2% women) were randomized to the intervention (n= 136 [49.5%]) or control (n= 139 [50.5%]) groups. No significant intergroup differences were found at baseline, and main outcome data were available for analyses for 100% of participants. Referral adherence was statistically significantly higher in the intervention group (70/136 [51.5%]) versus the control group (55/139 [39.6%]; P= 0.048), a 30.1% increase. Older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.05; P < 0.0001), male sex (OR, 2.07; 95% CI, 1.22-3.51; P= 0.007), rural residence (OR, 1.79; 95% CI, 1.07-3.01; P= 0.027), and intervention group (OR, 1.74; 95% CI, 1.05-2.88; P= 0.031) were statistically significantly associated with acceptance of referral in multivariate analyses. Immediate feedback on referral status based on AI-supported screening was associated with statistically significantly higher referral adherence compared with delayed communications of results from human graders. These results provide evidence for an important benefit of AI screening in promoting adherence to prescribed treatment for diabetic eye care in sub-Saharan Africa.

Artificial intelligence for diabetic retinopathy screening

AbstractDiabetes constitutes a significant problem for global health and wellbeing. The number of people living with diabetes raised from 108 million in 1980 to 422 million in 2014. By 2035, 592 million people will have diabetes, with the largest rise in low‐ and middle‐income regions. Diabetic retinopathy (DR) is one of the major complications of diabetes, estimated to be the leading cause of blindness among working‐age adults globally. The increasing worldwide population, coupled with increasing prevalence of diabetes and increased incidence of diabetic retinopathy all lead to increasing number of patients with ocular complications of diabetes. Only a few countries were able to successfully establish and continue diabetic retinopathy screening on national level, most prominently – United Kingdom and Singapore. The NHS Diabetic Eye Screening Programme, a continuation of an English screening programme set up in 2006, reported in 2014 that DR is no longer the leading cause of certifiable blindness in England and Wales for the first time in 50 years. The advent of deep‐learning based DR detection revealed a significant improvement in the accuracy of the newly developed or improved systems. It requires a careful balance between sensitivity and specificity, imaging modality, gradeability of the images, all of which will need to be weighed against the potential cost. Deep learning DR detection has been found to be cost‐effective in developed countries, like Singapore and United Kingdom. However, the feasibility of implementing AI DR screening in countries without a robust teleophthalmology screening programme setup beforehand and other resource‐limited settings should still be evidenced. IDx‐DR is the first autonomous diagnostic software and one of the very first AI‐based software's in medicine to receive Federal Drug and Administration (FDA) approval. Eyeart was approved by FDA for the similar purpose in 2020. In European Union, there are more than 10 different AI‐based devices for DR screening registered, however in different classes, I and IIa. There are also significant shortcomings in current studies of AI in DR, including that great majority of them are sponsored or dependent on the respective algorithm's' company. Independent studies, particularly comparisons or studies establishing objective criteria through which the respective algorithms could be compared are rare.

Postoperative Bleed after PARS Plana Vitrectomy with Pre-Operative Intra Vitreal Bevacizumab in Diabetic Patients with Advance Diabetic Eye Disease

Objectives: The aim of this study is to investigate the effect of preoperative intravitreal Bevacizumab on postoperative incidence of vitreous cavity hemorrhage in patients with advance diabetic eye disease undergoing 23 gauge pars plana vitrectomy. Study Duration: This study was conducted in the department of Ophthalmology Services Hospital Lahore from April 2021 to September 2021. Study Design: Randomized Controlled Trail Patients &amp; Methods: Forty eyes of forty diabetic patients with advance diabetic eye disease were selected for three port 23 gauge pars plana vitrectomy (PPV) and were split into two groups of twenty patients each. One week before the pars plana vitrectomy, Group A received preoperative intravitreal bevacizumab (1.25 mg/0.05 ml) and sham injection were given to Group B patients and postoperative vitreous cavity bleeding was noted on day one , day three , day seven and bleeding was graded from no bleeding to mild and severe based on clinical examination. Practical implication: To assess the decrease in potential risk of postoperative vitreous cavity bleeding following 23 gauge three port pars plana vitrectomy Results: The patients in this study had an average age of 58.46 ±3.62 yrs and mean duration of diabetes among these patients selected for this trial was 11.25±1.52 years (range 8-22 years). Out of 20 eyes in Group A , 15 (75.0%) had no bleeding, 4 (20.0%) had mild and 1(5.0%) had severe postoperative vitreous cavity bleed. In group B , out of 20 eyes 11(55.0%) had no bleeding , 7(35%) had mild to moderate bleeding and 2(10.0%) had severe vitreous cavity hemorrhage. Conclusion: Preoperative Intravitreal bevacizumab prior to pars plana vitrectomy was found effective in reducing the risk of postoperative vitreous cavity bleeding in patients with advance diabetic eye disease. Keywords: Intravitreal Bevacizumab, advanced diabetic eye disease, vitreous hemorrhage, Postoperative bleed, Vitrectomy

Program Evaluation and Assessment of Vital Sign Measurement at Student-Run Free Ophthalmology Clinics

Background: Uninsured patients (8.6% of the United States population) are more likely to have poorly controlled diabetes and hypertension, which can lead to altered vision or even blindness. Checking vital signs regularly is important in monitoring chronic diseases to prevent poorer health outcomes, especially in populations with limited access to care. HOPES (Health Outreach Partnership of Eastern Virginia Medical School Students) and CCE (Clínica Comunitaria Esperanza) are student-run free clinics that serve the uninsured population of Hampton Roads, Virginia. This study describes the services offered and examines trends in measuring vital signs at HOPES and CCE Ophthalmology Clinics to evaluate clinical operations and areas for improvement.&#x0D; Methods: A retrospective chart review of 347 HOPES and CCE Ophthalmology appointments from January 2015 to June 2021 explored patient demographics, vital sign measurement, reason for visit, diagnoses, and services provided. Chi-square tests were utilized to compare the measurement of vital signs between the two clinics.&#x0D; Results: 179 appointments met inclusion criteria. Of the 39 different reasons for visit, the most common were blurry vision, diabetic eye exams, floaters, and systemic hypertension. Of the 63 distinct diagnoses made, the most common were cataracts, diabetes with or without retinopathy, and presbyopia. A total of 175 services were provided, including 61 custom frames and glasses, 48 prescriptions for glasses, 54 medications, and 26 referrals to other providers. Vital signs were obtained during 113 appointments (63.10%) and the frequency of vital sign measurement differed significantly between the two clinics (68.80% at HOPES and 50.00% at CCE), p = 0.02.&#x0D; Conclusion: Vital signs were not consistently obtained at the HOPES and CCE Ophthalmology clinics despite diabetes and hypertension, diseases with known ophthalmologic sequelae, representing primary reasons for visit. Findings are a call to action for quality improvement measures in clinics to enforce vital sign measurement during every encounter.

Enablers and barriers to diabetic retinopathy eye care among first nations and Métis women.

Diabetes is increasingly prevalent in Indigenous women and increases their risk of developing diabetic retinopathy, an eye complication of diabetes and a common cause of vision loss in Canada, especially among adults. Early detection is the most effective approach to prevent vision loss and reduce the impact of diabetic retinopathy. This study examined enablers and barriers that influence the diabetes eye care behaviour of First Nations and Métis women with diabetes and at risk of diabetes. We conducted a descriptive qualitative study with 35 First Nations and Métis women with diabetes or at risk of diabetes in Saskatoon, Canada. Data were collected via four sharing circle discussions and were analysed using thematic analysis. The study findings showed that understanding of diabetes eye care access and cost, and unsupportive interactions with health care practitioners, were barriers to diabetic retinopathy care behaviour. Conversely, the presence of eye complications, participants' resolve to manage diabetes, self-efficacy and fear due to experiences of family members with diabetes enabled diabetes eye care. Our study advances knowledge in socio-cultural factors influencing diabetic retinopathy care behaviour among First Nations and Métis women living with and at risk of diabetes. The study shows the need for further public health and health system interventions to address barriers and support Indigenous peoples with or at risk of diabetes to make informed health decisions.

Management of Patients with Diabetic Macular Edema Switched from Dexamethasone Intravitreal Implant to Fluocinolone Acetonide Intravitreal Implant.

To assess anatomical and functional outcomes after switching from dexamethasone implant (DEXi) to fluocinolone acetonide implant (FAci) in 113 diabetic macular edema eyes, a multicentric retrospective observational study was conducted. Seventy-five eyes (73.5%) were switched 1-8 weeks after their last DEXi. The mean best-corrected visual acuity improved to 59.8 letters at month 4 and remained stable during the follow-up. The mean central macular thickness (CMT) significantly decreased during the follow-up, with a minimum of 320.9 μm at month 3. The baseline CMT was higher in eyes that received the last DEXi &gt;8 weeks versus &lt;8 weeks before the first FAci (p &lt; 0.021). After FAci injection, additional treatments were needed in 37 (32.7%) eyes. A longer diabetes duration (p = 0.009), a longer time between the last DEXi and the first FAci (p = 0.035), and a high baseline CMT (p = 0.003) were risk factors for additional treatments. The mean intraocular pressure was &lt;19 mmHg at all timepoints, with no difference between eyes receiving the last DEXi ≤8 weeks or &gt;8 weeks before the switch. Switching from DEXi to FAci in DME is effective and safe. A short time between the last DEXi and the first FAci reduced CMT fluctuations and the need for early additional treatments.

Optical coherence tomography angiography analysis of microvascular abnormalities and vessel density in treatment-naïve eyes with diabetic macular edema

BackgroundThe aim of this study was to evaluate the structural retinal vascular integrity using optical coherence tomography angiography (OCTA) in treatment-naïve eyes with diabetic macular edema (DME) and to compare it with findings in diabetic eyes without DME.MethodsIn this prospective study, 70 eyes with diabetic retinopathy were included (37 eyes with DME and 33 eyes without DME). The medical records, including swept-source optical coherence tomography and 9 × 9 mm swept-source OCTA images were reviewed and compared between DME and non-DME groups. Microaneurysms, intraretinal microvascular abnormalities (IRMA), areas of capillary non perfusion, foveal avascular zone (FAZ), and capillary vascular density (CVD) were analyzed in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP).ResultsCompared to the non-DME eyes, DME eyes had more microaneurysms in the SCP and the DCP (p = 0,039 and p = 0,024 respectively), more IRMA in the SCP (p = 0,005), larger areas of capillary non perfusion in the SCP and the DCP (p = 0,026 and p = 0,02 respectively) and larger FAZ in both plexuses (p = 0,048 in the SCP and p = 0,012 in the DCP). The CVD in the DCP was lower in DME eyes compared to non-DME eyes (p = 0,007). The severity of DME was significantly correlated to the number of microaneurysms and to the FAZ surface. Central macular thickness was significantly correlated with the number of microaneurysms in the DCP, the surface of capillary non perfusion areas and the FAZ area in both plexuses.ConclusionsOCTA with a 9 × 9 mm field of view showed that the retinal vascular integrity regarding the number of microaneurysms, the number of IRMA, the surface of capillary non perfusion areas, the FAZ area and the CVD, was significantly more impaired in DME eyes compared to diabetic eyes without DME. The DCP seemed to be more affected in diabetic eyes with and without DME than the SCP.

A systematic review and meta-analysis of the effect of intravitreal VEGF inhibitors on cardiorenal outcomes.

Vascular endothelial growth factor inhibitors (VEGFis) have transformed the treatment of many retinal diseases, including diabetic maculopathy. Increasing evidence supports systemic absorption of intravitreal VEGFi and development of significant cardiorenal side effects. We conducted a systematic review and meta-analysis (PROSPERO: CRD42020189037) of randomised controlled trials of intravitreal VEGFi treatments (bevacizumab, ranibizumab and aflibercept) for any eye disease. Outcomes of interest were cardiorenal side effects (hypertension, proteinuria, kidney function decline and heart failure). Fixed effects meta-analyses were conducted where possible. There were 78 trials (81 comparisons; 13 175 participants) that met the criteria for inclusion: 47% were trials in diabetic eye disease. Hypertension (29 trials; 8570 participants) was equally common in VEGFi and control groups {7.3 versus 5.4%; relative risk [RR] 1.08 [95% confidence interval (CI) 0.91-1.28]}. New or worsening heart failure (10 trials; 3384 participants) had a similar incidence in VEGFi and control groups [RR 1.03 (95% CI 0.70-1.51)]. Proteinuria (5 trials; 1902 participants) was detectable in some VEGFi-treated participants (0.2%) but not controls [0.0%; RR 4.43 (95% CI 0.49-40.0)]. Kidney function decline (9 trials; 3471 participants) was similar in VEGFi and control groups. In participants with diabetic eye disease, the risk of all-cause mortality was higher in VEGFi-treated participants [RR 1.62 (95% CI 1.04-2.46)]. In trials of intravitreal VEGFi, we did not identify an increased risk of cardiorenal outcomes, although these outcomes were reported in only a minority of cases. There was an increased risk of death in VEGFi-treated participants with diabetic eye disease. Additional scrutiny of post-licensing observational data may improve the recognition of safety concerns in VEGFi-treated patients.

Diabetic Patients With Rosacea Increase the Risks of Diabetic Macular Edema, Dry Eye Disease, Glaucoma, and Cataract.

Inflammation plays a role in diabetic eye diseases, but the association between rosacea and eye diseases in patients with diabetes remains unknown. This retrospective cohort study used claims data from the National Health Insurance Research Database in Taiwan to investigate the association between rosacea and eye diseases in patients with diabetes. Taiwanese patients diagnosed as having diabetes mellitus between January 1, 1997, and December 31, 2013, and using any hypoglycemic agents were included and divided into rosacea and nonrosacea groups. After applying 1:20 sex and age matching and exclusion criteria, 1:4 propensity score matching (PSM) was conducted to balance the covariate distribution between the groups. The risk of time-to-event outcome between rosacea and nonrosacea groups in the PSM cohort was compared using the Fine and Gray subdistribution hazard model. A total of 4096 patients with rosacea and 16,384 patients without rosacea were included in the analysis. During a mean follow-up period of 5 years, diabetic patients with rosacea had significantly higher risks of diabetic macular edema [subdistribution hazard ratio (SHR): 1.31, 95% confidence interval (CI): 1.05-1.63], glaucoma with medical treatment (SHR: 1.11, 95% CI: 1.01-1.21), dry eye disease (SHR: 1.55, 95% CI: 1.38-1.75), and cataract surgery (SHR: 1.13, 95% CI: 1.02-1.25) compared with diabetic patients without rosacea. A cumulative incidence analysis performed up to 14 years after the index date revealed that the risks of developing ocular diseases consistently increased over time. No significant differences in diabetic retinopathy, age-related macular degeneration, retinal vascular occlusion, ischemic optic neuropathy, optic neuritis, uveitis, or retinal detachment were identified according to rosacea diagnosis. However, we observed significant associations between rosacea and psoriasis, irritable bowel syndrome, anxiety, and major depressive disorder among patients with diabetes. Rosacea is associated with diabetic macular edema, glaucoma, dry eye disease, and cataract development in diabetic patients, as well as increased risks of psoriasis, irritable bowel syndrome, anxiety, and depression in diabetic patients.

Correlation study of biomechanical changes between diabetic eye disease and glaucoma using finite element model of human eye with different iris-lens channel distances.

To find out the effect on the biomechanical response of the eye in the setting of diabetes combined with glaucoma. Five finite element models of the human eyes with various iris-lens channel (ILC) distances (2μm-20μm) were constructed, respectively. The human eye model used for finite element analysis contain all the ocular contents and the optic nerve head. All these models with different ILC distances were used to simulate the effect of pupillary block and abnormal aqueous flow induced by diabetes. And those models were also used for the biomechanical properties study of ocular tissues under the elevated intraocular pressure (IOP), using unidirectional fluid-solid coupling numerical simulation method. For the most severe cases of pupil block (2μm), a significant difference in chamber pressure caused the iris to move forward and had posterior adhesion to the lens. And the strain, stress, and displacement of the whole eyeball were significantly higher than those of the other four cases, while the Optic Nerve Head (ONH) region was the opposite. The promotion of IOP to biomechanical response at both global eye and ONH region was close to the normal eye conditions, or even ease for ILC=2μm. But in the cases of glaucoma with pupil block and high aqueous flow, the biomechanical properties of the whole eyeball were remarkably enhanced for all IOP conditions. Less influence was observed in the ONH region. The promotion of diabetes for glaucoma is not directly on the optic nerve, instead, it indirectly affects the optic nerve by affecting the global eye. Glaucoma combined with diabetes complications may increase the biomechanical damage of IOP to the whole eye.

Effectiveness of Non-mydriatic Ultra-widefield Retinal Imaging to Screen for Diabetic Eye Disease: A Randomized Controlled Trial (Clearsight)

Suboptimal diabetic eye disease screening is a major cause of preventable vision loss. Screening barriers include mydriasis and need for dedicated screening appointments. The Clearsight trial assessed whether non-mydriatic ultra-widefield (NM UWF) screening on the day of a diabetes clinic visit improved detection of clinically important eye disease vs usual screening. This single-centre, randomized, parallel-group controlled trial was conducted at St. Joseph’s Health Care, London, Canada. Adults with diabetes due for screening were randomized to same-day On-Site Screening (NM UWF imaging) on the day of a scheduled diabetes clinic visit or Usual Screening (encouraged to arrange optometric screening).

Ambient air pollution associated with incidence and dynamic progression of type 2 diabetes: a trajectory analysis of a population-based cohort

BackgroundThough the association between air pollution and incident type 2 diabetes (T2D) has been well documented, evidence on the association with development of subsequent diabetes complications and post-diabetes mortality is scarce. We investigate whether air pollution is associated with different progressions and outcomes of T2D.MethodsBased on the UK Biobank, 398,993 participants free of diabetes and diabetes-related events at recruitment were included in this analysis. Exposures to particulate matter with a diameter ≤ 10 μm (PM10), PM2.5, nitrogen oxides (NOx), and NO2 for each transition stage were estimated at each participant’s residential addresses using data from the UK’s Department for Environment, Food and Rural Affairs. The outcomes were incident T2D, diabetes complications (diabetic kidney disease, diabetic eye disease, diabetic neuropathy disease, peripheral vascular disease, cardiovascular events, and metabolic events), all-cause mortality, and cause-specific mortality. Multi-state model was used to analyze the impact of air pollution on different progressions of T2D. Cumulative transition probabilities of different stages of T2D under different air pollution levels were estimated.ResultsDuring the 12-year follow-up, 13,393 incident T2D patients were identified, of whom, 3791 developed diabetes complications and 1335 died. We observed that air pollution was associated with different progression stages of T2D with different magnitudes. In a multivariate model, the hazard ratios [95% confidence interval (CI)] per interquartile range elevation in PM2.5 were 1.63 (1.59, 1.67) and 1.08 (1.03, 1.13) for transitions from healthy to T2D and from T2D to complications, and 1.50 (1.47, 1.53), 1.49 (1.36, 1.64), and 1.54 (1.35, 1.76) for mortality risk from baseline, T2D, and diabetes complications, respectively. Generally, we observed stronger estimates of four air pollutants on transition from baseline to incident T2D than those on other transitions. Moreover, we found significant associations between four air pollutants and mortality risk due to cancer and cardiovascular diseases from T2D or diabetes complications. The cumulative transition probability was generally higher among those with higher levels of air pollution exposure.ConclusionsThis study indicates that ambient air pollution exposure may contribute to increased risk of incidence and progressions of T2D, but to diverse extents for different progressions.

Diabetic Retinopathy and Eye Screening: Diabetic Patients Standpoint, Their Practice, and Barriers; A Cross-Sectional Study.

Diabetes mellites (DM) is one of the most common systemic disorders in Saudi Arabia and worldwide. Diabetic retinopathy (DR) is a potentially blinding ophthalmic consequence of uncontrolled DM. The early detection of DR leads to an earlier intervention, which might be sight-saving. Our aim in this cross-sectional study is to assess patients' knowledge and practices regarding DR, and to detect the barriers for eye screening and receiving a check-up from an ophthalmologist. The study included 386 diabetic patients. One hundred and thirty-one patients (33.9%) had T1DM and 188 (48.7%) had T2DM. Most of the diabetic patients (73.3%) know that they must have an eye check-up regardless of their blood sugar level. DM was agreed to affect the retina in 80.3% of the patients, 56% of patients agree that DM complications are always symptomatic, and 84.5% know that DM could affect their eyes. The fact that blindness is a complication of diabetic retinopathy was known by 65% of the diabetic patients. A better knowledge was detected among patients older than 50 years of age (54.9%) compared to those aged less than 35 years (40.9%), which was statistically significant (p = 0.030). Additionally, 61.2% of diabetic patients who were university graduates had a significantly better knowledge in comparison to 33.3% of illiterate patients (p = 0.006). Considering the barriers to not getting one's eyes screened earlier, a lack of knowledge was reported by 38.3% of the patients, followed by lack of access to eye care (24.4%). In conclusion, there is a remarkable increase in the awareness of DR among the Saudi population. This awareness might lead to an earlier detection and management of DR.

Optical coherence tomography evaluation of choroidal structure changes in diabetic retinopathy patients: A systematic review and meta-analysis

Diabetic retinopathy (DR) is one of the major causes of blindness among working-aged adults worldwide. This study aimed to evaluate the differences in the subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) using optical coherence tomography (OCT) of patients with diabetic eyes with no retinopathy (NDR) and with diabetic retinopathy (DR). We performed a comprehensive literature search of the PubMed, Embase, and Cochrane Library databases up to October 2021. The weighted mean difference (WMD) with the 95% confidence interval (CI) was pooled for continuous outcomes. Twenty-three cross-sectional studies comprising 2,534 eyes including 1,070 NDR eyes, 1,464 DR eyes were included in the systematic review and meta-analysis. The pooled results showed SFCT was significantly thicker in DR than in NDR patients after adjusting for axial length (WMD = 27.90 μm; 95% CI: 11.51 to 44.28; P = 0.001), and the CVI was significantly lower in DR patients (WMD = -1.59; 95% CI: -2.67 to -0.52; P = 0.004). We described changes in the SFCT and CVI in DR. Resultantly, the CVI and SFCT may be valuable parameters for monitoring the onset of DR and helpful for a better understanding of the role of the choroid in the pathological process of DR. https://www.crd.york.ac.uk/prospero/#myprospero, CRD42021228738.

INCIDENCE OF NEW DIABETIC MACULAR EDEMA IN FELLOW EYES OF PATIENTS IN THE VISTA AND VIVID STUDIES.

To characterize diabetic macular edema (DME) incidence in fellow eyes of patients treated for DME in the study eye. This post hoc analysis of VISTA/VIVID data evaluated fellow eyes without DME at baseline through Week 100. Diabetic macular edema presence in the fellow eye was inferred by investigator-reported DME adverse events and use of DME treatments. Over 100 weeks, 44.9%, 44.2%, and 42.9% of fellow eyes developed DME in the intravitreal aflibercept injection 2 mg every 4 weeks (n = 245), intravitreal aflibercept injection 2 mg every 8 weeks (n = 258), and laser control (n = 252) groups, respectively. Mean time to DME development in combined treatment groups was ∼6 months. Multivariable regression analysis confirmed patients with shorter diabetes duration (hazard ratio per 10-year decrease, 1.16; 95% confidence interval, 1.03-1.30; P = 0.0160) and thicker baseline study eye central subfield thickness (hazard ratio per 10- µ m increase, 1.01; 95% confidence interval, 1.01-1.02; P = 0.0002) were at higher risk of developing DME in the fellow eye. Among patients with DME in one eye at baseline, almost half developed DME in the fellow eye over 2 years. Shorter duration of diabetes and thicker study eye central subfield thickness were predictors of DME development in the fellow eye.

Formal registration of visual impairment in people with diabetic retinopathy significantly underestimates the scale of the problem: a retrospective cohort study at a tertiary care eye hospital service in the UK

AimsTo analyse the prevalence of visual impairment (VI), compare it to certification of visual impairment (CVI) and analyse VI associations in patients with diabetic retinopathy (DR).MethodsRetrospective cohort study, which included...

Reducing Akt2 in retinal pigment epithelial cells causes a compensatory increase in Akt1 and attenuates diabetic retinopathy

The retinal pigment epithelium (RPE) plays an important role in the development of diabetic retinopathy (DR), a leading cause of blindness worldwide. Here we set out to explore the role of Akt2 signaling—integral to both RPE homeostasis and glucose metabolism—to DR. Using human tissue and genetically manipulated mice (including RPE-specific conditional knockout (cKO) and knock-in (KI) mice), we investigate whether Akts in the RPE influences DR in models of diabetic eye disease. We found that Akt1 and Akt2 activities were reciprocally regulated in the RPE of DR donor tissue and diabetic mice. Akt2 cKO attenuated diabetes-induced retinal abnormalities through a compensatory upregulation of phospho-Akt1 leading to an inhibition of vascular injury, inflammatory cytokine release, and infiltration of immune cells mediated by the GSK3β/NF-κB signaling pathway; overexpression of Akt2 has no effect. We propose that targeting Akt1 activity in the RPE may be a novel therapy for treating DR.

Trends in diabetes-related complications in Singapore, 2013-2020: A registry-based study.

BackgroundDiabetes mellitus (DM) is a growing global health problem. In Singapore, the prevalence of Type 2 DM is rising, but comprehensive information about trends in DM-related complications is lacking.ObjectivesWe utilized the Singapore Health Services (SingHealth) diabetes registry (SDR) to assess trends in DM micro and macro-vascular complications at the population level, explore factors influencing these trends.MethodsWe studied trends for ten DM-related complications: ischemic heart disease (IHD), acute myocardial infarction (AMI), peripheral arterial disease (PAD) and strokes, diabetic eye complications, nephropathy, neuropathy, diabetic foot, major and minor lower extremity amputation (LEA). The complications were determined through clinical coding in hospital (inpatient and outpatient) and primary care settings within the SingHealth cluster. We described event rates for the complications in 4 age-bands. Joinpoint regression was used to identify significant changes in trends.ResultsAmong 222,705 patients studied between 2013 and 2020. 48.6% were female, 70.7% Chinese, 14.7% Malay and 10.6% Indian with a mean (SD) age varying between 64.6 (12.5) years in 2013 and 65.7 (13.2) years in 2020. We observed an increase in event rates in IHD, PAD, stroke, diabetic eye complications nephropathy, and neuropathy. Joinpoints was observed for IHD and PAD between 2016 to 2018, with subsequent plateauing of event rates. Major and minor LEA event rates decreased through the study period.ConclusionWe found that DM and its complications represent an important challenge for healthcare in Singapore. Improvements in the trends of DM macrovascular complications were observed. However, trends in DM microvascular complications remain a cause for concern.

Hemodynamic Effects of Anti-Vascular Endothelial Growth Factor Injections on Optical Coherence Tomography Angiography in Diabetic Macular Edema Eyes.

PurposeTo evaluate retinal hemodynamic responses to anti-vascular endothelial growth factor (VEGF) injection in eyes with diabetic macular edema using optical coherence tomography angiography (OCTA). We performed a comparison of two different thresholding methods to identify the most accurate for studying the vessel density (VD) in diabetic macular edema eyes.MethodsThe study prospectively included 26 eyes of 22 subjects (aged 60.2 ± 13.7 years) who underwent OCTA scan before and after anti-VEGF injection (mean interval between OCTA = 31.1 ± 17.3 days). We analyzed adjusted flow index, VD, and Skeletonized vessel length density in the parafoveal area (3-mm annulus with a 1-mm inner circle), along with full-thickness fovea avascular zone area and central foveal thickness (CFT). Using averaged scans VD as the ground truth, we compared two different algorithms for VD at the different plexuses. Longitudinal changes were assessed using a generalized linear model correcting for central foveal thickness and Q-score.ResultsWe found significantly decreased adjusted flow index in the DCP layer (P = 0.010) at the follow-up. Furthermore, foveal avascular zone (P < 0.001) and central foveal thickness (P = 0.003) showed significant decrease on follow-up compared with baseline. Comparing the thresholding algorithms showed that vessel length density–based thresholding was more accurate for quantifying the DCP VD.ConclusionsThe adjusted flow index decreased significantly in the DCP layer on follow-up OCTA scan, suggesting vascular flow disruption and decreased deep retinal perfusion after anti-VEGF injection. Our results also highlight the fact that the choice of thresholding method is particularly critical for DCP quantification in eyes with diabetic macular edema.Translational RelevanceFindings confirmed impaired deep retinal capillary flow after anti-VEGF injection.