Digital Fundus Camera Research Articles

Screening for diabetic retinopathy at a health centre in South Africa: A cross-sectional study

Background: In South Africa, screening for diabetic retinopathy (DR) is non-existent at the primary healthcare (PHC) level because of the absence of a screening programme. This leads to preventable vision loss.Aim: To describe the clinical characteristics and outcomes of eye screenings and subsequent referrals.Setting: Laudium Community Health Centre (CHC), a PHC facility in Tshwane.Methods: We conducted a cross-sectional study from February 2022 to August 2022. Individuals with diabetes were screened for eye complications using visual acuity testing, intraocular pressure measurement, and fundoscopy with a non-mydriatic digital fundus camera. Fundus images were analysed by an optometrist and an artificial intelligence (AI) programme. Demographic and clinical data were collected.Results: A total of 120 participants were included, with the majority (60.7%) from Laudium CHC. Most participants (64.2%) were on oral agents, and 66.7% were women. The mean haemoglobin A1c (HbA1c) was 8.3%, with a median diabetes duration of 8 years. Artificial intelligence detected more glaucoma cases (17.5% vs 9.2%) and DR (23.3% vs 15.8%) compared to the optometrist. In contrast, the optometrist identified more cases of macula pathology (29.2% vs 19.2%). Participants (n = 79) were referred to an ophthalmologist for diagnosis confirmation and management.Conclusion: The study revealed that while DR was not highly prevalent among PHC patients with diabetes, there was a significant referral rate for other ocular complications. Artificial intelligence can enhance early detection and improve efficiency.Contribution: The findings underscore the need to integrate diabetes eye screening programmes into PHC services for people living with diabetes.

Ophthalmic assessment of an intensive care ward patients in the first and last wave of the COVID-19. Do they have a difference?

BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly. AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease. MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation. RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p 0.001; in group 2, 28% vs. 44%, p 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p 0.001). CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.

Clinical characteristics and associated factors of diabetic retinopathy in Sudanese patients

Background: Diabetic retinopathy (DR) is a leading cause of vision loss and preventable blindness, particularly in middle- and high-income countries.Aim: This study aimed to assess the characteristics and associated factors of DR in Sudanese patients with type 2 diabetes mellitus (DM).Setting: A cross-sectional hospital-based study included 119 patients with type 2 DM was conducted at EL-Walidain Eye Hospital, Khartoum, Sudan, from February 2021 to May 2021.Methods: A non-mydriatic digital fundus camera was used for fundus photography, and Scottish Diabetic Retinopathy Grading Scheme was used for the final classification of DR.Results: Females comprised 53.8% of patients, mean age of 58.8 ± 8.5 years. Uncontrolled DM was found in 37.8% with a mean duration of 10.5 ± 4.8 years. Myopia was the most common refractive error found in 57.8% of the uncontrolled group, followed by emmetropia (17.8%). Whereas in the controlled group, 47.3% were hyperopic and 39.2% were myopic. Maculopathy grade M1 was found to be 37.8% in the uncontrolled group and 18.9% in the controlled group, with no significant difference (p = 0.361). Conversely, the difference in retinopathy between the two groups was statistically significant (p = 0.043).Conclusion: Decreased vision and increased retinopathy were associated with an increase in patients’ age. More widespread diabetes awareness and screening programmes to improve diabetes management and control in Sudan and other developing countries.Contribution: This study observed maculopathy grade M1 and myopia were more common in uncontrolled DM, and vision function was inversely correlated with age (p 0.05).

Using a smartphone-based digital fundus camera for screening of retinal and optic nerve diseases in veterinary medicine: A preliminary investigation.

Ophthalmoscopy is a valuable tool in clinical practice. We report the use of a novel smartphone-based handheld device for visualisation and photo-documentation of the ocular fundus in veterinary medicine. Selected veterinary patients of a referralophthalmology service were included if one or both eyes had clear ocular media, allowing for examination of the fundus. Following pharmacological mydriasis, fundic images were obtained with a handheld fundus camera (Volk VistaView). For comparison, the fundus of a subset of animals was also imaged with a veterinary-specific fundus camera (Optomed Smartscope VET2). The large field of view achieved by the Volk VistaView allowed for rapid and thorough observation of the ocular fundus in animals, providing a tool to visualise and record common pathologies of the posterior segment. Captured fundic images were sometimes overexposed, with the tapetal fundus artificially appearing hyperreflective when using the Volk VistaView camera, a finding that was less frequent when activating a 'veterinary mode' that reduced the sensitivity of the camera's sensor. The Volk VistaView compared well with the Optomed Smartscope VET2. The main study limitation was the small sample size. The Volk VistaView camera was easy to use and provided good-quality fundic images in veterinary patients with healthy or diseased eyes, offering a wide field of view that was ideal for screening purposes.

Dehazing Algorithm for Enhancing Fundus Photographs Using Dark Channel and Bright Channel Prior

Purpose: We present a dehazing algorithm using dark channel prior (DCP) and bright channel prior (BCP) to enhance the quality of retinal images obtained through conventional fundus photography.Methods: A retrospective analysis was conducted on retinal images from patients who visited Gangnam Sacred Heart Hospital between January 2000 and September 2022. These images were captured using a digital fundus camera (KOWA Nonmyd 8S Fundus Camera, KOWA Company, Nagoya, Japan) without pupil dilation. We used two mathematical algorithms: DCP only and DCP and BCP combined. The original, DCP-processed, and DCP & BCP-processed images were compared. Fisher's exact test was used to identify significant quality improvements.Results: The DCP and the newly proposed DCP plus BCP algorithm effectively eliminated haze and enhanced the contrast of cataract images. Notably, DCP demonstrated limited improvements in fundus photographs from patients with small pupils, whereas the proposed DCP plus BCP method effectively revealed previously obscured retinal details and vessels. However, these methods exhibited limited performance in severe cataracts compared to the clear images obtained after surgery. The quality enhancement with the proposed method was significant in photographs of patients with cataracts (<i>p</i> = 0.032) and small pupils (<i>p</i> < 0.01).Conclusions: Our algorithm produced clearer images of blood vessels and optic disc structures, while significantly reducing artifacts in fundus images from patients with small pupils or cataracts. The proposed algorithm can provide visually enhanced images, potentially aiding physicians in the diagnosis of retinal diseases in patients with cataracts.

Prevalence and Predictors of Diabetic Retinopathy, Its Progression and Regression in Indian Children and Youth With Type-1 Diabetes

Objective: There are very few reports on the prevalence of diabetic retinopathy (DR) in children and youth with type-1 diabetes (T1D). Studies have also found very low rates of referral for DR screening in children and youth with T1D. We conducted this study to determine the prevalence of DR, to study the reliability of ISPAD screening recommendations and to identify predictors of DR, its progression and regression in Indian children and youth with T1D. Methods: This study included 882 children and youth with T1D. Demographic data, anthropometry, blood pressure, sexual maturity rating, ophthalmological examination (slit lamp for cataract) and biochemical measurements were performed using standard protocols. Fundus images were captured using the Forus Health 3netra classic digital non-mydriatic fundus camera by the same experienced operator. De-identified images were assessed by a senior grader and ophthalmologist (Belfast Ophthalmic Reading Center). Severity of DR was graded as per the UK National Health Service (NHS) DR classification scale. Result: We report 6.4% and 0.2% prevalence of DR and cataract in Indian children and youth with T1D, respectively. All the subjects with DR had early non-proliferative DR. We report that amongst subjects with DR, only 2 subjects were aged less than 11 years and had duration of illness less than 2 years. Presence of hypertension and older age were significant predictors of DR ( P < .05). Subjects with DR had significantly higher triglyceride concentrations ( P < .05), of these, 6.9% had progression and 2.9% had regression at 1 year follow up; the change in glycaemic control was a significant positive predictor of progression of DR ( P < .05). None of the participants included in the study progressed to develop sight-threatening DR. Conclusion: DR is not uncommon in Indian children and youth with T1D, thus screening for DR needs to be initiated early, particularly in older individuals with higher disease duration. Controlling blood pressure and triglyceride concentrations may prevent occurrence of DR. Improving glycaemic control may prevent progression of DR in Indian children and youth with T1D.

Short-term duration of diabetic retinopathy as a predictor for development of diabetic kidney disease.

Diabetic retinopathy (DR) is a risk factor for diabetic kidney disease (DKD). Whether the duration, especially the short-term duration, of DR is associated with the development and progression of DKD remains unclear. A retrospective study and two-sample Mendelian randomization (MR) analysis were conducted. Kidney disease was defined by the urinary albumin-to-creatinine ratio (ACR) and the estimated glomerular filtration rate (eGFR). DR was diagnosed by an expert ophthalmologist by using a digital fundus camera. Binary and ordinal logistic regression analyses were performed. A restricted cubic spline was utilized to detect nonlinear associations. Summary statistics for DR- and DKD-associated single-nuclear polymorphisms (SNPs) were extracted from the FinnGen and the UK Biobank consortia. A total of 2674 patients with type 2 diabetes mellitus (T2DM) and type 2 diabetic kidney disease (T2DKD) were included. The prevalence and mean duration of DR increased with elevation of ACR and decline in eGFR. Renal function was significantly reduced in patients with DR in the fifth year of life. Binary and ordinal logistic regression showed that each 1-year increase in DR duration was associated with a 19% risk increase in the development of DKD, 16% in the elevation of ACR, and 21% in the decline of renal function. MR estimates indicated that DR was causally associated with DKD development, with an odds ratio of 2.89. DR and the duration of DR were independent risk factors for the development and progression of DKD. The short-term duration of DR may be associated with DKD development. DR had a statistically significant effect on DKD.

Prevalence and associated factors of diabetic retinopathy among people with diabetes screened using fundus photography at a community diabetic retinopathy screening program in Nepal

BackgroundThis study aimed to assess the prevalence and associated factors of diabetic retinopathy (DR) and vision threatening DR (VTDR) among people with diabetes screened using fundus photography in Nepal.MethodsThis is a retrospective study among people with diabetes presented for DR screening using fundus photography from 2013 to 2019. Detailed demographics, duration of diabetes, medical history, visual acuity, and grading of DR on fundus photography were analyzed. Fundus camera used in the study were;Topcon digital fundus camera 900 CXR and digital portable fundus cameras (Nidek-10 portable non-mydriatric fundus camera; Versacam & Trade & Alpha, France), and a Zeiss portable fundus camera (Zeiss Visucout 100). Macula centred and disc centred 45 degree two images were taken from each eye. Pupil were dilated in cases where there was media haze in un-dilated cases. DR was graded using early treatment diabetic retinopathy study criteria. The images were graded by fellowship trained retina specialist. DR prevalence included any DR changes in one or both eyes.ResultsTotal of 25,196 patients with diabetes were enrolled. Mean age was 54.2 years with Standard Deviation (S.D):12.9 years, ranging from 6 years to 97 years. Type 1 and type 2 diabetes comprised of 451 people (1.79%) and 24,747 (98.21%) respectively. Overall, 1.8% of the images were un-gradable. DR prevalence was 19.3% (95% Confidence Interval (CI): 18.8 − 19.7%). DR prevalence in type 1 and type 2 diabetes was 15.5% (95% CI: 12.5 − 18.6%) and 19.3% (CI: 18.8 − 19.8%) respectively. Clinically significant macular edema (CSME) was found in 5.9% (95% CI: 5.6-6.2%) and VTDR in 7.9% (95% CI: 7.7-8.3%). In multivariate analysis, our study revealed strong evidence to suggest that there is meaningful association between DR and VTDR with duration of diabetes, diabetic foot, diabetic neuropathy, agriculture occupation, those under oral hypoglycaemic agents or insulin or both as compared to those under diet only, and presenting visual acuity > 0.3LogMAR.ConclusionPrevalence and associated factors for DR and VTDR were similar to other DR screening programs in the region. Emphasis on wider coverage of DR screening could help for timely detection and treatment of STDR to avoid irreversible blindness.

Lifestyle Changes Reduced Estimated White Matter Hyperintensities Based on Retinal Image Analysis.

This study evaluates if there is an association between lifestyle changes and the risk of small vessel disease (SVD) as measured by cerebral white matter hyperintensities (WMH) estimated by the automatic retinal image analysis (ARIA) method. We recruited 274 individuals into a community cohort study. Subjects were assessed at baseline and annually with the Health-Promoting Lifestyle Profile II Questionnaire (HPLP-II) and underwent a simple physical assessment. Retinal images were taken using a non-mydriatic digital fundus camera to evaluate the level of WMH estimated by ARIA (ARIA-WMH) to measure the risk of small vessel disease. We calculated the changes from baseline to one year for the six domains of HPLP-II and analysed the relationship with the ARIA-WMH change. A total of 193 (70%) participants completed both the HPLP-II and ARIA-WMH assessments. The mean age was 59.1 ± 9.4 years, and 76.2% (147) were women. HPLP-II was moderate (Baseline, 138.96 ± 20.93; One-year, 141.97 ± 21.85). We observed a significant difference in ARIA-WMH change between diabetes and non-diabetes subjects (0.03 vs. -0.008, respectively, p = 0.03). A multivariate analysis model showed a significant interaction between the health responsibility (HR) domain and diabetes (p = 0.005). For non-diabetes subgroups, those with improvement in the HR domain had significantly decreased in ARIA-WMH than those without HR improvement (-0.04 vs. 0.02, respectively, p = 0.003). The physical activity domain was negatively related to the change in ARIA-WMH (p = 0.02). In conclusion, this study confirms that there is a significant association between lifestyle changes and ARIA-WMH. Furthermore, increasing health responsibility for non-diabetes subjects reduces the risk of having severe white matter hyperintensities.

Automated Detection and Segmentation of Exudates for the Screening of Background Retinopathy.

Exudate, an asymptomatic yellow deposit on retina, is among the primary characteristics of background diabetic retinopathy. Background diabetic retinopathy is a retinopathy related to high blood sugar levels which slowly affects all the organs of the body. The early detection of exudates aids doctors in screening the patients suffering from background diabetic retinopathy. A computer-aided method proposed in the present work detects and then segments the exudates in the images of retina acquired using a digital fundus camera by (i) gradient method to trace the contour of exudates, (ii) marking the connected candidate pixels to remove false exudates pixels, and (iii) linking the edge pixels for the boundary extraction of exudates. The method is tested on 1307 retinal fundus images with varying characteristics. Six hundred and forty-nine images were acquired from hospital and the remaining 658 from open-source benchmark databases, namely, STARE, DRIVE MESSIDOR, DiaretDB1, and e-Ophtha. The exudates segmentation method proposed in this research work results in the retinal fundus image-based (i) accuracy of 98.04%, (ii) sensitivity of 95.345%, and (iii) specificity of 98.63%. The segmentation results for a number of exudates-based evaluations depict the average (i) accuracy of 95.68%, (ii) sensitivity of 93.44%, and (iii) specificity of 97.22%. The substantial combined performance at image and exudates-based evaluations proves the contribution of the proposed method in mass screening as well as treatment process of background diabetic retinopathy.

PS-C03-7: FUNDOSCOPIC EXAMINATION USING A SMARTPHONE CAMERA: A REVIEW OF EFFECTIVENESS AND FEASIBILITY IN DETECTING HYPERTENSIVE RETINOPATHY IN HYPERTENSIVE CRISIS PATIENTS

Introduction: In patients presented with hypertensive crises, a fundoscopic assessment is necessary because once hypertensive retinopathy is discovered, a hypertensive emergency is diagnosed, and intravenous antihypertensive medication is recommended. However, direct ophthalmoscopy is relatively underutilized, especially under the social distance regulation, which may result in delayed diagnosis and treatment. The novel method, namely, smartphone-based fundoscopy offers longer working distance and shorter doctor-patient contact time, however, there is limited data regarding its feasibility and effectiveness. Objective: We aimed to gather scientific evidence on the smartphone-based fundoscopy in terms of its effectiveness, accessibility, and trainability in detecting hypertensive retinopathy among hypertensive crisis patients in emergency room settings. Methods: A literature search was conducted on PubMed, Google Scholar, and the Cochrane Library for papers published from January 2010 to November 2021. Keywords including hypertensive crisis, hypertensive retinopathy, target organ damage, fundoscopic optic examination, direct ophthalmoscope, fundus images, smartphone fundoscopy, digital fundus camera, and COVID-19 were used. Full papers published in English and abstracts of non-English publications were all reviewed. Results: Eight studies out of 34 fulfilled our search criteria. Five observational studies confirmed the effectiveness of smartphone-based fundoscopy in obtaining fundus images adequate for interpretation compared with those from commercially available fundus cameras. Also, smartphone-based fundoscopy offers time-saving properties as it allows fundus examination to be effectively completed within 74 seconds compared to 130 seconds with a traditional direct ophthalmoscope. Two studies investigated the accessibility of smartphone-based fundoscopy and discovered that fundus images can be obtained by using 20 diopter condensing lenses with the video mode of the smartphone camera, which can be easily provided even at a primary level hospital due to their low cost. Another study reviewed the trainability of the smartphone-based fundoscopy in 137 undergraduate medical students which concluded that 75% of these students can identify the optic nerve within 20–25 minutes of face-to-face demonstration. Conclusion: With a greater diagnostic capability, accessibility, and trainability of smartphone-based fundoscopy makes it a potentially game-changing technique for detecting hypertensive retinopathy in hypertensive emergency patients, especially during the current COVID-19 pandemic, in which longer working distance and shorter doctor-patient contact time are both required.

Evaluation of the Anterior Chamber Angle Structures in Perinatal Infants Using a Wide-Field Digital Fundus Camera

This study aimed to evaluate the ability of a digital fundus camera to observe the development of the anterior chamber angle (ACA) in premature infants. Forty-eight eyes of preterm infants (n=48) were examined by a digital fundus camera to observe the development of the ACA. ACA grading was performed based on the visualization of the anterior chamber structures according to the Scheie Angle Depth Evaluating System. ACA images from all 48 infants were successfully acquired using RetCam3. The corrected gestational age ranged from 30 weeks to 49 weeks, which covered the period from 2 months preterm to >2 months post-term. As the corrected gestational age increased, the corrected gestational age grading was significantly decreased. The mean corrected gestational ages of the infants corresponding to the ACA classification from grade IV to grade 0 were 32.75±1.89, 37.20±1.30, 39.75±2.38, 40.56±2.24, and 44.23±2.14 weeks, respectively, which were all significantly different (P<0.05). The regression analysis showed a linear correlation between the grading of the ACA and the corrected gestational age (R2=0.724, P=0.0001). The ACA of a full-term newborn can be fully detected and evaluated by a digital fundus camera. For premature infants, part of the ACA is not visible physiologically; however, it should not be misdiagnosed as angle closure or a narrow angle.

Optics and Utility of Low-Cost Smartphone-Based Portable Digital Fundus Camera System for Screening of Retinal Diseases

Purpose: To describe optical principles and utility of inexpensive, portable, non-contact digital smartphone-based camera for the acquisition of fundus photographs for the evaluation of retinal disorders. Methods: The digital camera has a high-quality glass 25 D condensing lens attached to a 21.4-megapixel smartphone camera. The white-emitting LED light of the smartphone at low illumination levels is used to visualize the fundus and limit source reflection. The camera captures a high-definition fundus (5344 × 4016) image on a complementary metal oxide semiconductor (CMO) with an area of 6.3 mm × 4.5 mm. The auto-acquisition mode of the device facilitates the quick capture of the image from continuous video streaming in a fraction of a second. Results: This new smartphone-based camera provides high-resolution digital images of the retina (50° telescopic view) in patients at a fraction of the cost (USD 1000) of established, non-transportable, office-based fundus photography systems. Conclusions: The portable user-friendly smartphone-based digital camera is a useful alternative for the acquisition of fundus photographs and provides a tool for screening retinal diseases in various clinical settings such as primary care clinics or emergency rooms. The ease of acquisition of photographs from a continuously streaming video of fundus obviates the need for a skilled photographer.

An Evaluation of the Autofluorescence Changes with Wide-Angle Digital Fundus Camera in Chronic Central Serous Chorioretinopathy Patients

To evaluate the autofluorescence variations and localisation in wide-angle digital fundus camera images of patients with chronic central serous chorioretinopathy (CSCR). A retrospective scan was made of the images of patients diagnosed with chronic CSCR with wide-angle digital fundus angiography and applied at the same time with autofluorescence imaging. The ultra wide area autofluorescence images of 46 patients were examined. The retina was separated as zone 1, zone 2, and zone 3 in respect of disease involvement, and zone 3 represented the peripheral retina. The images of the patients were recorded as hyperautofluorescence (punctate, diffuse) or hypo-autofluorescence (granular, confluent) in respect of the type of autofluorescence involvement. After the exclusion of 2 patients because peripheral images could not be clearly selected, the study evaluations were made of 44 eyes of 44 patients. The mean duration of the disease was found to be 2.7 years. In the result of the examination with wide-angle digital fundus autofluorescence imaging, there was seen to be zone 2 involvement in the 4 quadrants of inferior, nasal, temporal and superior. Peripheral retinal involvement in zone 3 was seen in a total of 7 (15.9%) patients in the form of inferior gravitational defect, in 6 (13.6%) patients together with zones 1 and 2, and in 1 (2.3%) patient together with zone 2. Hyperautofluorescence was determined in 39 (88.6%) patients and hypo-autofluorescence in 5 (11.4%). The involvement frequency was determined as zone 1+2 in 19 (43.2%) patients, followed by zone 1 involvement alone in 16 (36.4%) patients. Common autofluorescence type was detected as hyperautofluorescence in chronic CSCR patients with a high rate of approximately 90%. It has also been shown that in some patients, the disease may also affect the inferior peripheral retina due to the effect of gravity.

IDF21-0222 Prevalence and clinical predictors of Non-diabetic kidney disease in Type 2 Diabetes with renal involvement

Background: Renal Involvement in individuals with Type-2 Diabetes (T2DM) may be due to diabetes per se i.e., Diabetes kidney disease (DKD) or to other cause other than T2DM i.e., non-Diabetic kidney disease (NDKD) and in a group of individuals may have both (DKD+NDKD). Differentiation between the same is only possible with renal biopsy. Specific treatment options are available for NDKD which could potentially change outcomes. Data regarding the proportion of subtypes of renal involvement in diabetes is limited and flawed due to biases in performing renal biopsy. Most previous studies of renal biopsies are retrospective in nature. With increasing burden of T2DM worldwide it is imperative that we to establish non-invasive markers which could help to identify those who might benefit from renal biopsy to establish diagnosis of NDKD. Aim: To determine proportion of patients with T2D with renal involvement who have DKD, NDKD or mixed disease. To identify possible clinical predictor/s which could help decision making for targeted renal biopsy to identify those with NDKD component (NDKD and mixed group). Method: We recruited consecutive patient with renal involvement (eGFR >30ml/min/m2 and/or urinary albumin: creatinine excretion >/=300mg/g. Clinical history, demography of patients, Lipid profile, Liver function test, electrolytes, serum creatinine, urea, Albumin, globulin, Uric acid, 24hr urinary protein (by autoanalyzer), Glycated hemoglobin (HbA1C) Complete blood count (CBC) (automated hematology analyzer), Urine RE/ME (dipstick method), retinopathy (Digital fundus camera) and neuropathy (VPT) were documented. Histopathological classification of renal biopsy sample was undertaken as per International Society of Nephrology and the Renal Pathology Society classification. Results: Total 110 were included of whom 31% were female. 73 patients (66.4%) had DKD 20 patients (18.2%) had NDKD and in 17 patients (15.4%) had an overlap (Mixed group). Amongst NDKD IgA nephropathy was commonest cause of NDKD (25%). Duration of diabetes (p<0.001), late age of onset (p=0.03), BMI (p=0.02), presence of hematuria (p=0.04), retinopathy (p=0.003) and neuropathy(p=0.002) were present in different proportions in the DKD vs the other two groups combined. Multivariable regression analysis however showed that only duration of diabetes was able to discriminate DKD from the other two groups. (AOR=0.9, CI 0.945 0.996, P=0.02), but it had sensitivity of 54% and specificity of 81% (AUC 0.765, P <0.001). Discussion: Almost 25% of our patients with T2DM had some evidence of NDKD (either pure NDKD or mixed) and warrants biopsy for appropriate diagnosis and management. Amongst currently used discriminators, only duration of diabetes was able to predict (not very robust) which patients needed biopsy to identify NDKD.

Diabetic Retinopathy Trends in a Digital Screening Program of Eight and Half Years

Objectives: To share the trending of Diabetic Retinopathy (DR) over eight and half years period digital screening program of DR in Bangladesh at a tertiary eye hospital. Methods: This study analyze 8 and 1/2 years (102 months, from July 2010 to December 2018) findings of a digital screening and subsequent grading programs of DR in a tertiary eye care centre. A total 45289 eyes of 22645 diabetic person underwent retinal photography.7818 (17.26%) retinal Photographs were excluded because of unassessable for grading remaining 37471 retinal photographs were analyzed. Screening was performed by non-mydriatic digital fundus camera. Optometrist &amp; Ophthalmologist review of all photographs were done at three level of grading system. Evaluation of the percentage distribution of degree of retinopathy was done. Data analysis was done by SPSS software version 16.0. Results: A total of 22645 patients (64.12 % male,35.88 % female) with mean age of 55.58 ± 9.88 (±SD) years were under went DR screening during a 8.5 years period. Features of DR was found in 18958 of 37471 (50.59%) retinal photographs. Non-proliferative diabetic retinopathy (NPDR) was documented in 14457 of 37471 photographs (38.59 %), while 4501 of 37471 photographs (12.00%) showed proliferative diabetic retinopathy (PDR). Diabetic Macular Edema (DME) was found in 10788 (28.79 %) of total 37471 assessable photograph and (56.90 %) of a total 18958 DR. Conclusion: DR is highly prevalent among Bangladeshi patients. In order to provide a sensitive, cost effective and easily accessible DR screening, digital imaging is a useful means

Comparison of retinal vascular arcade trajectory between eyes with an idiopathic macular hole and the healthy fellow eye.

We aimed to present a method to evaluate the retinal arcade vascular trajectory by measuring the distance between the retinal veins in eyes with idiopathic macular hole (IMH) and comparing this measurement with healthy fellow eyes. In this cross-sectional study 18 patients with unilateral IMH were enrolled. We used standard fundus photographs, which were obtained from each eye with a digital fundus camera using a 55-degree lens. The calculation of the retinal arcade vascular trajectories was done by drawing and measuring five vertical lines within the macular area. The mean age of the patients was 65 ± 9years. The between-groups differences of each vertical line were not statistically significant, except for the differences between the most temporal line, which was greater in the diseased group (9388 vs. 8322μm; P = 0.034). The ratio between the fifth (most temporal) and the third (fovea-center) vertical lines was greater than 1 (V-shape) in 72% of eyes with a macular hole, whereas it was less than one (U-shape) in 78% of control eyes (P = 0.003). We demonstrated that in eyes with an IMH the vascular arcade has more tendency to diverge on its path temporal to the fovea.

Multimodal Imaging, Tele-Education, and Telemedicine in Retinopathy of Prematurity.

Retinopathy of prematurity (ROP) is a disease that affects retinal vasculature in premature infants and remains one of the leading causes of blindness in childhood worldwide. ROP screening can encounter some difficulties such as the lack of specialists and services in rural areas. The evolution of technology has helped address these issues and led to the emergence of state-of-the-art multimodal digital imaging devices such fundus cameras with its variable properties, optical coherence tomography (OCT), OCT angiography, and fluorescein angiography which has helped immensely in the process of improving ROP care and understanding the disease pathophysiology. Computer-based imaging analysis and deep learning have recently been demonstrating promising outcomes in regard to ROP diagnosis. Telemedicine is considered an acceptable alternative to clinical examination when optimal circumstances for ROP screening in certain areas are lacking, and the expansion of these programs has been reported. Tele-education programs in ROP have the potential to improve the quality of training to physicians to optimize ROP care.

Implementation of telemedicine screening for retinopathy of prematurity in rural areas in Guatemala

To report findings of a telemedicine retinopathy of prematurity (ROP) screening program in six neonatal units in rural areas of Guatemala, using a portable, noncontact, 40° field digital fundus camera (Pictor Plus) operated by trained technicians. National ROP Program Guidelines screening criteria were used: gestational age <36 weeks and/or birth weight (BW) <2000 g, or GA <36 weeks but BW ≥2000 g, with qualifying medical history. Retinal images were obtained by two technicians and graded by ophthalmologists experienced in ROP. Infants with signs of pre-plus or plus disease in one or both eyes were referred for clinical examination. Screening was stopped when retinal vessels in anterior zone II were normal on two successive evaluations or the infant had reached 45 week's postmenstrual age. A total of 418 of 1,890 eligible infants (22.1%) were screened. Mean GA was 33.9 ± 2.2 weeks (range, 27-36), and mean BW 1728.3 ± 379.3 g (range, 840-2830 g). Thirty-three infants (8.6%) developed plus or pre-plus disease, and 19 (58%) underwent ophthalmologic examination. Fifteen infants were confirmed with type 1 ROP, and 14 were treated. Mean GA of treated infants treated was 33.6 ± 3.0 weeks (range, 32-34.9), and mean BW was 1,646 ± 245.8 g (range, 1100-1774.1 g). Imaging with a noncontact fundus camera can facilitate detection of treatable ROP in countries with limited resources. Strengthening the health systems, including motivation and continued training of neonatal intensive care personnel is essential to improve and maintain program effectiveness. Reasons for, and interventions to address the low uptake of screening need to be explored to extend coverage of ROP screening to district hospitals in Guatemala.

Selfie fundus imaging for diabetic retinopathy screening.

BackgroundRegular screening for retinopathy and timely intervention reduces blindness from diabetes by 90%. Screening is currently dependent on the interpretation of images captured by trained technicians. Inherent barriers of accessibility and affordability with this approach impede widespread success of retinopathy screening programs. Herein, we report our observations on the potential of a novel approach, Selfie Fundus Imaging (SFI), to enhance diabetic retinopathy screening.MethodsThe study was undertaken over a two-month period during COVID 19 lockdown. 60 diabetic patients participated in the study. Retinal images were captured using three different approaches, handheld smartphone-based photographs captured by patients themselves after a short video-assisted training session (SFI group), and smartphone-based photographs captured by a trained technician and photographs taken on desktop conventional digital fundus camera (Gold standard). Sensitivity and kappa statistics was determined for retinopathy and macular oedema grading.FindingsMean age of the study participants was 52.4 years ± 9.8 years and 78% were men. Of 120 images captured using SFI, 90% were centred-gradable, 8% were decentred-gradable and 2% were ungradable. 82% patients captured the image within a minute (majority by 31–45 s). The sensitivity of SFI to detect diabetic retinopathy was 88.39%. Agreement between SFI grading and standard fundus photograph grading was 85.86% with substantial kappa (0.77). For the detection of diabetic macular oedema, the agreement between SFI images and standard images was 93.67, with almost perfect kappa (0.91).ConclusionFundus images were captured by patients using SFI without major difficulty and were comparable to images taken by trained specialist. With greater penetrance, advances, and availability of mobile photographic technology, we believe that SFI would positively impact the success of diabetic retinopathy screening programs by breaking the barriers of availability, accessibility, and affordability. SFI could ensure continuation of screening schedules for diabetic retinopathy, even in the face a highly contagious pandemic.