Management Of Diabetic Retinopathy Research Articles

Does addition of intravitreal bevacizumab confer additional benefit in management of proliferative diabetic retinopathy?

To evaluate visual outcome and complications of PDR after treatment with Intravitreal Bevacizumab followed by Pan Retinal Photocoagulation A hospital based retrospective study was done in the Department of Ophthalmology, to evaluate visual outcome and complications of PDR after treatment with intravitreal Bevacizumab followed by Pan Retinal Photocoagulation. Visual Acuity, Dilated fundus examination, OCT macula were done on subsequent follow ups 135 eyes of 133 patients were included in the study.The mean pre procedure visual acuity is 0.639±0.5327 which improved to 0.451±0.4089 post procedure. P value is <0.001 which is statistically significant.i.e, 94 (69.62%) eyes had improved vision, 21(15.55%) had stable vision and 20(14.81%) eyes had decreased vision. After injection followed by PRP out of 135 eyes,4(2.96%) eyes developed vitreous hemorrhage which resolved with repeat intravitreal anti-VEGF injection, 6(4.44%) eyes developed diabetic macular edema,3(2.2%) eyes developed Neovascularisation of iris and 4(2.96%)eyes developed vitreous hemorrhage with traction retinal detachment.From our study it appears that addition of intravitreal anti VEGF to Pan Retinal Photocoagulation for PDR confers the additional benefit of less incidence of vitreous hemorrhage and less incidence of traction retinal detachment requiring surgery in the 1 one year of follow up. This amounts to more compliance by the patient for taking the treatment as well as better visual outcome

Factors Associated with Low Accessibility to Diabetic Retinopathy Management Services in Cotonou, Benin

Factors Associated with Low Accessibility to Diabetic Retinopathy Management Services in Cotonou, Benin

Risk factors for diabetic retinopathy, diabetic macular edema, and sight-threatening diabetic retinopathy

OBJECTIVETo identify the risk factors for the development of diabetic retinopathy (DR), diabetic macular edema (DME), and sight threatening DR (STDR) based on a city-wide diabetes screening program. RESEARCH DESIGN AND METHODSDiabetic patients were prospectively recruited between June 2016 and December 2022. All patients underwent dilated fundus photography centered on the disc and macula or macula spectral domain optical coherence tomography (SD-OCT) scan. Complete medical history was documented.Systematic examination, blood analysis, and urinalysis were performed. Multivariate logistic regression analysis adjusting for age and sex was conducted. RESULTSOut of 7,274 diabetic patients, 6,840 had gradable images, among which 3,054 (42.0%) were graded as DR, 1153 (15.9%) as DME, and 1,500 (20.6%) as STDR. The factors associated with DR, DME, and STDR included younger age (odds ratio [OR]: 0.96, 0.97, and 0.96 respectively), lower BMI (OR: 0.97, 0.95, and 0.95 respectively), longer duration of diabetes (OR: 1.07, 1.03, and 1.05 respectively) and positive of urinary albumin (OR: 2.22, 2.56, and 2.88 respectively). Other associated factors included elevated blood urea nitrogen (OR: 1.22, 1.28, and 1.27 respectively), higher LDL-cholesterol, lower blood haemoglobin (OR: 0.98, 0.98, and 0.98), insulin intake, presence of diabetic foot pathologies and diabetic peripheral neuropathy. We also identified novel risk factors, including high serum potassium (OR: 1.37, 1.46, and 1.55 respectively), high serum sodium (OR: 1.02, 1.02, and 1.04 respectively). Better family income was a protective factor for DR, DME, and STDR. Alcohol consumption once a week was also identified as a protective factor for DR. CONCLUSIONSThis study revealed high serum sodium, high serum potassium, low blood haemoglobin, and the level of family income as novel associated factors for DR, which can help with DR monitoring and management.

Knowledge, attitude study on diabetic retinopathy among paramedical students

Introduction: Diabetes mellitus, particularly type II, is a major public health concern worldwide. It is estimated to increase approximately by 150%, from 30 million in 2000, to 80 million in 2030. Early screening and intervention is the key to treatment. Bridging the gap between the physician and patients can be done by the paramedic staff, who sensitize the patients towards the disease and refer the patients for screening. Effective management of diabetic retinopathy needs multi - disciplinary approach that is participation of the community and health personals. Material and methods: Closed ended questionnaire specific to knowledge attitude and practice regarding Diabetic retinopathy were handed to paramedical students. There were total of 15 questions, in that 7 questions to evaluate knowledge and 8 questions to evaluate attitude. Conclusion: The knowledge towards morbidity of diabetes was good. The treatment options was chosen correctly,majority promoted regular screening to prevent complications. The attitude towards the factors affecting diabetic retinopathy was poorly known. So Proper Training of medical staff and community nurses in screening patients of diabetes and referral to ophthalmology centers should be emphasized to decrease the disease morbidity and blindness associated with diabetes.

Management of retinal diseases, therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy

Introduction: Effective management of retinal diseases, especially diabetic retinopathy, is crucial for preventing severe visual complications. Collaboration between ophthalmologists and endocrinologists plays a fundamental role in the effective treatment of this condition, aiming to preserve vision and improve patients' quality of life. Methods: A bibliographic review was conducted to understand the management of retinal diseases and the therapeutic association between ophthalmology and endocrinology in the treatment of diabetic retinopathy. We used databases such as MEDLINE, PubMed, and Scielo to identify relevant articles published in the last 20 years. Inclusion and exclusion criteria were defined to ensure the selection of pertinent studies. Results: After the search and selection of articles, patterns and trends in the management of diabetic retinopathy were identified. A variety of treatment options were located, including laser photocoagulation, intravitreal injections of medications, and vitreoretinal surgery. The importance of metabolic control of diabetes to prevent retinal damage was noted. The analysis of the studies also highlighted that the interaction between these specialties ensures better clinical outcomes. Conclusion: The importance of collaboration between ophthalmologists and endocrinologists in the management of diabetic retinopathy is reinforced. An integrated approach that considers both ophthalmological and endocrinological aspects of the disease is essential to provide effective care to patients. This cooperation can result in better visual outcomes and quality of life for those affected by diabetic retinopathy.

Assessment of prevalence and need for screening of diabetic retinopathy using non-mydriatic fundus camera in rural and tribal diabetic populations in Maharashtra.

To assess the prevalence of DR and the need for screening and management of DR with medical management of diabetes in rural and tribal population in Maharashtra. The known diabetics of rural area and tribal area were screened at corresponding primary health centers, subcenters, and village level with the help of local healthcare workers using a portable non-mydriatic fundus camera. The prevalence of blindness among known diabetics in rural area was 1.29%, and 0.84% in tribal area. In the rural area, the prevalence of diabetic retinopathy (DR) was 5.67% (n = 776), out of those 18.18% had sight threatening diabetic retinopathy (STDR). The prevalence of DR was 7.73% (n = 711) in tribal areas, out of those, 30.90% had STDR. The significant risk factors were identified to be the duration of diabetes and poor glycemic control. Implementation of targeted interventions for screening and management are required to reduce the risk of blindness among known diabetics in rural and tribal areas.

Exploring the Therapeutic Potential of Anti-VEGF Drugs for the Management of Diabetic Retinopathy: An Overview

Exploring the Therapeutic Potential of Anti-VEGF Drugs for the Management of Diabetic Retinopathy: An Overview

Aldose Reductase as a Key Target in the Prevention and Treatment of Diabetic Retinopathy: A Comprehensive Review.

The escalating global prevalence of diabetes mellitus (DM) over the past two decades has led to a persistent high incidence of diabetic retinopathy (DR), necessitating screening for early symptoms and proper treatment. Effective management of DR aims to decrease vision impairment by controlling modifiable risk factors including hypertension, obesity, and dyslipidemia. Moreover, systemic medications and plant-based therapy show promise in advancing DR treatment. One of the key mechanisms related to DR pathogenesis is the polyol pathway, through which aldose reductase (AR) catalyzes the conversion of glucose to sorbitol within various tissues, including the retina, lens, ciliary body and iris. Elevated glucose levels activate AR, leading to osmotic stress, advanced glycation end-product formation, and oxidative damage. This further implies chronic inflammation, vascular permeability, and angiogenesis. Our comprehensive narrative review describes the therapeutic potential of aldose reductase inhibitors in treating DR, where both synthetic and natural inhibitors have been studied in recent decades. Our synthesis aims to guide future research and clinical interventions in DR management.

An Ayurvedic Management of Diabetic Retinopathy - A Case Report

Diabetic retinopathy (DR) is the most frequent micro vascular complication of Diabetes mellitus. It is an eye condition that can cause vision loss and blindness. Globally the prevalence of Diabetic retinopathy among diabetic patients is estimated to be 27.0% which leads to 0.4 million blindness in the world.[1] It affects blood vessels in the retina (the light-sensitive layer of tissue in the back of the eye). It commonly affects both eyes and can lead to vision loss if it left untreated. Currently available conventional treatments (Focal laser therapy, Anti-vascular growth factor drug) for DR have certain limitations, considering which options from alternative resources are being searched. Despite advances in science the treatment of DR is challenging. So, in this case Ayurveda treatment was done.

Controllable editing via diffusion inversion on ultra-widefield fluorescein angiography for the comprehensive analysis of diabetic retinopathy.

By incorporating multiple indicators that facilitate clinical decision making and effective management of diabetic retinopathy (DR), a comprehensive understanding of the progression of the disease can be achieved. However, the diversity of DR complications poses challenges to the automatic analysis of various information within images. This study aims to establish a deep learning system designed to examine various metrics linked to DR in ultra-widefield fluorescein angiography (UWFA) images. We have developed a unified model based on image generation that transforms input images into corresponding disease-free versions. By incorporating an image-level supervised training process, the model significantly reduces the need for extensive manual involvement in clinical applications. Furthermore, compared to other comparative methods, the quality of our generated images is significantly superior.

Application of non-mydriatic fundus photography-assisted telemedicine in diabetic retinopathy screening.

Early screening and accurate staging of diabetic retinopathy (DR) can reduce blindness risk in type 2 diabetes patients. DR's complex pathogenesis involves many factors, making ophthalmologist screening alone insufficient for prevention and treatment. Often, endocrinologists are the first to see diabetic patients and thus should screen for retinopathy for early intervention. To explore the efficacy of non-mydriatic fundus photography (NMFP)-enhanced telemedicine in assessing DR and its various stages. This retrospective study incorporated findings from an analysis of 93 diabetic patients, examining both NMFP-assisted telemedicine and fundus fluorescein angiography (FFA). It focused on assessing the concordance in DR detection between these two methodologies. Additionally, receiver operating characteristic (ROC) curves were generated to determine the optimal sensitivity and specificity of NMFP-assisted telemedicine, using FFA outcomes as the standard benchmark. In the context of DR diagnosis and staging, the kappa coefficients for NMFP-assisted telemedicine and FFA were recorded at 0.775 and 0.689 respectively, indicating substantial intermethod agreement. Moreover, the NMFP-assisted telemedicine's predictive accuracy for positive FFA outcomes, as denoted by the area under the ROC curve, was remarkably high at 0.955, within a confidence interval of 0.914 to 0.995 and a statistically significant P-value of less than 0.001. This predictive model exhibited a specificity of 100%, a sensitivity of 90.9%, and a Youden index of 0.909. NMFP-assisted telemedicine represents a pragmatic, objective, and precise modality for fundus examination, particularly applicable in the context of endocrinology inpatient care and primary healthcare settings for diabetic patients. Its implementation in these scenarios is of paramount significance, enhancing the clinical accuracy in the diagnosis and therapeutic management of DR. This methodology not only streamlines patient evaluation but also contributes substantially to the optimization of clinical outcomes in DR management.

Insights Into Visual Rehabilitation: Pan-Retinal Photocoagulation for Proliferative Diabetic Retinopathy.

This review comprehensively explores pan-retinal photocoagulation (PRP) as a pivotal intervention in visually rehabilitating individuals afflicted with proliferative diabetic retinopathy (PDR). The review begins by elucidating the significance of PDR within the spectrum of diabetic retinopathy (DR), emphasizing the progressive nature of the disease and the consequential impact on visual health. A detailed analysis of PRP follows, encompassing its definition, purpose, and historical development, shedding light on the procedural intricacies and mechanisms of action. The postoperative care and follow-up section underscores the necessity of vigilant monitoring for complications, visual recovery, and the importance of regular ophthalmic check-ups. The subsequent discussion delves into patient education and counseling, stressing the need to manage expectations, encourage lifestyle modifications, and highlight the significance of follow-up appointments. The review concludes with insights into future directions, including advancements in laser technology and emerging therapies, offering a glimpse into the evolving landscape of DR management. By addressing ongoing challenges and embracing innovative approaches, this review provides a comprehensive guide for clinicians, researchers, and healthcare practitioners who visually rehabilitate individuals struggling with PDR.

Trends of Diabetic Retinopathy Research from 2018-2022: A bibliometric analysis

Introduction & Objectives : Diabetic Retinopathy (DR) is one of the leading cause of visual impairment and blindness. Abundant studies have been done around the topic. This study aims to identify research hotspot of DR during the last five years.
 Methods : Document search in the Scopus database was done using the term “diabetic retinopathy” in Title, Abstracts, and Author Keywords. We included only articles written in English published between 2018 and 2022. The dataset were analyzed using VOSviewer to conduct bibliometric analysis, such as citation analysis of sources and institutions, co-authorship analysis of countries, and co- occurrence analysis of author keywords.
 Results : A total of 8.377 articles on DR were retrieved. Number of articles in DR had been increasing steadily overtime. China had the most publications with over 2.000 articles, while United States had the most international collaboration. The most active institution was Guangdong Provincial Clinical Research Center for Ocular Diseases. Scientific Reports was the most prolific journal in DR research. Co- occurrence analysis of author keywords formed 5 clusters; DR management, risk factors for DR, examination for DR, pathogenesis of DR, and diagnostic method for DR.
 Conclusion : This study revealed research trends on diabetic retinopathy research for the last five years. It may provide information for researchers to identify potential collaborator and give better insight on DR research topics

Outlook of Diabetic Retinopathy Management through Universal Health Care in Indonesia from 2015 – 2020

Introduction & ObjectivesTo identify the National Health Expenditure associated with diabetic retinopathy (DR) from theperspective of Jaminan Kesehatan Nasional [JKN].
 MethodsA dataset of 1% of all individuals registered in JKN database was used from 2015 to 2020. Weretrieved primary diagnosis with type 2 diabetes mellitus (T2DM) (ICD-10 E11) and/or T2DM withophthalmic complications (E11.3). Further diagnosis with DR (H36) was retrieved. Four groups ofmedical procedures related to DR management were developed according to Indonesian Case BaseGroups (INA-CBGs): diagnostic, laser photocoagulation and cryotherapy, minor (intravitrealinjection), and major surgical procedures (e.g., vitrectomy). We performed descriptive analyses forthe annual costs incurred for procedures, premium classifications, and regions.
 ResultsOverall DR costs were US $41.5 million from 156,752 individuals with DR in JKN database sample.The total cost and per unit procedures cost specifically increased annually from 2015 to 2019 butdeclined substantially in 2020. The largest amount was spent on intravitreal injection ($36.3 million[87.5%]), whereas vitrectomy was the least ($145.0 million [0.3%]). Region 1 (Java Island) with nonbeneficiariesof government subsidies (PBPU and PPU) was the major number of claims ($12.5million [30.1%] and ($7.3 million [17.7%]), while beneficiaries of government subsidies (PBI) outsideJava Island, conversely, were under average.
 ConclusionThere was significant increase in health expenditure associated with DR in Indonesia from 2015 to2019, but decreased in 2020 possibly due to COVID-19 pandemic. Majority of funding was spent totreat severe spectrum of DR and concerned in urban area.

Outlook of Diabetic Retinopathy Management through Universal Health Care in Indonesia from 2015 – 2020

Abstract
 Introduction & Objectives : To identify the National Health Expenditure associated with diabetic retinopathy (DR) from the perspective of Jaminan Kesehatan Nasional [JKN].
 Methods : A dataset of 1% of all individuals registered in JKN database was used from 2015 to 2020. We retrieved primary diagnosis with type 2 diabetes mellitus (T2DM) (ICD-10 E11) and/or T2DM with ophthalmic complications (E11.3). Further diagnosis with DR (H36) was retrieved. Four groups of medical procedures related to DR management were developed according to Indonesian Case Base Groups (INA-CBGs): diagnostic, laser photocoagulation and cryotherapy, minor (intravitreal injection), and major surgical procedures (e.g., vitrectomy). We performed descriptive analyses for the annual costs incurred for procedures, premium classifications, and regions.
 Results : Overall DR costs were US $41.5 million from 156,752 individuals with DR in JKN database sample. The total cost and per unit procedures cost specifically increased annually from 2015 to 2019 but declined substantially in 2020. The largest amount was spent on intravitreal injection ($36.3 million [87.5%]), whereas vitrectomy was the least ($145.0 million [0.3%]). Region 1 (Java Island) with non- beneficiaries of government subsidies (PBPU and PPU) was the major number of claims ($12.5 million [30.1%] and ($7.3 million [17.7%]), while beneficiaries of government subsidies (PBI) outside Java Island, conversely, were under average.
 Conclusion : There was significant increase in health expenditure associated with DR in Indonesia from 2015 to 2019, but decreased in 2020 possibly due to COVID-19 pandemic. Majority of funding was spent to treat severe spectrum of DR and concerned in urban area.

Current Trends in Diagnosis and Treatment Approach of Diabetic Retinopathy during Pregnancy: A Narrative Review.

Diabetes mellitus during pregnancy and gestational diabetes are major concerns worldwide. These conditions may lead to the development of severe diabetic retinopathy during pregnancy or worsen pre-existing cases. Gestational diabetes also increases the risk of diabetes for both the mother and the fetus in the future. Understanding the prevalence, evaluating risk factors contributing to pathogenesis, and identifying treatment challenges related to diabetic retinopathy in expectant mothers are all of utmost importance. Pregnancy-related physiological changes, including those in metabolism, blood flow, immunity, and hormones, can contribute to the development or worsening of diabetic retinopathy. If left untreated, this condition may eventually result in irreversible vision loss. Treatment options such as laser therapy, intravitreal anti-vascular endothelial growth factor drugs, and intravitreal steroids pose challenges in managing these patients without endangering the developing baby and mother. This narrative review describes the management of diabetic retinopathy during pregnancy, highlights its risk factors, pathophysiology, and diagnostic methods, and offers recommendations based on findings from previous literature.

Diabetic retinopathy screening guidelines for Physicians in India: position statement by the Research Society for the Study of Diabetes in India (RSSDI) and the Vitreoretinal Society of India (VRSI)-2023

Diabetic retinopathy (DR) is a leading cause of blindness among working-age adults worldwide. India is the diabetes capital of the world and one in five adults is said to have diabetes in India. With the increase in diabetes, there is an increasing burden of diabetic retinopathy (DR). All patients with diabetes have a risk of losing vision due to DR. The prevalence of diabetic retinopathy is 12.5%; out of which, 4% are said to have vision-threatening diabetic retinopathy (VTDR) The early stages of DR are symptomless, necessitating a proactive screening for an early detection of DR in all people with diabetes before they develop VTDR. This is a position statement jointly developed by RSSDI (Research Society for the Study of Diabetes in India) and VRSI (Vitreo Retinal Society of India) to provide guidelines for Physicians on DR screening in India. These guidelines emphasize the need for regular DR screening of all people with diabetes. It is recommended that the Physicians establish an effective DR screening model in their clinics, eg., a non-mydriatic fundus camera utilizing artificial intelligence (AI) algorithms for fundus photography to identify referral or non-referral DR. This will facilitate early detection and timely referral to an ophthalmologist thereby preventing VTDR. The need to create public awareness regarding blindness due to DR and a collaboration between Physicians and ophthalmologists for the management of diabetes, opportunistic screening of DR, and timely management of DR may play a crucial role in decreasing the burden of blindness secondary to diabetes.

The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: a scoping review

IntroductionDiabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care.MethodsThe review protocol was determined and scoping review was conducted.The population, concept, and context were “cadre”, “role of cadre in the management of DR”, and LMICs”. Data were collected from databases and searches, including grey literature.ResultsCadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health.ConclusionThe current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.

DiabNet: A Convolutional Neural Network for Diabetic Retinopathy Detection

Diabetic retinopathy is a leading cause of blindness among diabetic patients, and early detection is crucial. This research proposes DiabNet, a novel convolutional neural network (CNN) architecture designed to enhance the accuracy, efficiency, and robustness of diabetic retinopathy detection from retinal images. DiabNet incorporates unique features like skip connections, attention mechanisms, and batch normalisation to improve feature extraction. The paper details DiabNet’s architecture, feature extraction, and training process. Evaluation on a standard dataset shows that DiabNet surpasses existing methods in accuracy, efficiency, and robustness. The research also explores the interpretability of DiabNet and suggests future research directions. The potential impact of DiabNet includes improved early detection and management of diabetic retinopathy. In addition, DiabNet’s deployment as a mobile app enables convenient and accessible diabetic retinopathy screening. Finally, it is noted that DiabNet, as a mobile app, has the potential to significantly impact the field of diabetic retinopathy detection, leading to improved early detection of diabetic retinopathy. The experimental validation proves that the proposed DiabNet architecture is feasible for real-time deployment yielding an accuracy of 98.72%.

Peripheral retinal lesions in diabetic retinopathy on ultra-widefield imaging

Abstract: Peripheral retinal imaging plays a crucial role in the diagnosis, management, and prognosis of diabetic retinopathy (DR). Traditional fundus imaging techniques have limited coverage of the retina, resulting in missed peripheral lesions. The advent of ultra-widefield (UWF) imaging has revolutionized the assessment of the peripheral retina. UWF imaging modalities provide comprehensive visualization of the retina, enabling the detection of peripheral lesions without the need for mydriasis. Integration of UWF imaging with other modalities, including fluorescein angiography (FA), indocyanine green angiography, pseudocolor imaging, and fundus autofluorescence, further enhances our understanding of peripheral retinal lesions. UWF imaging has demonstrated improved detection of DR lesions and presumably more accurate management of DR compared to traditional fundus photography and dilated fundus examination. UWF-FA and UWF-optical coherence tomography angiography have emerged as valuable tools for assessing retinal and choroidal vascular abnormalities, nonperfusion areas, neovascularization, and microvascular abnormalities. The presence and increasing extent of predominantly peripheral lesions detected using UWF FA are associated with a higher risk of DR progression and proliferative DR. UWF imaging provides a comprehensive evaluation of DR severity, aiding in more accurate risk stratification and treatment decision-making. Overall, UWF imaging modalities have significantly advanced our understanding of peripheral retinal lesions in DR, facilitating early detection and targeted management for better visual outcomes.