Management Of Retinopathy Research Articles

Clinical Applications and Future Directions of Smartphone Fundus Imaging.

The advent of smartphone fundus imaging technology has marked a significant evolution in the field of ophthalmology, offering a novel approach to the diagnosis and management of retinopathy. This review provides an overview of smartphone fundus imaging, including clinical applications, advantages, limitations, clinical applications, and future directions. The traditional fundus imaging techniques are limited by their cost, portability, and accessibility, particularly in resource-limited settings. Smartphone fundus imaging emerges as a cost-effective, portable, and accessible alternative. This technology facilitates the early detection and monitoring of various retinal pathologies, including diabetic retinopathy, age-related macular degeneration, and retinal vascular disorders, thereby democratizing access to essential diagnostic services. Despite its advantages, smartphone fundus imaging faces challenges in image quality, standardization, regulatory considerations, and medicolegal issues. By addressing these limitations, this review highlights the areas for future research and development to fully harness the potential of smartphone fundus imaging in enhancing patient care and visual outcomes. The integration of this technology into telemedicine is also discussed, underscoring its role in facilitating remote patient care and collaborative care among physicians. Through this review, we aim to contribute to the understanding and advancement of smartphone fundus imaging as a valuable tool in ophthalmic practice, paving the way for its broader adoption and integration into medical diagnostics.

Unilateral Retinopathy in a Preterm Infant With 4q Duplication: Description and Management.

A 33-5/7, 1570 g dichorionic diamniotic twin presented with cryptorchidism, failed hearing examination (both ears), poor feeding, profound hypoglycemia, coagulopathy, conjugated hyper-bilirubinemia, hydronephrosis, and hypotension. Microarray sent with results of whole genome SNP microgray analysis detected an interstitial duplication of the chromosomal segment 4q35 1q35.2. On this basis, telemedicine screening was performed to evaluate for ocular abnormalities in association with abnormal gene testing. Unilateral advanced retinopathy was noted affecting the right eye, with mature vascularization in the left eye. This infant was managed in concordance with retinopathy of prematurity guidelines, despite not making screening criteria. Off-label intravitreal bevacizumab injection (0.625 mg in 0.025 mL) resulted in full vascular maturation assessed by fluorescein angiography 6 months later. This represents the first description and management of retinopathy in 4q duplication syndrome. [Ophthalmic Surg Lasers Imaging Retina 2024;55:228-230.].

Rationale for integration of services for diabetes mellitus and diabetic retinopathy in Kenya

BackgroundGood diabetes mellitus (diabetes) and diabetic retinopathy (DR) management depends on the strength of the health system, prompting us to conduct a health system assessment for diabetes and DR in Kenya. We used diabetes and DR as tracer conditions to assess the strengths and weaknesses in the health system, and potential interventions to strengthen the health system. In this paper, we report on the need and relevance of integration to strengthen diabetes and DR care. This theme emerged from the health system assessment.MethodsUsing a mixed methods study design, we collected data from service providers in diabetes clinics and eye clinics in three counties, from key informants at national and county level, and from documents review.ResultsThere is interest in integration of diabetes and DR services to address discontinuity of care. We report the findings describing the context of integration, why integration is a goal and how these services can be integrated. We use the results to develop a conceptual framework for implementation.ConclusionsThe principal rationale for integrated service provision is to address service gaps and to prevent complications of diabetes and DR. The stakeholder interest and the existing infrastructure can be leveraged to improve these health outcomes.

Magnesium, A Key Element for The Management of Hypertension, Cardiovascular Complications, Retinopathy, and Diabetic Foot in Diabetes

Magnesium, A Key Element for The Management of Hypertension, Cardiovascular Complications, Retinopathy, and Diabetic Foot in Diabetes

The prevalence of Diabetic Retinopathy in a Tertiary Centre in Western Region, Nepal

Background: Diabetes mellitus is a multisystem disease. It has multiple complications like retinopathy, neuropathy, nephropathy, diabetes ketoacidosis, and stroke. Diabetes retinopathy (DR) is one of the blinding complications of diabetes. This study was done to find out the prevalence of diabetic retinopathy among diabetic patients attending in the outpatient department (OPD) of internal medicine, Gandaki Medical College and Teaching Hospital (GMCTHRC), Pokhara, Nepal.
 Materials and Methods: A hospital based cross-sectional study was performed among the 200 diabetes mellitus patients attending in the medicine OPD from 15th December 2017 to 15thDecember 2018. They were referred to eye OPD of GMC. The detailed eye examination including fundus evaluation under mydriasis was done to all the patients. The diagnosis of DR was graded using the Early Treatment Diabetic Retinopathy Study classification (ETDRS). Patients having hypertension and other retinal diseases were excluded from the study. Data analysis was done using statistical package for social sciences (SPPS) version 11.20.
 Results: The mean age of the patients was 63.02 ±11.8 years. In our study 60.5% of the patients were male and 39.5% were female. Diabetes retinopathy was seen in 29.5% patients, of which non proliferative diabetes retinopathy (NPDR) was present in 19.5%, proliferative diabetes retinopathy (PDR) in 9.5% and 0.5% had diabetes maculopathy.
 Conclusion: The prevalence of DR is quite significant in the people with diabetes. Early diagnosis and management of retinopathy will help to avoid blindness due to the diabetic retinopathy.

Assessment of Systems and Services for Management of Diabetes and Diabetic Retinopathy in Cameroon

ABSTRACT Aim To evaluate systems and services for management of diabetes and diabetic retinopathy. Methodology The National Program for Blindness Control conducted a nationwide descriptive study from 1st February to 31st October 2016. Data was collected using WHO’s:“Tool Assessment of Diabetic Retinopathy and Diabetes Management Systems” adapted to the context. Using direct interviews, all previously identified stakeholders, were involved from all levels of management and throughout the territory. The IBM version 20 software permitted analysis. Results Out of the 48 individuals selected, 46 agreed to participate in the survey. Four participants (8.7%) worked at the central level of the Ministry of Public Health, 2 (4.4%) were NGOs partners, 6 (13%) diabetic patients, and 34 (73.9%) health staff. According to the answers of participants, diabetes stands among priorities in the national health policy. Diabetic care services have been integrated into the National action plan for Chronic Non-Communicable Diseases, but a specific program for control of diabetes has not been created neither are national guidelines recommended by the Ministry available. Some health facilities provide care for diabetes and its complications. Modern technologies for evaluation and follow-up of diabetes of its complications are available only in tertiary level hospitals and in some private clinics. The cost of care obtained is the responsibility of the patients and families. Conclusion The political will to manage diabetes and diabetic retinopathy is recognized by stakeholders and beneficiaries but not translated into an effective program. A suitable implementation strategy is necessary.

The medical transition of young adults with type 1 diabetes (T1D): a retrospective chart review identifies areas in need of improvement

BackgroundThe transition process from pediatric to adult care in individuals with T1D has long-term ramifications on health outcomes. Recognition of differences in care delivery and changes made in management during this time may improve the process. We hypothesized that pediatric providers would be less likely to address T1D-related comorbidities than their adult counterparts, highlighting opportunities to strengthen care.MethodsA retrospective chart review of patients aged 16–21 years diagnosed with T1D before age 18 was performed. Data on diagnosis, screening, and management of hypertension, dyslipidemia, microalbuminuria, retinopathy, and neuropathy were collected for 1 year before and 1 year after transition to adult care. The ‘ADA Standards of Medical Care in Diabetes’ were used to determine adherence to the above parameters. Data before and after transition was compared by Fischer’s Exact and Exact McNemar tests.ResultsComplete medical records for 54 subjects were reviewed before and after transition from pediatric to adult care providers within a single academic medical system (52% male; 78% Caucasian). Transition to adult care occurred at a mean age of 18 years. Mean length of transition was 7.8 months with no significant change in an individual’s HbA1c over that time. Over the transition period, there was no difference in diagnoses of hypertension or the use of anti-hypertensive. Adherence to lipid and retinopathy screening was similar across the transition period; however, adherence to microalbuminuria screening was higher after the transition to adult providers (p = 0.01). Neuropathy screening adherence was overall poor but also improved after transition (p < 0.001).ConclusionsOverall, there were no significant changes in the diagnosis or management of several T1D-related comorbidities during the transition period in a small cohort of young adults with T1D. The transition length was longer than the recommended 3-months, highlighting an opportunity to improve the process. There was no deterioration of glycemic control over this time, although HbA1c values were above target. Adult providers had significantly higher rates of adherence to screening for microalbuminuria and neuropathy than their pediatric counterparts, but adherence for neuropathy was quite poor overall, indicating a need for practice improvement.

Assessment of diabetic retinopathy and diabetes management systems in Pakistan using a WHO tool.

Using WHO questionnaire known as TADDS(Tool for Assessment of Diabetic Retinopathy and Diabetes Management System), a country wide survey was conducted to assess the health care system for diabetes mellitus (DM) and diabetic retinopathy (DR). This would also provide any evidence of the presence and usefulness of links between the two. A total of 190 key informants for DR and DM services from 47 districts were interviewed. The answers were reviewed and any disagreement was resolved through discussion with stakeholders'. The final results were disseminated. The results showed that diabetes is listed as a priority; national plan exists but programme has not been implemented. Health professionals are unaware about Ministry of Health guidelines. There is infrequent networking between DM and DR care providers. Transport and cost are the main barriers for accessing these services. Out of pocket expenses provide 55% of health care financing.

Management of severe retinopathy of prematurity in Jaffna

Introduction and objectives: Treatment of Retinopathy of Prematurity (ROP) is revolutionized by the use of Anti-Vascular Endothelial Growth Factor agents over the last decade. This study describes the results of the treatment in the newest paediatric ophthalmology unit in Sri Lanka- Teaching hospital, Jaffna. Methods: Retrospective analysis of the ROP screening and treatment data at the paediatric ophthalmology unit at teaching hospital was carried out. All the screening and treatment sessions were carried out under topical anaesthesia. Out of the 118 babies who underwent screening examinations, 12 babies had severe ROP requiring treatment with intravitreal injection of Bevacizumab. In conclusion intravitreal injection of Bevacizumab is very successful in managing severe Zone 1 and Zone 2 ROP although prolong follow up is mandatory to detect recurrences of ROP.

A Stakeholder Perspective on Diabetes Mellitus and Diabetic Retinopathy Care in Iran; A Qualitative Study.

To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR). In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire contains seven different sections, each consisting of closed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health. Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients. The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve universal health coverage.

To determine the prevalence of diabetic retinopathy (DR) in Karachi

To study the prevalence of diabetic retinopathy (DR) in a sample of 150 patients living in different hospitals in Karachi, as well as to estimate the current eye care to the diabetic population. Population based cross-sectional study in which patients with diabetes aged 25 to 60 years in Karachi, Pakistan. This survey was conducted from April to October 2012. All patients known to have diabetes underwent an eye examination by bio-microscope and indirect ophthalmoscope to check for any signs of DR through dilated pupils by + 78 lens. Participants were also interviewed and examined to determine their demographic characteristics, medical conditions and the regularity of their eye visits. Participants received a comprehensive ocular examination in hospital and a grading of DR was done using standard protocols. Physicians then provided us with the systemic and demographic data. The patients with diabetes aged 25 to 60 years in different hospitals of Karachi. Methdology: This survey was conducted in hospital of Karachi and checks the patients of diabetes as well as to estimate the current eye care to the diabetic population. Result: Among 150 screened patients, 71 had diabetes of them, 71 examined patients with diabetes, and 43 had diabetic retinopathy. Only 16 patients with diabetes had a regular eye examination. Conclusion: This suggests the need for regular screening for diabetic retinopathy and aggressive management of modifiable risk factors could reduce the numbers of people who develop vision-threatening retinopathy. This study demonstrated a high prevalence and poor control of DR in Karachi. This suggests the need for adequate prevention and treatment in patients with diabetes.

Fluorescein Angiography–Based Diagnosis for Retinopathy of Prematurity: Expert-non Expert Comparison

To evaluate accuracy and inter-rater reliability of RetCam fundus images and digital camera fluorangioscopic images in acute retinopathy of prematurity (ROP) by comparing diagnoses given by trainee ophthalmologists with those provided by expert ophthalmologists. This is a multicenter retrospective observational study of diagnostic data from 48 eyes of 24 premature infants with classical ROP, stage II, as evaluated by RetCam 3 and fluorescein angiography (FA). Average gestational age was 25.4 weeks, average weight 804.7 g. A staging grid (with ocular fundus divided into 3 concentric zones) and 24 15° sectors centered around the optic papilla were superimposed on 360° retina photomontages (Photoshop) made from RetCam and FA images. Non expert vs expert diagnosis agreement was measured for each sector by means of Cohen kappa (Fleiss, 1981). A high degree of concordance was found. Inter-rater agreement between expert and non expert interpretations of retinal photomontages was greater for fluorangiographic images than for RetCam images, with κ = 0.61-1 for 120/152 (78.9%) sectors examined on the RetCam images and κ = 0.61-1 for 168/198 (84.8%) sectors examined on the FA images. The FA images appear to be easier to interpret than RetCam images, both by expert and non expert ophthalmologists. The results confirm that FA is a good examination technique with a high degree of reliability, even where trainee practitioners are involved. This suggests that retinopathy management can be improved by entrusting diagnostic responsibilities to trainee ophthalmologists, in order to extend access to correct diagnosis, recognition of threshold lesions, and prompt treatment.

Outcome of transpupillary diode laser photocoagulation for retinal diseases

Background: Diode lasers have been used in ophthalmic practice for several years. They are useful in the management of vasoproliferative retinopathies and have been shown to be comparable in efficacy to the argon laser. Aim: To report on the outcome of transpupillary diode laser treatment for retinal diseases. Patients and Methods: A retrospective study carried out using the case files of patients that had retinal diode laser photocoagulation between June 2011 and May 2012 at the Jos University Teaching Hospital, Jos, Nigeria. Information retrieved included patients' age, sex, diagnosis, indication for retinal laser photocoagulation, prelaser and postlaser visual acuity (VA), best corrected VA, and operative complications. Results: A total of 31 eyes of 21 patients had transpupillary retinal laser photocoagulation during the study period. The commonest indication for retinal laser photocoagulation was proliferative diabetic retinopathy (PDR), and this was seen in 16 eyes (52%). Six eyes (19%) had both PDR and clinically significant macular edema (CSMO), while 3 eyes had CSMO only. Other indications were retinal vein occlusion (RVO) with secondary neovascularization (four eyes), proliferative sickle cell retinopathy (one eye), and traumatic retinal tear (one eye). Following laser therapy in those with diabetic retinopathy, VA improved by at least a line in 6 eyes, remained the same in 13 eyes, and deteriorated in 2 eyes. Neovascular regression was observed in 13 eyes and resolution of macular edema in 3 eyes. In the eyes with RVO, neovascular regression was observed in two eyes. Conclusion: Transpupillary diode laser photocoagulation was beneficial in the treatment of retinal diseases. Fibrovascular proliferation with significant fibrous tissue component was, however, associated with poor response to laser treatment in proliferative retinopathies.

Progress in the study of cancer-associated retinopathy in breast cancer patients

Cancer-associated retinopathy (CAR) typically has a sudden or progressive onset of severe visual loss and an ominous association with an occult malignancy which contains breast cancer. Pathologically, CAR is the degeneration of photoreceptors. But the precise mechanism has not been fully established, CAR may result from autoimmune mediated apoptosis. And in recent years, there also have been some results demonstrating that tumor derived angiogenic factors such as VEGF may also confer the development of CAR, which may offer novel avenues for the therapeutic intervention in CAR. Early initiation of immunosuppressive therapy is critical for vision preservation. Future developments in rapid identification and longitudinal quantification of antibody levels would enable individualized management in these patients. The goal of this review was to analyze the epidemiology, the clinical features, the diagnosis and management of retinopathy in the context of recent advances in the elucidation of breast cancer-associated retinopathy (BCAR) pathogenesis.

Pattern of Presentation of Sickle Cell Retinopathy in Ibadan

Background: Sickle cell retinopathy is not uncommon in Nigeria. Most cases of retinopathy occur in patients with the hemoglobin SC genotype. A significant proportion present late.Methods: A review of Thirty three (33) cases of sickle retinopathy seen over 3years (2008- 2010) that presented to the retinal unit of the department of Ophthalmology, University College Hospital, Ibadan were reviewed. Demographics and pattern of presentation were recorded in the proforma prepared for the study.Results: Hb SC produces most of the presentations. Male: Female ratio was 3:1. About 2/3 of the patients were below 40 years of age. 24/33 (70%) of the patients presented with proliferative retinopathy. About half of them were blind at presentation. Pan retinal laser photocoagulation is the commonest mode of treatment. The role of AntiVEGF intravitreal injection in the management of sickle retinopathy is discussed.Conclusion: General/ Family physicians are to refer patients with sickle retinopathy for regular ophthalmic examinations to identify treatable lesions amenable to intervention.

Cancer-Associated Retinopathy: Update on Pathogenesis and Therapy

Paraneoplastic retinopathies comprise a diverse group of immune-mediated conditions affecting the eye. Cancer-associated retinopathy (CAR) typically has a sudden onset of severe visual loss and an ominous association with an occult malignancy. CAR is one of the best studied and better understood conditions in the multifarious group of autoimmune retinopathies. Recent developments have correlated the disease presentation, course, and therapeutic response to the underlying immune mediators and the inciting antigens. Signaling involving cytotoxic T-lymphocytes antigen 4 (CTLA-4) and vascular endothelial growth factor (VEGF) receptor-1 appears to play a role in the pathogenesis and may offer novel avenues for therapeutic intervention in CAR. Future developments in rapid identification and longitudinal quantification of antibody levels would enable individualized management in these patients. The goal of this review is to analyze the clinical features of diagnosis and management of retinopathy in the context of recent advances in the elucidation of CAR pathogenesis.

Digital Image Processing for Ophthalmology: Detection of the Optic Nerve Head

Fundus images of the retina are color images of the eye taken by specially designed digital cameras. Ophthalmologists rely on fundus images to diagnose various diseases that affect the eye, such as diabetic retinopathy and retinopathy of prematurity. A crucial preliminary step in the analysis of retinal images is the identification and localization of important anatomical structures, such as the optic nerve head (ONH), the macula, and the major vascular arcades. Identification of the ONH is an important initial step in the detection and analysis of the anatomical structures and pathological features in the retina. Different types of retinal pathology may be detected and analyzed via the application of appropriately designed techniques of digital image processing and pattern recognition. Computer-aided analysis of retinal images has the potential to facilitate quantitative and objective analysis of retinal lesions and abnormalities. Accurate identification and localization of retinal f atures and lesions could contribute to improved diagnosis, treatment, and management of retinopathy. This book presents an introduction to diagnostic imaging of the retina and an overview of image processing techniques for ophthalmology. In particular, digital image processing algorithms and pattern analysis techniques for the detection of the ONH are described. In fundus images, the ONH usually appears as a bright region, white or yellow in color, and is indicated as the convergent area of the network of blood vessels. Use of the geometrical and intensity characteristics of the ONH, as well as the property that the ONH represents the location of entrance of the blood vessels and the optic nerve into the retina, is demonstrated in developing the methods. The image processing techniques described in the book include morphological filters for preprocessing fundus images, filters for edge detection, the Hough transform for the detection of lines and circles, Gabor filters to detect the b ood vessels, and phase portrait analysis for the detection of convergent or node-like patterns. Illustrations of application of the methods to fundus images from two publicly available databases are presented, in terms of locating the center and the boundary of the ONH. Methods for quantitative evaluation of the results of detection of the ONH using measures of overlap and free-response receiver operating characteristics are also described. Table of Contents: Introduction / Computer-aided Analysis of Images of the Retina / Detection of Geometrical Patterns / Datasets and Experimental Setup / Detection of the\Optic Nerve Head\Using the Hough Transform / Detection of the\Optic Nerve Head\Using Phase Portraits / Concluding Remarks

Diabetic retinopathy

<h2>Abstract</h2> Diabetic retinopathy is more common in type 1 diabetes than in type 2. In the UK, it is the principal cause of blindness in individuals of working age and places a significant burden on health services. At least 2% of the UK population are currently known to have diabetes, and 10–13% of these have sight-threatening retinopathy. This contribution covers the risk factors, epidemiology, pathogenesis and management of retinopathy in patients with diabetes.

Diabetic retinopathy: medical management and assessment.

Diabetic retinopathy is a common and potentially devastating complication. This review discusses the practical assessment and management of retinopathy, focusing on the treatment of concomitant systemic disorders that influence the development and progression of this complication.

NICE guidelines and diabetic retinopathy

published guidelines for eye screening and management of retinopathy in people with type 2 diabetes (NICE, February 2002). The Health Technology Board for Scotland (HTBS) has also published advice concerning the organisation of services for diabetic retinopathy screening for both type 1 and type 2 diabetes (HTBS, April 2002). NICE utilises the grading system proposed by Eccles et al. (1998) to indicate the strength of evidence upon which they base their recommendations. The strongest evidence is derived from meta-analysis of randomised controlled trials (grade A). The weakest evidence (grade D) is largely derived from expert committee reports and/or clinical experience of respected authorities. Most of the NICE recommendations are based upon the lowest level of evidence with the exception of preventative strategies to achieve a target blood pressure of less than 140/80 and tight glycaemic control (HbA1C less than 7%) which are derived from the UKPDS and graded A (UKPDS 38 and 33). Screening for retinopathy, even by carefully co-ordinated screening programmes utilising retinal photography and conducted and evaluated by trained personnel, or examination by slit lamp indirect ophthalmoscopy, only achieved grade C levels of evidence. The guidelines also provide indications for urgent ophthalmology referral. They state that sight-threatening retinopathy should be seen ‘within a day’ whilst less acute but still urgent categories are left to the strategic health authorities and trusts to agree local standards for maximum waiting times. This latter ‘soft’ target is strengthened by the statement that the NICE guidance development group considered a maximum waiting time of one week to be the appropriate non-immediate, but still ‘urgent’, category and four weeks for the ‘soon’ category. These guidelines, based upon available clinical evidence, are helpful and must be seen as a challenge to those providing diabetes services. The differences between the recommendations from NICE and the specific framework required by the Scottish screening programme is instructive. The latter requires all people with diabetes (not just type 2) to have had their eye status recorded on the local diabetes clinical management system by September 2003. The Scottish diabetes group are also to produce plans to take forward the recommendations of their HTBS report on the organisation of services for diabetic retinopathy screening by summer 2002. Implementation of clinical guidelines for retinopathy screening will require health communities to produce strategies to identify and provide the necessary resources. The NICE guidelines are ambitious but without specified milestones it is difficult to imagine that they will be uniformly applied across the country. Many health authorities currently have some form of diabetic eye screening programme but to-date their quality has been difficult to assess and published audit data, even of the proportion of patients attending for annual screening, is rarely forthcoming. Those responsible for providing diabetes services, which should involve joint management between primary and secondary care, need to ensure that appropriate NICE guidelines and diabetic retinopathy