Moderate NPDR Research Articles

Prevalence and Risk Factors of Diabetic Retinopathy among Type 2 Diabetic Patients in Tertiary Care Hospital of Gandaki Province of Nepal

Background Diabetic retinopathy (DR) is one of the commonest causes of blindness in Nepal. This study aimed to determine the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients in a tertiary care hospital of Gandaki Province of Nepal. Methods This was a hospital based cross-sectional study conducted among 162 patients of type 2 diabetes aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and diabetic retinopathy was classified according to Early Treatment of Diabetic Retinopathy Study Classification. Results The mean ±SD of age of the study sample was 61.99 ±11.69 years. The prevalence of diabetic retinopathy was 41.98%. Among the patients with diabetic retinopathy, the prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR and PDR were 51.47%, 25%, 11.76%, 1.47%, and 10.29% respectively. There was statistically significant association of diabetic retinopathy with duration of diabetes and chronic kidney disease. However, there was no statistically significant association of diabetic retinopathy with gender, family history, hypertension, history of smoking, history of alcohol, treatment history and physical activity. Conclusions There is high prevalence of diabetic retinopathy among the diabetic patients. Longer duration of diabetes and chronic kidney disease were the significant risk factors for diabetic retinopathy. Early diagnosis and treatment of diabetic retinopathy is essential to reduce blindness in diabetic patients.

Assessment of Baseline Ultrawidefield Fluorescein Angiographic Quantitative Leakage Parameters with Ultrawidefield Fundus Features and Clinical Parameters in Diabetic Retinopathy in Protocol AA

PurposeEvaluate quantitative leakage parameters on ultra-widefield fluorescein angiography (UWF-FA) images and explore their association with Diabetic Retinopathy Severity Scale (DRSS), predominantly peripheral lesions (PPLs), visual acuity, and clinical characteristics. DesignA post-hoc analysis of baseline UWF-FA images in the DRCR Retina Network observational study Protocol AA. ParticipantsN = 575 eyes from 384 adults across 38 sites in the US and Canada with gradable UWF-FA. MethodsA machine learning-enhanced feature extraction platform provided initial leakage segmentation of UWF-FA images sequentially reviewed and corrected by two certified readers for segmentation accuracy. UWF-FA leakage was measured in five retinal zones: panretinal (whole retina), central macular (3-disc diameter fovea-centered circle), posterior pole (6-disc diameter fovea-centered circle), peripheral (outside 6-disc diameter circle) and widefield far peripheral (outside 9-disc diameter circle); associations with clinical factors were evaluated with marginal beta regression models. Main Outcome MeasuresUWF-FA leakage index, calculated as the area with leakage divided by the analyzable retinal area. ResultsThe mean quantitative leakage index was 3.5% for panretinal, 6.6% for macular, 4.8% for posterior pole, 3.3% for peripheral and 2.8% for wide-field far peripheral retinal zones. Panretinal leakage was associated with DRSS (mean 2.2% for no to mild NPDR, 3.4% for moderate NPDR, 4.2% for moderately severe NPDR, 4.8% for severe NPDR and 5.1% for PDR; P<.001), HbA1c (3.2% for HbA1c <8% vs. 3.8% for HbA1c ≥8%; P=.01 for continuous HbA1c), visual acuity (3.3% for 20/25 or better vs. 4.7% for 20/32 or worse; continuous P<.001), and UWF-FA-PPL types of IRMA (4.3% vs. 3.3%; P=.005) or NVE (5.7% vs. 3.4%; P=.003). DRSS was also statistically significant for leakage within all retinal zones (P<.001); eyes with non-central DME versus no DME had higher mean leakage in the central macular (11.2% vs. 5.9%; P=0.005) and posterior pole regions (9.2% vs. 4.2%; P=.002). ConclusionQuantitative UWF-FA leakage analysis identified associations between leakage and DRSS, visual acuity, and presence of DME. In the future, quantitative UWF-FA leakage parameters may be explored as potential biomarkers for disease progression risk.

A Study of the Prevalence of Diabetic Retinopathy in Patients With Ischemic Heart Disease and Diabetes Mellitus.

Background Diabetes mellitus is one of the most important and common chronic diseases worldwide and is expected to increase in prevalence. Diabetic retinopathy (DR) is one of the most prevalent microvascular sequelae of diabetes mellitus (DM), and ischemic heart disease is a macrovascular sequela. This study was conducted to find out the relation between the degree of DR and ischemic heart disease severity in Indian patients. Materials and methods This cross-sectional, descriptive, hospital-based study was conducted in the ophthalmology department at Dr. D. Y. Patil Medical Hospital, Pune, Maharashtra, India, from September 2022 to June 2024. A total of 200 eyes from 100 patients who were diagnosed with cases of ischemic heart disease and diabetes mellitus were included in the study. Patients with corneal pathology like endothelial dystrophies, corneal degenerations, corneal scars, or trauma preventing good visualization of the posterior segment were excluded from the study. Patients with active uveitis, patients with a history of undergoing any previous vitreoretinal surgery or laser procedures, non-compliant patients, patients not willing to undergo the procedure, or those not consenting to the study were also excluded. Written informed consent was obtained from each patient. Data was entered in Microsoft Exceland statistical analysis was done using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. As the continuous variables showed a skewed distribution, we used the Mann-Whitney test and the Kruskal-Wallis test to test the significance of the difference between continuous and categorical variables. A chi-square test was employed to check the association between categorical variables. Significance was assumed at an alpha error of 5%. Results The prevalence of diabetic retinopathy was found to be 95%. The mean age of patients with DR and patients with no diabetic retinopathy was 58.38 and 59.40 years, respectively, with the majority of the patients being in the age group of 60-69 years (46%). The majority of the patients were males (65%), while 35% were females. There was a significant association between the severity of diabetic retinopathy and the higher HbA1c levels, the use of insulin as a treatment modality, and the higher blood sugar levels in our study population. It was observed that the patients in our study with an ejection fraction of <40% had significantly higher severity of diabetic retinopathy in the form of PDR and high-risk PDR. The severity of the DR was directly correlated with the severity of IHD in our study, with most of the IHD patients with a 40-60% ejection fraction having moderate NPDR and patients with a >60% ejection fraction having mild or moderate NPDR. Conclusion The prevalence of diabetic retinopathy among the IHD patients with diabetes was 95% in our study, with moderate NPDR being the most common stage of DR seen among the patients. It was observed that more severe stages of diabetic retinopathy were seen in patients who were on treatment with insulin than in patients who were on treatment with OHA. Severe stages of diabetic retinopathy were associated with higher blood sugar levels (BSL) and higher glycated hemoglobin levels. In the present study, it was observed that a lower ejection fraction (<40%), which is a marker of reduced cardiac function, was associated with more severe stages of diabetic retinopathy.

Association of Severity of Diabetic Retinopathy with HbA1c Level.

Objective: To compare the association of the severity of Diabetic Retinopathy with the level of HbA1c. Methodology: This cross-sectional study was conducted at Pak International Medical College and Hospital Peshawar from March (2019) to June (2019) after approval of ethical review board. Using consecutive sampling technique, total of 106 patients with Diabetic Mellitus type -2 were enrolled in the study who presented to out patient department of ophthalmology, Pak International Medical College and Hospital, Peshawar. Non diabetic patients and those who did not give consent to participate were excluded. After informed consent, full ophthalmologic examination was carried out for each patient. Diabetic retinopathy was graded as 0-5. No diabetic changes were labeled as Grade-0, and mild to moderate NPDR were included in Grade-1, CSME with NPDR as Grade 2, PDR as Grade 3, Advanced DR (VIT HE+ RD) was labeled as Grade 4, and nerve Palsy, CRAO, CRVO was labeled as Grade-5. Frequency and percentages were calculated for categorical data while mean, maximum, minimum, and standard deviation for continuous data via SPSS version- 27. One way ANOVA was applied to check for significance. P value less than 0.05 was considered significant. Results Out of the 106 participants, 44 were male (41.50%) and 62 were female (58.50%). Among participants, Grade -2 (HbA1c range 8-12) comprised the highest percentage of patients at 44.3%, followed by Grade-1 (HbA1c range 5-8) with 35.8%, and Grade -3 (HbA1c range 12-15) with 19.8%. This suggests that as HbA1c values increase, the severity of DMR tends to escalate, emphasizing the critical role of glycemic control in managing diabetic complications affecting the retina. Conclusion As the HbA1c level increases the severity of diabetic retinopathy increases.

Comparison of 21 artificial intelligence algorithms in automated diabetic retinopathy screening using handheld fundus camera

Background Diabetic retinopathy (DR) is a common complication of diabetes and may lead to irreversible visual loss. Efficient screening and improved treatment of both diabetes and DR have amended visual prognosis for DR. The number of patients with diabetes is increasing and telemedicine, mobile handheld devices and automated solutions may alleviate the burden for healthcare. We compared the performance of 21 artificial intelligence (AI) algorithms for referable DR screening in datasets taken by handheld Optomed Aurora fundus camera in a real-world setting. Patients and methods Prospective study of 156 patients (312 eyes) attending DR screening and follow-up. Both papilla- and macula-centred 50° fundus images were taken from each eye. DR was graded by experienced ophthalmologists and 21 AI algorithms. Results Most eyes, 183 out of 312 (58.7%), had no DR and mild NPDR was noted in 21 (6.7%) of the eyes. Moderate NPDR was detected in 66 (21.2%) of the eyes, severe NPDR in 1 (0.3%), and PDR in 41 (13.1%) composing a group of 34.6% of eyes with referable DR. The AI algorithms achieved a mean agreement of 79.4% for referable DR, but the results varied from 49.4% to 92.3%. The mean sensitivity for referable DR was 77.5% (95% CI 69.1–85.8) and specificity 80.6% (95% CI 72.1–89.2). The rate for images ungradable by AI varied from 0% to 28.2% (mean 1.9%). Nineteen out of 21 (90.5%) AI algorithms resulted in grading for DR at least in 98% of the images. Conclusions Fundus images captured with Optomed Aurora were suitable for DR screening. The performance of the AI algorithms varied considerably emphasizing the need for external validation of screening algorithms in real-world settings before their clinical application.

Association of Inflammatory Markers and Diabetic Retinopathy

Abstract Introduction: Diabetic retinopathy is a micro-angiopathy, the pathogenesis of which is manifold. Chronic inflammation releasing various mediators has been proposed to cause micro-angiopathy in long-term diabetics. These markers can be easily measured in serum and may serve as a risk factor for progression as well as allow newer modalities of management aimed at this pathology. Aims and Methodology: The aim of the study was to determine the association between different inflammatory markers and diabetic retinopathy. A total of 100 eyes in diabetic patients, 20 each with no retinopathy, mild NPDR, moderate NPDR, severe NPDR, and PDR were included. The serum levels of C-reactive protein (CRP) and absolute neutrophil count were recorded and compared across each of these groups. Results: The mean ANC among these groups, respectively, was 5525, 5162, 5374, 5239, and 5313 (per microlitre), and neither were these raised significantly nor was the difference between groups statistically significant. Mean CRP levels were within normal limits in all groups (2.56, 2.87, 4.06, 5.15, 6.97 mg/dl), although there was a steady increase with each grade of retinopathy, and this was found statistically significant. Conclusion: There was no association between absolute neutrophil count and diabetic retinopathy. Serum CRP levels may guide progression of retinopathy and can be monitored to help management protocols.

Study on the association between total vitamin D levels and diabetic retinopathy in type 2 diabetic mellitus

This study aims to recognize the interrelation among total vitamin D levels and diabetic retinopathy in diabetic mellitus particular type 2 variant.That was a cross-sectional look on 276 patients with diabetes mellitus. Cases were grouped similarly into with and without DR.Screening tactics like unique records, best-corrected visual acuity, fundoscopic examination, and blood investigations like fasting blood sugar, post prandial blood sugar, HbA1C vitamin-D were carried out. Diabetic retinopathy is graded the use of ETDRS.The relation of the period of diabetes to the severity of retinopathy showed an advantageous correlation, with a p-value &amp;#60;0.001. It has confirmed an inverse relationship among the severity of diabetic retinopathy and Vitamin D values. Sufferers with mild NPDR and moderate NPDR had Vitamin D insufficiency, which decreased to Vitamin D deficiency stages in severe NPDR and PDR.A relation change is observed among diabetic retinopathy and total Vitamin D levels. Henceforth, it is important to examine the affiliation of Vitamin D with the extent of DR, its use to forecast of the severity of DR, and as a device to restrict or prevent the development of retinopathy modifications.

Investigating the Utility of Near-Infrared Reflectance Imaging for Diabetic Retinopathy Screening.

We investigated the reliability of near-infrared reflectance (NIR) imaging as a method of assessing severity of diabetic retinopathy (DR). One hundred ninety-five NIR images were reviewed by two graders for the number of hyporeflective foci, presence or absence of vascular abnormalities, and presumptive DR stage; these were correlated to fundus photography-defined DR stage. Interrater reliability was confirmed via one-way random effects model of intraclass correlation coefficients. Analysis of variance was used in subgroup analysis, receiver operating characteristic (ROC) curves were created to validate reliability of the model, and logistic regression was used to model foci and vascular abnormalities as predictors for moderate or worse disease. A statistically significant difference in mean number of hyporeflective foci was found between no DR and moderate non-proliferative DR (NPDR; P < 0.0001), no DR and severe NPDR (P < 0.001), no DR and proliferative DR (PDR; P < 0.0001), mild and moderate NPDR (P = 0.008), mild and severe NPDR (P < 0.001), and mild NPDR and PDR (P < 0.001). The area under the ROC curve was 0.849 (CI: 0.792 to 0.905). The threshold for detection of moderate NPDR or worse was 4.75 foci, with a sensitivity of 79.0% and a false positive rate of 20.0%. Multivariate logistic regression model incorporating hyporeflective foci with vascular abnormalities (odds ratio [OR] = 1.592, 95% CI: 1.381 to 1.835; P < 0.001) was able to accurately predict moderate disease or worse, just moderate disease (OR = 1.045, 95% CI: 1.003 to 1.089; P = 0.035), severe disease (OR = 1.050, 95% CI: 1.006 to 1.096; P = 0.027), and proliferative disease (OR = 1.050, 95% CI: 1.008 to 1.095; P = 0.018). NIR imaging may be an adjunct tool in screening for DR. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Association between visceral fat area and diabetic retinopathy among people with type 2 diabetes mellitus: a cross-sectional study in Ningbo, Zhejiang Province, China.

The objective of this study is to investigate the relationship between visceral fat area (VFA) and diabetic retinopathy (DR) in the context of type 2 diabetes mellitus (T2DM) within Ningbo, China. The data of a total of 3,707 subjects with T2DM treated at The First Affiliated Hospital of Ningbo University were enrolled. The existence and severity of diabetic retinopathy were assessed by employing the 45° two-field stereoscopic digital photography. Subjects were categorized into four distinct groups: those without DR (NDR), individuals with mild non-proliferative DR (mild NPDR), people with moderate non-proliferative DR (moderate NPDR), and those suffering from vision-threatening DR (VTDR). Bio-electrical impedance was employed to estimate the Visceral fat area (VFA). Multinomial logistic regression models were utilized to evaluate the association between VFA and DR. The mean VFA in patients without diabetic retinopathy (NDR) was notably lower compared to that of patients with diabetic retinopathy (DR) (85.21 ± 37.78 vs. 97.37 ± 44.58 cm2, p < 0.001). As the severity of DR increased, VFA increased gradually but insignificantly (94.41 ± 43.13 cm2, 96.75 ± 40.82 cm2, 100.84 ± 49.34 cm2, p = 0.294). After adjusting the confounding factors, there was an association identified between VFA and the occurrence of DR (OR = 1.020, 95% CI = 1.016-1.024). It showed that regardless of BMI, whether it's less than 25 kg/m2 or greater than or equal to 25 kg/m2, a higher VFA (≥100 cm2) level came with a higher prevalence of DR (p < 0.001). The outcomes of this research indicate a modest association between VFA and the incidence of DR among Chinese patients who have been diagnosed with T2DM in Ningbo.

DIABETES DURATION AND RETINAL NERVE FIBER LAYER THICKNESS RELATED DEGREE OF DIABETIC RETINOPATHY

Introduction &amp; ObjectivesDiabetic retinopathy is an ocular complication of diabetes mellitus (DM). Several studies have shownthat neurodegenerative changes in the retina occur earlier than microvascular changes.Measurement of retinal nerve fiber layer thickness can detect neurodegeneration at an early stage.This study aims to analyze the relationship of diabetes duration and retinal nerve fiber layerthickness with degree of diabetic retinopathy in type 2 diabetes mellitus patients.&#x0D; MethodsThis research was analytic observational research with cross-sectional design. The sample was type2 diabetes mellitus patients with diabetic retinopathy who visited the eye clinic at the University ofSumatera Utara General Hospital. The sample were then analyzed with the Kruskal Wallis test tofind relationship of diabetes duration and retinal nerve fiber layer thickness with degree of diabeticretinopathy in type 2 diabetes mellitus patients.&#x0D; ResultsThe sample of this study were 20 subjects with diabetic retinopathy and 20 subjects without diabeticretinopathy as the control group. The mean duration of having DM in the group of patients with mildNPDR was 5.33 years, with moderate NPDR was 9.13 years and with PDR was 15.33 years. Usingthe Kruskal Wallis test revealed that there was no significant relationship between degree ofdiabetic retinopathy with Avg RNFL (p=0.495), superior RNFL (p=0.385), inferior RNFL (p=0.111),temporal RNFL (p=0.064), nasal RNFL (p=0.535).&#x0D; ConclusionThere was a significant difference between diabetes duration with degree of diabetic retinopathy butno significant between retinal nerve fiber layer thickness with degree of diabetic retinopathy.

A 39-Year-Old Woman with Oculodermal Melanocytosis: A Case Report

Introduction: Nevus of Ota, also known as oculodermal melanocytosis (ODM), is characterized by macular pigmentation which localized to the forehead and periocular area. It usually shows a dermatomal distribution from the first two branches of the trigeminal nerve. We reported a case of oculodermal melanocytosis (ODM).&#x0D; Case presentation: A 39-year-old woman, came with complaints of her left eye rolling inwards for the past 5 years accompanied by a flat black spot on her forehead that spread to her left cheek. She was done macular OCT and orbital ultrasonography of the left eye. She was diagnosed with oculodermal melanocytosis in the left eye, moderate NPDR in both eyes, juvenile cataracts in both eyes, and esotropia in the left eye due to left-eye cranial nerve VI paralysis. Follow-up at 6 months was advised to the patient.&#x0D; Conclusion: Although this is a benign condition, patients are at risk of developing complications such as increased intraocular pressure and melanoma of the skin and/or uvea, ongoing evaluation with imaging methods is highly recommended even if only skin lesions may be repaired using laser for cosmetic reasons.

MicroRNA-150 (miR-150) as a Potential Biomarker for Diabetic Retinopathy

Diabetic retinopathy (DR) is a known chronic complication of diabetes mellitus and is one of the leading causes of visual impairment. The chronic inflammation associated with DR poses large risks not only for the vasculature but also for the surrounding neuronal tissue. Potential biomarkers, especially those surrounding microRNAs (miRNAs), have been proposed to indicate the progression of DR. Levels of certain miRNAs have been shown to be either down or upregulated in type 1 diabetes patients and have shown correlations with specific types of DR. MicroRNA-150 (miR-150) has also been shown to have protective effects on cells in hypoxic environments, but when downregulated, miR-150 actually induces apoptosis. And, it has been shown to be downregulated in patients with type 1 and type 2 diabetes as well as patients with obesity. We hypothesize then that the levels of miR-150 from a peripheral blood sample should be indicative of the progression of DR and may be used for potential early intervention. In this project, we assessed miR-150 levels in the peripheral blood mononuclear cells (MNCs) of individuals with different severities of DR by isolating mononuclear cells and extracting RNA. We then reverse-transcribed the RNA into cDNA and used RT-qPCR to measure the levels of miR-150 in individuals with varying DR severity. MiR-150 levels in the MNCS were decreased in individuals with diabetes with no retinopathy, moderate NPDR and severe NPDR groups when compared to control individuals; however, there was a marginal increase in the miR-150 mild NPDR group. The data could show evidence that a peripheral blood draw could be used as a less invasive approach to assessing the severity of diabetic retinopathy in patients. This would change the disease management and future treatments individually.

Optical coherence tomography characteristics and factors affecting visual acuity in diabetic papillopathy.

To analyse baseline imaging characteristics and factors affecting poor visual acuity in diabetic papillopathy. This was a retrospective, observational study conducted at a tertiary eye care centre in eyes with a diagnosis of diabetic papillopathy. Demographic data including age, gender, duration of diabetes, type of diabetes, HbA1c values and other systemic co-morbidities were recorded. Baseline best corrected visual acuity (BCVA), and various imaging characteristics were noted. 37 eyes of 22 patients with diagnosis of diabetic papillopathy were included [mean age of 46.6 ± 13.5 years, five (22.7%) females and 17 (77.3%) males]. Bilateral involvement was seen in 15 (68.2%) patients. The mean baseline BCVA was 0.51 ± 0.49 logMAR (Snellen equivalent 20/60). Two eyes (5.4%) had features of concurrent mild NPDR, 9 eyes (24.3%) had moderate NPDR, 10 eyes (27.03%) had severe NPDR while 16 (43.2%) other had PDR. All eyes had optic disc edema while 4 had disc pallor at presentation. Telangiectatic vessels/ neovascularisation of disc was present in 17 eyes (45.9%) detected either clinically or on optical coherence tomography (OCT) angiography. 11 (29.7%) eyes had a peripapillary cuff of subretinal fluid accompanying the disc edema. Sixteen eyes (43.2%) had centre involving macular edema seen on OCT. In eyes with a macular edema, the mean central macular thickness was 407.4 ± 71.42 microns at baseline. On assessing the baseline factors that contribute to the final visual acuity, presenting visual acuity was the only variable found to be statistically significant. Although described to have good visual outcome, eyes presenting with poor visual acuity tend to have worse vision on follow up. This may aid in prognosticating and guiding management plan.

Association of Male Sex and Microvascular Alterations on Optical Coherence Tomography Angiography in Diabetes.

Epidemiologically, men have a higher incidence, severity, and progression of diabetic retinopathy (DR) than women. We investigated microvascular differences between men and women with diabetes on optical coherence tomography angiography (OCTA). Three × 3 mm OCTA macula scans of non-diabetic and patients with diabetes were obtained. Vascular parameters included parafoveal vessel density (VD), vessel length density (VLD), and flow index (FI) of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) as well as foveal avascular zone (FAZ) area and perimeter. Multivariable linear regression was used for statistical analysis. There were 1809 patients with diabetes and 217 non-diabetic participants that were included in this study. Diabetic individuals included those with no DR (n = 1356), mild non-proliferative DR (NPDR; n = 286), moderate NPDR (n = 126), and severe NPDR/proliferative DR (PDR; n = 41). Male sex was significantly associated with smaller FAZ area/perimeter and lower DCP VLD in both non-diabetic subjects and patients with diabetes. Male sex in the diabetic group was additionally associated with lower SCP VD/VLD and DCP VD. Addition of an interaction between male sex and diabetes status in the interaction analysis showed that being male and diabetic conferred increased reduction in DCP VD and VLD compared to sex-based changes in non-diabetics. Larger FAZ perimeter, lower SCP VD/VLD, and lower DCP VLD were associated with poorer visual acuity in diabetics. On OCTA, male patients with diabetes may have more severe microvascular disease especially in the DCP compared to women. Sex-based alterations in diabetic microvascular disease has the potential to influence future basic and clinical studies as well as the implementation of OCTA disease markers.

Abstract 17639: Association of Retinal Microvascular Changes With Incidence and Progression of Coronary Artery Calcium Score in Individuals With vs Without Diabetes Mellitus; Data From the Multi-Ethnic Study of Atherosclerosis

Introduction: Retinopathy (RP) is a microvascular complication of diabetes mellitus (DM); however, it is also increasingly recognized in persons without DM. Microvascular disease may play a prominent role in coronary heart disease (CHD) development. We performed this study to evaluate the association of grades of RP with incidence of CAC (Coronary Artery Calcium) among those with zero CAC at baseline. Hypothesis: We performed this study to evaluate the association of grades of RP with incidence of CAC among those with zero CAC at baseline and to Identify the association of grades of MA and RP with progression of CAC among those with positive CAC at baseline. Methods: We included 5709 subjects with and without DM from the Multi-Ethnic Study of Atherosclerosis (MESA), who had retinal photos and CAC score available. We analyzed the association of grades of RP with incidence and progression of CAC among subjects with and without DM with zero CAC and positive CAC at baseline from robust regression models. The grades of RP were defined as: no retinopathy, minimal non-proliferative R (NPR) (level 14 -20), early to moderate NPR (level 31-41) and severe NPR or proliferative RP (level 51-80). Results: Among those with zero CAC, in the diabetic group, early to moderate (95% CI [1.2, 2]) and severe (95% CI [1.3, 3]) NPR had significantly higher incident CAC risk than the non-retinopathy group. Among those with positive CAC at baseline, in the diabetic group, the early to moderate NPR group had higher CAC progression than the non-retinopathy group. (95% CI [-146, 228]). In the non-diabetic group, the minimal NPR group had significantly higher CAC progression than the non-retinopathy group (95% CI [1.8, 52.7]). Conclusions: In conclusion, after adjustment for major CHD risk factors, RP with any severity was associated with incident CAC in DM individuals, however only early to moderate NPDR was associated with CAC progression in them.

The Prevalence of Diabetic Retinopathy and Associated Risk Factors among Diabetic Patients in a Tertiary Care Hospital

Background: One of the most serious complications of diabetes that places an enormous strain on the patient, the healthcare system, and the world economy is diabetic retinopathy (DR). It includes long-term exposure to the metabolic changes linked to diabetes, which cause damage to the retina's microvasculature. Objectives: The aim of the study was to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in a tertiary care hospital. Methods: This cross-section observational study was carried out in the Department of Ophthalmology, North Bengal medical College. Convenience sampling technique was followed. Face to face interview was done to collect data with a semi-structured questionnaire. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). The duration of the period from July 2018 to July 2022. A total of 120 patients were participate in the study. Results: About 58.33% respondents were male and 41.67% were female. Majority (33.33%) of the respondents were within the age group of 50-59. 33.33% were service holder, 41.67% were businessman, 12.5 were day labor, 6.67% were farmer. 75% were from urban area and 25% from rural area. The prevalence of DR in this study was 41.1%. About 90% had DM of &lt;5 years, 55% had 6-10 years, 40% had 15-20 Years, 30% had 16-20 years and only 7% had &gt;21 years. About 50% had normal grade of diabetic retinopathy in the worse eye, 15% had Mild NPDR, 8.33% had Moderate NPDR, 6.67% had Mild to moderate NPDR with non-CSME, 2.5% Moderate NPDR with CSME, Severe NPDR with non-CSME Severe NPDR with CSME and Advanced PDR respectively. Mean FBS (mg/dl) was 160.86±70.6, Total cholesterol (mg/dl) was 183.2 ± 2.1, Triglycerides (mg/dl) was 161.2 ± 2.6, Systolic BP was 130.56±15.7 and Diastolic BP was 80.86±13.4. Patients with baseline age of &lt;60 years were three times (AOR = 3.2:95% CI: 1.19–8.63) more likely to develop DR. The odds of DR is about 3 times (AOR = 2.91:95% CI: 1.01–8.35) higher for patients with disease duration of ≥6 years as compared to disease duration of &lt;6 years. Systolic blood pressure also had statistically significant association with patients having blood pressure of &lt;140 mmHg being about 3.6 times (AOR = 0.28:95% CI: 0.09–0.82) less likely to have DR as compared to hypertensive patients with systolic blood pressure of ≥140 mmHg. The other cofactors, history of hypertension, and total cholesterol level were not independent significant factors for the development of DR in our study. Conclusion: Systolic hypertension, being on insulin alone or in combination with OHA, and having diabetes for a longer period of time were all independently linked to the occurrence of DR. The significant DR prevalence our study suggests that routine patient care, including treatment facilities, has to be improved. Healthcare practitioners must make a consistent effort to educate diabetic patients about the importance of blood sugar control and hypertension management in lowering the risk of the start and progression of DR. It is advised that diabetic patients get health education regarding the importance of routine eye exams for the early detection and treatment of diabetes-related eye problems.

Association between Diabetic Foot Ulcer and Diabetic Retinopathy

Diabetes mellitus is a metabolic disorder with disturbance in carbohydrate, protein and fat metabolism because of partial or complete deficiency of insulin secretion or action. As it can cause various complications and Diabetic retinopathy being the most common and perhaps the most serious of all ocular complications. Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus which result in significantly elevated morbidity and mortality. Aim of the study was to assess the severity of diabetic retinopathy in relation to various grades of diabetic foot ulcer among 100 patients with clinically diagnosed type 2 Diabetes Mellitus with diabetic foot ulcer patients. 25% of the study participants were found to have Moderate NPDR with 15% of the study participants having severe NPDR. 11.1% of study participants with grade 4 DFU had PDR with HRC and 33.3% of study participants with grade 4 DFU had Severe NPDR. 47.1% and 35.3% of study participants with grade 3 DFU had Severe NPDR and moderate NPDR respectively. The association was found to be statistically significant between the severity of diabetic retinopathy and the grades of diabetic foot ulcer of the study participants. The study concluded that the severity of diabetic retinopathy increases with the increase in the stages of DFU and there is a possibility that the presence of DFU can predict the progression to advanced stages of DR. The results of our study support the need for a system of ophthalmological referral in case of detection of DFU, as well as a prompt referral of DR patients to a DFU specialist. Also, in advanced age DFU patients, and particularly those with longer duration of diabetes, early detection of DR and timely treatment may decrease the risk of severe vision loss or blindness. Keywords: diabetic foot ulcer, diabetic retinopathy, risk factors, severity, India

Frequency of Diabetic Retinopathy in Diabetic Patients in Pakistan

Objective: To determine the frequency of diabetic retinopathy and its types in diabetic patients of Pakistan. Study Design: cross sectional study. Place and duration: study was conducted in department of Ophthalmology, Nishtar Hospital Multan from 1st June 2020 to 2nd June 2021 in one-year duration. Methodology: Study was conducted on 300 diabetic patients and presented at the outpatient’s department of hospital. Refraction was done in all patients with the Snellen chart and fundus was examined with slit lamp or fundoscopy method. Main variables of study were diabetic retinopathy, macular edema, and types of diabetic retinopathy. Diabetic retinopathy was further divided into proliferating retinopathy, non-proliferating retinopathy (mild, moderate and sever) according to severity of DR. Results: Out of three hundred patients 65.0% were observed with diabetics’ retinopathy. Prevalence of macular edema in diabetics patients was 13.0%. The diabetic's patients were categories according to retinopathy severity; 28.3% had mild NPDR, 13.0% had moderate NPDR, 11.0% had severe NPDR and 7.7% had PDR. Conclusion: Diabetic retinopathy either proliferative or non-proliferative is highly prevalent in Pakistani population. Early detection and management are necessary to prevent its role in blindness.

Study of changes in choroidal thickness with severity of diabetic retinopathy and diabetic macular edema in type 2 diabetic patients

: Diabetic retinopathy (DR) is one of the long-term microvascular complications of Diabetes mellitus. Chronic hyperglycemia cause microvascular abnormalities to both retina and choroid. Optical coherence tomography (OCT) is a non-invasive fundus imaging modality, which plays a vital role in revealing the pathogenesis and development of retinal–choroidal diseases.This prospective observational study included 128 eyes of 64 subjects diagnosed with type 2 diabetes and out of 128 eyes, 113 (88%) eyes were found to have DR. Collected data included age, gender, duration of diabetes, glycemic control, comprehensive ocular examination, fundus photography, and CT measurement on OCT.Mean age in the study group was 53.71 ± 9.37 years (45–70 years). Out of 113 eyes, 19 (17%) eyes were diagnosed as mild NPDR, 21 (19%) eyes had moderate NPDR, 36 (31%) eyes had severe NPDR and 37 (33%) eyes had PDR. The average SFCT in MILD NPDR was 310 ± 14.70 μm at 95% CI (1.86), MODERATE NPDR was 316 ± 17.97 μm at 95% CI (2.70), SEVERE NPDR was 326.02 ± 14.05 μm at 95% CI (4.59) and PDR was 298.55 ± 18.75μm at 95% CI. (1.41). The presence of DME significantly affects average SFCT. It was observed that choroidal thickness tends to increase as the severity DR with DME progress.The average SFCT was thicker in patients with increase in severity of DR, and then SFCT decreased in patients with PDR. As the severity of NPDR increased from mild to moderate to severe NPDR, there was increase in sub foveal choroidal thickness. (p&amp;#60;0.05). PDR showed decrease in sub foveal choroidal thickness in comparison to NPDR which is highly statistically significant. p=0.01 (p&amp;#60;0.05). The presence of DME significantly affects average SFCT (p&amp;#60;0.05). It was observed that choroidal thickness tends to increase as the severity DR with DME progress. Thus, Choroidal thickness measurement can help in assessment of DR pathogenesis.

Prevalence of microalbuminuria in patients with type 2 diabetes mellitus having diabetic retinopathy in a tertiary care hospital in eastern India: A cross-sectional study

Diabetic retinopathy is a common microvascular complication of diabetes mellitus and one of the leading causes of acquired blindness. Microalbuminuria reflects a pathophysiological state of vascular dysfunction and organ damage. It is noticed that a rise in urinary albumin excretion is seen in the early phase of diabetic retinopathy. The concordance of microalbuminuria and diabetic retinopathy has been well reported in type 1 diabetes; however, for type 2 diabetes, there is a paucity of data. To estimate the prevalence of microalbuminuria in diabetic retinopathy patients with type 2 diabetes attending the out-patient department (OPD) in a tertiary care center in eastern India and also to find out any association between microalbuminuria and severity of diabetic retinopathy. : The study included 200 patients with type 2 diabetic patients having diabetic retinopathy. The study populations were selected by thorough clinical examination and as per inclusion–exclusion criteria. Estimation of urinary albumin and albumin creatinine ratio was done by using Konelab 20 Autoanalyzer machine by the immunoturbidimetry method. Diabetic retinopathy was classified as per the International Clinical Diabetic Retinopathy Severity Scales into mild, moderate, severe, very severe non-proliferative as well as proliferative diabetic retinopathy. Data were analyzed with ratio, rate, percentage, and statistical significance was considered if p&amp;#60;0.5. : The prevalence of microalbuminuria was found in 36% (72 patients). The highest number of patients (88.24%) with microalbuminuria was found in severe NPDR. 93.06% of patients with microalbuminuria had clinically significant macular edema. A statistically significant correlation (p&amp;#60;0.001) was found between microalbuminuria and the degree of retinopathy in mild, moderate, and severe NPDR. A significant correlation was found between urinary microalbumin and the severity of diabetic retinopathy.