Moderate Retinopathy Research Articles

Diabetic Retinopathy Grading using Blended Deep Learning

Diabetic retinopathy is a complication of diabetes that is mainly caused by the damage of the blood vessels located in the retina. Retinal screening contributes to early detection and treatment of diabetic retinopathy. DR has five stages, namely healthy, mild, moderate, severe and proliferative diabetic retinopathy. Computer-aided diagnosis approaches are needed to allow an early detection and treatment. Several automated deep learning (DL) based approaches have been proven to be a powerful tool for DR grading. However, these approaches are usually based on one DL architecture only which could produce over-fitted results. Another identified problem is the use of imbalanced datasets. In this paper, we proposed a blended deep learning approach obtained by training several individual DL models, using a 5-fold cross-validation technique and combining their predictions in a final score. This blended model highlights each individual model where it performs best and discredits where it performs poorly, increasing the robustness of the results. The experiments were conducted on a balanced DDR dataset containing 33310 retina fundus images equally distributed for the DR grades. An explainability algorithm was also used to show the efficiency of the proposed approach in detecting DR signs.

Correlation of leucocyte and platelet indices in patients with type 2 diabetes mellitus with microvascular complications at a tertiary care hospital in south India - A prospective cross-sectional study.

Objective. The present study was directed to assess the correlation between leukocyte and platelet indices and microvascular complications in patients with type 2 diabetes mellitus (T2DM). Methods. A prospective cross-sectional study was conducted between January 2020 and May 2021 at a tertiary healthcare center. Sixty T2DM patients, who fulfilled the inclusion and exclusion criteria, were included into the study and divided into 2 groups: T2DM patients with microvascular complications and T2DM patients without vascular complications. Clinical history was taken and examinations (routine complete blood count) were done to obtain platelet indices, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were obtained and tabulated. A correlation was statistically analyzed from the obtained data, p value <0.05 was considered to be statistically significant. Results. From the patients with microvascular complications, 18 cases suffered from retinopathy and nephropathy. Majority of the participants suffered from moderate non-proliferative retinopathy. The creatine median and absolute neutrophil count (ANC) were significantly higher in T2DM patients with microvascular complications (p<0.0001 and p<0.0054, respectively) compared to T2DM patients without vascular complications. No significant correlation was found between platelet indices, NLR, PLR with regard to fasting blood sugar, post prandial blood sugar, HbA1C in T2DM patients. Conclusions. Since no significant correlation was found between the different platelet indices and microvascular complications, it is evident that these markers cannot be used as the predictors of microvascular complications in T2DM patients.

Quantification of risk factors for diabetic retinopathy progression.

To determine the importance of blood sugar control, blood pressure, and other key systemic factors on the risk of progression from no retinopathy to various stages of diabetic retinopathy. Restrospective cohort analysis of patients (N = 99, 280) in the Kaiser Permanente Northern California healthcare system with a baseline retina photographic screening showing no evidence of retinopathy and a minimum follow-up surveillance period of 3 years from 2008 to 2019. We gathered longitudinal data on diabetic retinopathy progression provided by subsequent screening fundus photographs and data captured in the electronic medical record over a mean surveillance of 7.3 ± 2.2 (mean ± SD) years. Progression from an initial state of no diabetic retinopathy to any of four outcomes was determined: (1) any incident retinopathy, (2) referable (moderate or worse) retinopathy, (3) diabetic macular edema, and (4) proliferative diabetic retinopathy.Multiple predictors, including age, race, gender, glycosylated hemoglobin (HbA1c), systolic blood pressure (SBP), cholesterol, chronic renal disease, and type of diabetes were investigated. Among modifiable risk factors, the average HbA1c had the strongest impact on the progression of diabetic retinopathy, followed by average SBP control and total cholesterol. Patients with an average HbA1c of 10.0% or greater (≥ 97mmol/mol) had a risk ratio of 5.72 (95% CI 5.44-6.02) for progression to any retinopathy, 18.84 (95% CI 17.25-20.57) for referable retinopathy, 22.85 (95% CI 18.87-27.68) for diabetic macular edema, and 25.96 (95% CI 18.75-36.93) for proliferative diabetic retinopathy compared to those with an average HbA1c of 7.0% (53mmol/mol) or less. Non-white patients generally had a higher risk of progression to all forms of diabetic retinopathy, while Asian patients were less likely to develop diabetic macular edema (HR 0.76, 95% CI 0.66-0.87). We confirm the critical importance of glucose control as measured by HbA1c on the risk of development of diabetic retinopathy.

Changes in choroidal and retinal thickness assessed by optical coherence tomography in type 2 diabetes mellitus patients with moderate diabetic retinopathy

AbstractPurpose: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) without diabetic macular edema (DME) and to correlate with changes in retinal thickness (RT) with swept source OCT (SS‐OCT)) compared to healthy subjects.Methods: Fifty‐four DM2 patients with moderate DR without DME and 73 age‐matched healthy subjects were evaluated using SS‐OCT to measure changes in total RT and the CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid.Results: The mean ages were 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Visual acuity (VA) with ETDRS 100% was lower in the DM2 patients (p &lt; 0.001). In the total RT, statistically significant differences were found in the temporal inner area being thicker thickness in the DM2 group (260.70 ± 19.22 μm vs. 271.90 ± 37.61 μm with p = 0.010, in control and DM2 group, respectively). The CT did not show significant differences between both groups (p &gt; 0.05) in any ETDRS area. There was a significant negative correlation between RT and age in all of the external ETDRS areas and a positive significant correlation in the central area for DM2 group. There was also a negative significant correlation between CT and age in all ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner: p = 0.028, central: p = 0.039 and nasal inner: p = 0.003).Conclusions: DM2 patients with moderate DR have no changes in CT. CT and RT decrease with age and show a negative correlation with RT in the central and horizontal parafoveal areas of the ETDRS grid.

Telemedicine Screening of the Prevalence of Diabetic Retinopathy Among Type 2 Diabetic Filipinos in the Community

Purpose: To determine the feasibility of telemedicine screening for diabetic retinopathy in a community setting and to determine the prevalence of diabetic retinopathy among Filipino patients with type 2 diabetes in the community. Study Design: Cross-sectional study among patients with type 2 diabetes in six community health centers in an urban city in the Philippines. Materials and methods: Subjects were examined from November 2018 to December 2018. A three-field non-mydriatic 45’ fundus photographs were taken for each patient and photographs were uploaded in cloud storage and read by a retina specialist in a tertiary hospital for assessment of diabetic retinopathy and grading of the fundus photographs. The results were sent back to local health centers. Results: A total of 387 eyes of 195 persons were examined. Overall, 288 out of 387 eyes (95.36%) had gradable quality fundus photo (grade 3 and higher) and did not need eye dilation. Prevalence of diabetic retinopathy among the respondents was 25.26% - 3.16% had mild diabetic retinopathy, 15.79% had moderate diabetic retinopathy, 3.68% had severe diabetic retinopathy, and 3.68% had proliferative diabetic retinopathy. Other fundus findings noted include hypertensive retinopathy glaucomatous optic nerve, age-related macular degeneration, posterior vitreous detachment, clinically significant macular edema, and epiretinal membrane. Conclusion: Due to the significant number of patients with diabetic retinopathy among type 2 diabetics in the community, telemedicine screening was a feasible alternative to dilated fundus examination and may be considered as part of the local health program to prevent blindness due to diabetes.

The Prevalence of Diabetic Retinopathy in Prediabetes: A Prospective Observational Study in Kashmir

Background: A condition known as prediabetes occurs when some but not all of the diagnostic requirements for diabetes are satisfied. A retinal vascular condition that develops as a side effect of diabetes mellitus (DM) is the most common cause of blindness in working-age individuals around the globe. Methods: The present study was carried out in the Postgraduate Department of Medicine, Government Medical College, Srinagar for a period of two years after receiving ethical permission from the institutional ethics committee. Once they met the inclusion requirements, 200 patients in all were enrolled. Results: Out of a total of 200 patients, diabetic retinopathy was observed in 12 (6.0%) patients only. Of them, 10 (5.0%) had mild retinopathy, while 02 (1.0%) had moderate retinopathy. None of our patients had severe diabetic retinopathy and interestingly all the cases of retinopathy were non-proliferative Conclusion: the present study revealed that about 8% of people with pre-diabetes also have retinopathy supports the theory that retinopathy may begin in what is now thought of as the pre-diabetic condition and subsequently grow by about 50% shortly after diabetes starts Keywords: prediabetes; epidemiology; impaired fasting glucose; impaired glucose tolerance; prevalence; retinopathy.

Choroidal and Retinal Thicknesses in Type 2 Diabetes Mellitus with Moderate Diabetic Retinopathy Measured by Swept Source OCT.

Background: To study choroidal thickness (CT) in type 2 diabetes mellitus (DM2) patients with moderate diabetic retinopathy (DR) and to correlate with changes in retinal thickness (RT) with swept-source OCT (SS-OCT) compared to healthy subjects. Methods: Fifty-four DM2 patients with moderate DR without diabetic macular edema (DME) and 73 age-matched healthy subjects were evaluated using SS-OCT to measure changes in total RT and CT in the nine areas of the Early Treatment Diabetic Retinopathy Study (ETDRS) macular grid. Results: The mean age was 64.06 ± 11.98 years and 60.79 ± 8.62 years in the diabetic and control groups, respectively. Total RT showed statistically significant differences in the temporal inner area, with higher values in the DM2 group (p = 0.010). CT did not show differences between the groups. There was a significant negative correlation between RT and age in all of the outer ETDRS areas and a positive significant correlation in the central area for the DM2 group. There was also a negative significant correlation between CT and age in all of the ETDRS areas except for the inferior inner area. In the DM2 group, a negative correlation was observed between RT and CT in the central area (p = 0.039) and in both horizontal parafoveal areas (temporal inner, p = 0.028; nasal inner, p= 0.003). Conclusion: DM2 patients with moderate DR have no changes with regard to CT. Both CT and RT decreased with age in DM2, showing a negative correlation between these factors in the central and horizontal parafoveal areas of the ETDRS grid.

The Relationship Between Diabetic Retinopathy Degree With Visual Acuity And Retinal Nerve Fiber Layer Thickness In Type 2 Diabetes Mellitus Patients

Introduction: Diabetic retinopathy is an ocular complication of diabetes mellitus (DM), and is one of the leading causes of visual impairment and blindness worldwide.. More than one third of people with diabetes have signs of diabetic retinopathy.&#x0D; &#x0D; Methods: This was an analytic observational study with cross-sectional design. The sample was type 2 diabetes mellitus patients with diabetic retinopathy who visited the eye clinic at the University of Sumatera Utara General Hospital from September 2021-December 2021. The sample were then analyzed with the Mann-Whitney and Kruskal Wallis test to find the relationship between diabetic retinopathy degree with visual acuity and retinal nerve fiber layer thickness in type 2 diabetes mellitus patients.&#x0D; &#x0D; Results: The sample of this study were 20 subjects with diabetic retinopathy and 20 subjects without diabetic retinopathy as the control group. The mean visual acuity in subjects with mild diabetic retinopathy was 0.65+0.48. Average visual acuity in subjects with the degree of moderate diabetic retinopathy was 0.83+0.46. The mean visual acuity in subjects with a proliferative degrees diabetic retinopathy was 0.77+0.64. Mann Whitney test revealed no statistically significant relationship between the degree of diabetic retinopathy and visual acuity (p=0.734). Using the Kruskal Wallis test revealed that there was no significant relationship between the degree of retinopathy diabetic 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; &#x0D; Discussion: Controlling blood glucose levels becomes more important than the duration of diabetes in preventing the development of retinopathy. Most patients are advised to have an HbA1c of 7% or lower, and for certain patients it is recommended to be lower than6.5%. Diabetic retinopathy slowly damages the retinal blood vessels or the optic nerve layer, leading to leakage, thus resulting in accumulation of fluid containing lipid and blood in the retina which will gradually lead to visual impairment, and even blindness.&#x0D; &#x0D; Conclusion: There is no significant relationship between diabetic retinopathy degree with visual acuity and retinal nerve fiber layer thickness in type 2 diabetes mellitus patients.

Aqueous Humor Cytokines in Non-Proliferative Diabetic Retinopathy.

Background and Objectives: Cytokines are cell-signaling proteins whose identification may serve as inflammatory markers or early indicators for progressive disease. The aim of our study was to quantify several cytokines in aqueous humor (AH) and their correlations with biochemical parameters in diabetic eyes with non-proliferative diabetic retinopathy (NPDR). Materials and Methods: A total of 62 eyes from 62 patients were included in the study: 37 eyes from nondiabetic patients (group 1), 13 diabetic eyes with no retinopathy changes (group 2) and 12 diabetic eyes with early and moderate NPDR (group 3). AH samples were collected during uneventful cataract surgery. The cytokines IL-1β, IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, TNF-α and VEGF were quantified using multiplex bead-based immunoassay. Due to unreliable results, IL-1β, TNF-α, IL-10 and IL-12 were excluded. Concentrations were compared between groups. Biochemical parameters (fasting blood sugar, glycated hemoglobin, C-reactive protein) and the duration of diabetes were recorded. Results: VEGF levels were significantly different between groups (p = 0.001), while levels of IL-6, IL-8, IP-10 and MCP-1 were comparable across all groups (p > 0.05). IL-6 concentration correlated with VEGF in group 1 (rho = 0.651, p = 0.003) and group 3 (rho = 0.857, p = 0.007); no correlation could be proved between IL-6, IL-8, IP-10, MCP-1 or VEGF and biochemical parameters. Duration of diabetes was not correlated with the cytokine levels in groups 2 and 3. The receiver operating characteristic (ROC) curve revealed that VEGF concentrations could discriminate early and moderate NPDR from diabetes, with an area under the curve (AUC) of 0.897 (p = 0.001, 95% CI = 0.74–1.0). Conclusions: Diabetes mellitus induces significant intraocular changes in the VEGF expression in diabetic patients vs. normal subjects, even before proliferative complications appear. VEGF was increasingly expressed once the diabetes progressed from no retinopathy to early or moderate retinopathy.

Evaluation of Monocyte Chemoattractant Protein-1 levels as diagnostic biomarker of Diabetic Retinopathy.

Background: Monocyte Chemoattractant Protein-1 (MCP-1) is an inflammatory bio-peptide which release into body circulation in specific response to retinal inflammation. The objective of the current study was to find the levels of monocyte chemoattractant protein-1 in diabetic patients with and without diabetic retinopathy and to compare the functional role of MCP-1 as a better diagnostic biomarker in the early phase of diabetic retinopathy with conventional methods.&#x0D; Methodology: This case-control study was conducted at the Physiology Department of Basic Medical Science Institute (BMSI), Jinnah Postgraduate Medical Center (JPMC)-Karachi, from April 2019 to October 2020. Total 100 participants between 40-65 years of age were separated into four groups: Group A (n=25) diabetic-patients with diabetes duration 5-7 years with no retinopathy; Group B (n=25) diabetic patient’s diabetes duration 8-10 years with mild retinopathy, Group C (n=25) diabetic patient’s diabetes duration 10-15 years with moderate retinopathy while Group D (n=25) healthy normal individuals. All study participants were gone through a detailed history and blood sugar levels, visual acuity, slit-lamp examination, and serum MCP-1 were estimated.&#x0D; Results: The present study reported significantly elevated levels of MCP-1 among group-A (without retinopathy), group B (mild diabetic retinopathy), and Group- C (moderate retinopathy), while Group-D (healthy controls) had the least level of MCP-1 (p-value=0.001) that indicate the early phase of retinal inflammation. Current study has shown strong association between MCP-1 with duration of disease (r=0.885; p &lt; 0.01), and HbA1c (r =0.71; p &lt;0.01) in all study participants. While statistically significant and positive association and correlation were reported between MCP-1 with blood sugar parameters (fasting and random) (r = 0.876; p&lt; 0.01) in all study participants.&#x0D; Conclusion: Elevated levels of MCP-1 with the progression of early retinal inflammation diabetic retinopathy had been reported in the current study. These findings conceivably propose that MCP-1 could be an early diagnostic marker for an additional diagnostic tool for early detection of diabetic retinopathy compared with all conventional clinical findings.

Retinal Vascularization Abnormalities Studied by Optical Coherence Tomography Angiography (OCTA) in Type 2 Diabetic Patients with Moderate Diabetic Retinopathy.

Diabetic retinopathy (DR) is the most severe and frequent retinal vascular disease that causes significant visual loss on a global scale. The purpose of our study was to evaluate retinal vascularization in the superficial capillary plexus (SCP), the deep capillary plexus (DCP) and the choriocapillaris (CC) and changes in the foveal avascular zone (FAZ) by optical tomography angiography (OCTA) in patients with type 2 diabetes mellitus (DM2) with moderate DR but without diabetic macular oedema (DME). Fifty-four eyes of DM2 with moderate DR (level 43 in the ETDRS scale) and without DME and 73 age-matched healthy eyes were evaluated using OCTA with swept-source (SS)-OCT to measure microvascularization changes in SCP, DCP, CC and the FAZ. The mean ages were 64.06 ± 11.98 and 60.79 ± 8.62 years in the DM2 and control groups, respectively. Visual acuity (VA) was lower in the DM2 patients (p = 0.001), OCTA showed changes in the SCP with a significant diminution in the vascular density and the FAZ area was significantly higher compared to healthy controls, with p < 0.001 at the SCP level. The most prevalent anatomical alterations were peripheral disruption in the SCP (83.3%), microaneurysms (MA) in the SCP and in the DCP (79.6% and 79.6%, respectively) and flow changes in the DCP (81.5%). A significant positive correlation was observed between the DM2 duration and the FAZ area in the SCP (0.304 with p = 0.025). A significant negative correlation was also found between age and CC central perfusion (p < 0.001). In summary, a decrease in the vascular density in DM2 patients with moderate DR without DME was observed, especially at the retinal SPC level. Furthermore, it was found that the FAZ was increased in the DM2 group in both retinal plexuses and was greater in the SCP group.

Hypertensive retinopathy: clinical aspects

Funduscopic examination has long been recognized as the most affordable way to assess the condition of small diameter vessels. However, accumulation of new research data, changes in the requirements for the management of patients with various diseases require a return to the clinical, prognostic significance of fundoscopy and the specification of indications for its conduction in certain situations. This article discusses the prevalence of retinopathy depending on the etiological factor, criteria and stages of its development. Until now, a number of issues regarding retinopathy have not been finally resolved, in particular the classification optimal for routine practice, method of its study, etc. It is believed that changes in the fundus blood vessels reflect parallel changes in the vessels of other regions, but this is not always so. A moderate prognostic value of “mild” retinopathy has been established in terms of the risk of cardiovascular diseases, with moderate retinopathy, this relationship reaches a strong level, and with a malignant one, there is a strong correlation with death. The article discusses indications for fundoscopy in routine clinical practice, taking into account the latest scientific data and international recommendations. For the treatment of hypertensive retinopathy, only adequate control of blood pressure is recommended, which can reduce the signs of retinopathy. The authors concluded that the prognostic value of stage 1–2 hypertensive retinopathy is minimal and does not affect patient management. The latter eliminates the need for fundoscopy in patients with mild, controlled arterial hypertension, not suffering from diabetes, with the exception of young patients. Fundoscopy is required in patients with difficult-to-control and resistant arterial hypertension, high variability of blood pressure.

Diabetic Retinopathy Screening with Artificial Intelligence: A Pivotal Experience in Italian Healthcare System – Preliminary Report

Diabetic retinopathy is the main complication of diabetes. Its prevalence is 30% and if not diagnosed in time can cause serious damages to vision, up to blindness. Screening of retinopathy is a healthy procedure with the best ratio cost/effectiveness. If done in a massive way, it allows to detect initial lesions, and so preventing or delaying evolved forms. ASL TO 5 is a Local Health District of Turin Metropolitan Area with 310.315 residents. In 2019, ASL TO5 performed an integrated care pathway dedicated to diabetic retinopathy. The clinical pathway develops technological improvements, in order to make the diagnostic and therapeutic process more effective. New knowledge and technologies, such as non- mydriatic cameras and artificial intelligence (AI) software allow to recognize elementary lesions making a first diagnosis of presence or absence of retinopathy reducing the diagnostic burden on eye care specialists and time costs for patients. Dairet, an artificial intelligence system distributed by Meteda srl (Rome, Italy) powered by Retmarker SA, demonstrated accurate sensitivity in detecting both mild and moderate retinopathy. Sensitivity ratio was 91,6% for mild retinopathy and 100% for moderate retinopathy. More over specificity was acceptable with a low false positive rate (specificity ratio 82,6%).

Grading of Diabetic Retinopathy in Suspected Individuals

Diabetic retinopathy is a fast-spreading eye disease and this may lead to blindness in working-age adults. Between 32 to 40 % of about 347 million people suffer from diabetic retinopathy. It is a silent vision problem and thus, requires regular annual check-ups which will help in controlling the disease at initial stage and effective treatment will provide favorable results. The research utilizes a deep learning approach for diabetic retinopathy classification, which also will aid in addressing real-world issues. The work has already been done to solve this issue with the use of different classification techniques but somehow the efficiency of the training algorithm is dependent on the quality of feature extraction, which necessitates domain expertise. The current work solves the issue by applying a deep learning algorithm that recognizes the pattern and classifies retinal fundus images as normal or infected. In this study on the different categories of diabetic retinopathy 3662 retinal images were analyzed. The categories that are present in the data are No- diabetic retinopathy , mild, moderate, severe, and proliferative diabetic retinopathy . The publicly available retinopathy detection database and a trained model will be used in the experiments to retrieve the features of the ocular images and provide an appropriate output. The goal of this study is to apply and comprehend how the performance of a pretrained model distinguishes between proliferative and nonproliferative diabetic retinopathy.

Application and observation of artificial intelligence in clinical practice of fundus screening for diabetic retinopathy with non-mydriatic fundus photography: a retrospective observational study of T2DM patients in Tianjin, China.

Objective:To observe the consistency of a preliminary report of artificial intelligence (AI) in the clinical practice of fundus screening for diabetic retinopathy (DR) using non-mydriatic fundus photography.Methods:Patients who underwent DR screening in the Metabolic Disease Management Center (MMC) of our hospital were selected as research participants. The degree of coincidence of the AI preliminary report and the ophthalmic diagnosis was compared and analyzed, and the kappa value was calculated. Fundus fluorescein angiography (FFA) was performed in patients referred to the out-of-hospital ophthalmology department, and the consistency between fluorescein angiography and AI diagnosis was evaluated.Results:In total, 6146 patients (12,263 eyes) completed the non-mydriasis fundus examination. The positive DR screening rate was 24.3%. When considering moderate nonproliferative retinopathy as the cut-off point, the kappa coefficient was 0.75 (p < 0.001), the sensitivity was 0.973, and the precision was 0.642, which was shown in the precision–recall curve. Fifty-nine patients referred to receive FFA were compared with non-mydriatic AI diagnoses. The kappa coefficient was 0.53, and the coincidence rate was 66.9%.Conclusion:Non-mydriasis fundus examination combined with AI has a medium-high consistency with ophthalmologists in DR diagnosis, conducive to early DR screening. Combining diagnosis and treatment modes with the Internet can promote the development of telemedicine, alleviate the shortage of ophthalmology resources, and promote the process of blindness prevention and treatment projects.

Applicability of portable retinal cameras and telemedicine as facilitating tools in screening diabetic retinopathy in the COVID-19 pandemic scenario.

Diabetes mellitus is a leading cause of impaired vision. The objective of this study was to evaluate the feasibility of use of portable retinograph and remote analysis of images along with a virtual questionnaire for screening for diabetic retinopathy in basic health units in the city of Ribeirão Preto/SP during the Covid-19 pandemic. Standard Covid-19 protocol was followed during the screening. Blood pressure and capillary blood glucose were measured. Demographic and social data were collected through a standardized online questionnaire via smartphone. After pupillary dilation, fundal images were obtained with portable retinographs by trained ophthalmology residents. Two standardized 45° images were acquired: one posterior segment and another nasal to the optic nerve. Diabetic retinopathy was classified according to the Early Treatment Diabetic Retinopathy Study. A total of 350 patients (64% female; 45% aged 55-70 years; 55% Caucasian) were evaluated. For 40.5% of patients, the campaign was the first opportunity for retinal evaluation; 47.56% had diabetes mellitus for >10 years. On repeat analysis of images stored in a cloud-based repository by retinal specialist, a 7.8% difference was observed in the Early Treatment Diabetic Retinopathy Study diabetic retinopathy classification, compared to the screening findings. Mild diabetic retinopathy was observed in 12.23%, moderate diabetic retinopathy in 6.31%, and proliferative diabetic retinopathy in 2.58% patients. Macular edema was present in 4.58% patients. Diabetic retinopathy was not detected in 72.78% patients. Use of portable retinographs together with telemedicine can provide efficient alternative to traditional methods for screening and diagnosis of diabetic retinopathy.

Characteristics of spontaneous regression of mild and moderate retinopathy of prematurity (ROP)

Characteristics of spontaneous regression of mild and moderate retinopathy of prematurity (ROP)

Structural and functional findings in patients with moderate diabetic retinopathy

PurposeTo evaluate structural and functional ocular changes in patients with type 2 diabetes mellitus (DM2) and moderate diabetic retinopathy (DR) without apparent diabetic macular edema (DME) assessed by optical coherence tomography (OCT) and microperimetry.MethodsThis was a single-center cross-sectional descriptive study for which 75 healthy controls and 48 DM2 patients with moderate DR were included after applying exclusion criteria (one eye per patient was included). All eyes underwent a complete ophthalmic examination (axial length, macular imaging with swept-source OCT, and MAIA microperimetry). Macular thicknesses, ganglion cell complex (GCC) thicknesses, and central retinal sensitivity were compared between groups, and the relationships between the OCT and microperimetry parameters were evaluated.ResultsMacular thickness was similar in both groups (242.17 ± 35.0 in the DM2 group vs 260.64 ± 73.9 in the control group). There was a diminution in the parafoveal area thickness in the DM2 group in the GCC complex. Retinal sensitivity was reduced in all sectors in the DM2 group. The central global value was 24.01 ± 5.7 in the DM2 group and 27.31 ± 2.7 in the control group (p < 0.001). Macular integrity was 80.89 ± 26.4 vs 64.70 ± 28.3 (p < 0.001) and total mean threshold was 23.90 ± 4.9 vs 26.48 ± 2.6 (p < 0.001) in the DM2 and control group, respectively. Moderate correlations were detected between the central sector of MAIA microperimetry and retina total central thickness (− 0.347; p = 0.0035). Age, visual acuity, and hemoglobin A1c levels also correlated with retinal sensitivity.ConclusionMacular GCC thickness and central retinal sensitivity were reduced in patients with moderate DR without DME, suggesting the presence of macular neurodegeneration.

The Utility of Smartphone-Based Artificial Intelligence Approaches for Diabetic Retinopathy: A Literature Review and Meta-Analysis.

Purpose:To assess the diagnostic accuracy measures such as sensitivity and specificity of smartphone-based artificial intelligence (AI) approaches in the detection of diabetic retinopathy (DR).Methods:A literature search of the EMBASE and MEDLINE databases (up to March 2020) was conducted. Only studies using both smartphone-based cameras and AI software for image analysis were included. The main outcome measures were pooled sensitivity and specificity, diagnostic odds ratios and relative risk of smartphone-based AI approaches in detecting DR (of all types), and referable DR (RDR) (moderate nonproliferative retinopathy or worse and/or the presence of diabetic macular edema).Results:Smartphone-based AI has a pooled sensitivity of 89.5% (95% confidence interval [CI]: 82.3%–94.0%) and pooled specificity of 92.4% (95% CI: 86.4%–95.9%) in detecting DR. For referable disease, sensitivity is 97.9% (95% CI: 92.6%-99.4%), and the pooled specificity is 85.9% (95% CI: 76.5%–91.9%). The technology is better at correctly identifying referable retinopathy.Conclusions:The smartphone-based AI programs demonstrate high diagnostic accuracy for the detection of DR and RDR and are potentially viable substitutes for conventional diabetic screening approaches. Further, high-quality randomized controlled trials are required to establish the effectiveness of this approach in different populations.

Hypertensive Retinopathy and the Risk of Hemorrhagic Stroke

ObjectiveHemorrhagic stroke (HS) and hypertensive retinopathy are known end organ damage of the brain and eye respectively, with HS having deleterious consequence to the patients. This study is to correlate between hypertensive retinopathy and HS in hypertensive disease. MethodsA control group of hypertensive patients only, and an investigated group of hypertensive HS patients. Fundoscopic examination to determine the grade of retinopathy was performed and then divided into low or high severity hypertensive retinopathy. Clinical and radiological parameter included are demography, vital signs, Glasgow coma scale (GCS) on admission, clot volume, site of clot, Intracerebral hemorrhage (ICH) score and Glasgow outcome scale (GOS). Data were correlated with the severity of hypertensive retinopathy. ResultsFifty patient in the control group and 51 patients in the investigated group were recruited. In the hypertensive HS group, 21 had low severity retinopathy (no or mild retinopathy) accounting for 41.2% and 30 patients had high severity (moderate or severe retinopathy). In the hypertensive patients 49 had low severity and one had high severity (p-value of 0.001). In HS group low severity showed better GCS score of 9–15 on admission (p-value of 0.003), clot volume less than 30 mL (p-value 0.001), and also a better 30 days mortality rate by using the ICH score (p-value 0.006), GOS score of 4 and 5 the low severity retinopathy fair better than the high severity retinopathy (p-value of 0.001), and the relative risk to develop HS in low severity and high severity retinopathy was 0.42 and 29.4, respectively. ConclusionHypertensive retinopathy screening could be used as an indicator in hypertensive patient, to evaluate the risk of developing hypertensive HS in the future.