Nonmydriatic Fundus Photography Research Articles

Feasibility and effectiveness of a health examination center-based opportunistic eye diseases screening

Background Blindness and low vision represent significant public health issues in China.Late diagnosis is the major reason for the irreversible vision impairment.A feasible, cost-effective screening and referral program is very important for the eye health care, prevention and treatment of blindness in China. Objective This study was to evaluate the feasibility and effectiveness of a health examination center-based opportunistic eye disease screening program. Methods This was a cross-sectional study.Subjects undergoing a routine physical examination at the health examination center of the Fourth People's Hospital of Shenyang were invited to attend this program.Presenting visual acuity, intraocular pressure, and nonmydriatic fundus photography were obtained.Optic disc photographs were evaluated independently by two ophthalmologists.Blindness and moderate to severe vision impairment were defined based on the criteria of World Health Organization Visual Impairment Classification in 2009.Glaucoma, diabetic retinopathy(DR) and other suspected eye diseases were diagnosed according to the fundus photography and intraocular pressure.This study was approved by Ethic Committe of the Fourth People's Hospital of Shenyang, the informed consent of each subject was obtained. Results Totally, 15 303 subjects were enrolled and 15 197 of them finished the exanimations, giving a response rate of 99.3%.The overall percentage of blindness and moderate to severe visual impairment was 0.08% (12/15 197) and 2.34% (355/15 197). Two hundred and twenty-eight (1.50%) subjects were defined as glaucoma suspects and 80 individuals (0.53%) were diagnosed as epimacular membrane.Other suspected eye diseases included DR (0.41%), branchial retinal vessel occlusion (0.24%), macular degeneration (0.09%), and macular hole (0.06%). More than 95% of the eye disease suspects have never been previously diagnosed or treated.A total of 358 subjects (2.36%) were defined as ocular hypertension suspects. Conclusions This health examination center-based opportunistic eye disease screening shows a good efficiency and feasibility.It may become an optional program in the national eye health care project, as well as the work of prevention and treatment of blindness. Key words: Opportunistic eye disease screening; Prevention and treatment of blindness; Eye health care

Association of Abnormal Renal Profiles and Proliferative Diabetic Retinopathy and Diabetic Macular Edema in an Asian Population With Type 2 Diabetes

The comorbidity of chronic kidney disease and diabetic retinopathy (DR) is well known. However, to our knowledge, no cohort study has demonstrated the effect of chronic kidney disease on the development or progression of DR. To investigate the association of chronic kidney disease with the development of DR and diabetic macular edema (DME) in type 2 diabetes. This 8-year prospective cohort study that was conducted in 2 medical centers in Taiwan included 2135 patients with type 2 diabetes. The baseline and mean follow-up renal profiles including serum creatinine level, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR). Diabetic retinopathy and DME were detected with nonmydriatic fundus photography. Cox regression analyses was used to evaluate the hazard ratios (HRs) for the renal profiles of new-onset DR, proliferative DR, and DME. The mean (SD) age of the study participants was 63.4 (11.9) years and 1025 (48%) were women. A higher serum creatinine level (HR of 2.358 for an increase of 1 mg/dL [to convert to micromoles per liter, multiply by 76.25]; 95% CI, 1.901-2.924; P < .001), an estimated glomerular filtration rate of less than 60 mL/min/1.73m2 (40-60: HR, 2.235; 95% CI, 1.351-4.035; P = .002; 30-45: HR, 2.625; 95% CI, 1.436-4.798; P = .002; <30: HR, 5.488; 95% CI, 2.739-10.993; P < .001), and a urinary albumin to creatinine ratio (ACR) of more than 30 mg/g (31-300: HR, 3.202; 95% CI, 2.029-5.053; P < .001; >300: HR, 6.652; 95% CI, 3.922-11.285; P < .001) at baseline were all associated with the development of proliferative DR. A baseline urinary ACR of more than 30 mg/g (31-300: HR, 1.563; 95% CI, 1.078-2.267; P = .02; >300: HR, 2.707; 95% CI, 1.640-4.470; -2.707; P < 0.001) was associated with the development of DME. After adjusting the baseline values, the mean follow-up renal profiles, including a higher serum creatinine level (HR, 2.369 per mg/dL; 95% CI, 1.704-3.293; P < .001), an estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (HR, 4.215; 95% CI, 1.265-14.039; P = .02), and a urinary ACR of more than 30 mg/g (31-300: HR, 2.344; 95% CI, 1.200-4.503; P = .01; >300: HR, 4.193; 95% CI, 1.638-10.735; P = .003) were still correlated with new-onset PDR during the follow-up periods. Abnormal renal profiles at baseline, including a high serum creatinine level, low estimated glomerular filtration rate, and high urinary ACR, were associated with the development of PDR in patients with type 2 diabetes. A high baseline urinary ACR was associated with DME. Abnormal mean follow-up renal profiles were still correlated with new-onset PDR after adjusting for baseline values. Aggressive treatment for chronic kidney disease may have a role in preventing the deterioration of DR.

HIGH PREVALENCE AND SEVERITY OF POSTPARTUM RETINOVASCULAR CHANGES FOLLOWING PRE- ECLAMPSIA WITH SEVERE FEATURES COMPARED TO NORMAL PREGNANCY.

Background: Hypertensive retinopathy complicates about 40-100% of pregnancies with hypertensive disorders and its severity worsens with progression of hypertension. Reactive retinal vessel changes demonstrably also mirror cardiovascular changes in the course of normal pregnancy. There is low utility of fundoscopy in assessing target organ damage and prognosis in pre-eclampsia in low resource setting. Objective: To compare postpartum maternal retinovascular (RV) findings between pregnancies complicated with preeclampsia with severe features (PES) and normal pregnancies at Kenyatta National Hospital (KNH). Methodology: Design: Comparative cross-sectional study conducted between May 2017 and March 2018. Setting: KNH, a regional Teaching and Referral hospital. Study population: Sixty-five women within 72 hours postpartum without preexisting ocular or medical co morbidities following normal pregnancy (n=35) or pregnancies complicated with PES (n=30). Data collection: Participants were interviewed on sociodemographic and reproductive health characteristics and clinical parameters obtained from medical records. Visual acuity assessment was done using a portable LogMAR chart and non-mydriatic fundus photography used for retinovascular evaluation. RV changes were graded using Keith Wagner grading. Data analysis: Postpartum retinovascular findings and severity grades were analyzed and presented as percentages and compared between the two groups using Chi square or Fisher’s exact test. Odds ratios (OR) of retinovascular changes following pre-eclampsia compared to normal pregnancy was estimated. A p value of &lt;0.05 and 95% confidence interval (CI) that doesn’t include the null value were considered significant. Results: Overall prevalence of hypertensive retinovascular change was 90.8% (83.3% in PES versus 97.1% in normal pregnancies). We found statistically significantly greater odds, OR 5.05 CI (0.93, 27.6) of severe retinovascular changes after pregnancies complicated with PES (p=0.045). Conclusion: There is high but comparable prevalence of maternal retinovascular changes within 72 hours postpartum after pregnancies complicated with PES or normal pregnancy. PES is associated with greater odds of postpartum retinovascular changes Compared to normal pregnancies.

Utility of 1% Tropicamide in Improving the Quality of Images for Tele-Screening of Diabetic Retinopathy in Patients with Dark Irides

ABSTRACTPurpose: To compare the quality of fundus photographs taken before and after instillation of one drop of tropicamide.Methods: The 45º fundus photographs were taken with a non-mydriatic fundus camera in three conditions of the pupil; pre-mydriatic, 10 minutes after one drop of tropicamide, and fully dilated. Two photographs were taken in each condition; one centered on the macula and the other on the optic disc. Two vitreoretinal specialists graded the images.Results: A total of 1768 fundus photographs of 149 diabetic patients with dark irides were included. There were more ungradable images (38.1% and 50.3%, graders 1 and 2, respectively) in the non-mydriatic state than partially- (4.6% and 11.5%) or fully-dilated (15.4% and 10.0%) conditions (p < 0.001, both graders). Partially and fully dilated states had similar rates of ungradable images (p = 0.56 and p = 0.54, graders 1 and 2, respectively). Test–retest reliability (repeatability) was 92.5% and 74.3% for the two graders, respectively. Inter-grader agreement was moderate (Kappa = 0.50).Conclusion: Non-mydriatic fundus photographs have a high rate of ungradable images in patients with dark irides. Instillation of only one drop of tropicamide improves the quality of fundus photographs, which is not furthered by adding more drops. This strategy can be used in tele-ophthalmology programs.

Serum uric acid concentration is associated with hypertensive retinopathy in hypertensive chinese adults

BackgroundThis cross sectional investigation included 12,966 subjects with hypertension, a cohort of the China Stroke Primary Prevention Trial (CSPPT), a randomized, multicenter clinical trial. This study aimed to explore the correlation between serum uric acid (SUA) concentration and hypertensive retinopathy in hypertensive adults.MethodsDiagnosis of hypertensive retinopathy was determined by non-mydriatic fundus photography and classified with Keith-Wagener-Barker (KWB) system. The correlation of SUA levels with hypertensive retinopathy prevalence and severity was assessed by statistical analysis.Results9848 (75.95%) subjects were diagnosed with hypertensive retinopathy with the following retinopathy grade distribution: grade 1: 58.80%, grade 2: 14.81%, and grade 3–4: 2.34%. SUA levels were significantly associated with hypertensive retinopathy prevalence. Patients with hypertensive retinopathy had higher SUA levels than those without hypertensive retinopathy. Patients in the highest uric acid quartile had an odds ratio for hypertensive retinopathy of 1.21 compared to patients in the lowest uric acid quartile (OR = 1.21, 95% CI: 1.05–1.40, P = 0.008). When compared to the non-hyperuricemia group, those in the hyperuricemia group had an odds ratio for hypertensive retinopathy of 1.18(OR = 1.18, 95% CI: 1.05–1.33, P = 0.004). Every 1 mg/dl increase in uric acid concentration was significantly associated with a 6% higher odds of hypertensive retinopathy (OR = 1.06, 95% CI: 1.02–1.10, P = 0.002).ConclusionsThe prevalence of hypertensive retinopathy was high (75.95%) among hypertensives in our patients cohort. In addition, SUA concentration was significantly associated with hypertensive retinopathy.

Merritt Lecturer Nancy J. Newman Spreads the Gospel of Nonmydriatic Ocular Fundus Photography

Merritt Lecturer Nancy J. Newman Spreads the Gospel of Nonmydriatic Ocular Fundus Photography

Age-related macular degeneration in a randomized controlled trial of low-dose aspirin: Rationale and study design of the ASPREE-AMD study.

PurposeAlthough aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial.DesignA sub-study of the ‘ASPirin in Reducing Events in the Elderly’ (ASPREE) trial, ASPREE-AMD is a 5-year follow-up double-blind, placebo-controlled, randomized trial of the effect of 100 mg daily aspirin on the course of AMD in 5000 subjects aged 70 years or older, with normal cognitive function and without cardiovascular disease at baseline. Non-mydriatic fundus photography will be performed at baseline, 3-year and 5-year follow-up to determine AMD status.Primary outcome measuresThe incidence and progression of AMD. Exploratory analyses will determine whether aspirin affects the risk of retinal hemorrhage in late AMD, and whether other factors, such as genotype, systemic disease, inflammatory biomarkers, influence the effect of aspirin on AMD.ConclusionThe study findings will be of significant clinical and public interest due to a potential to identify a possible low cost therapy for preventing AMD worldwide and to determine risk/benefit balance of the aspirin usage by the AMD-affected elderly. The ASPREE-AMD study provides a unique opportunity to determine the effect of aspirin on AMD incidence and progression, by adding retinal imaging to an ongoing, large-scale primary prevention randomized clinical trial.

The Prevalence of Diabetic Retinopathy in Australian Adults with Self-Reported Diabetes: The National Eye Health Survey

To determine the prevalence of and factors associated with diabetic retinopathy (DR) among non-Indigenous and Indigenous Australian adults with self-reported diabetes. Population-based cross-sectional study. Non-Indigenous Australians (50-98 years of age) and Indigenous Australians (40-92 years of age) with known diabetes. Diabetes was determined based on self-report of previous diagnosis of the disease. Nonmydriatic fundus photographs were obtained of each eye and graded according to the modified Airlie House classification system. Any DR, vision-threatening DR (VTDR), treatment coverage rates (proportion of participants with proliferative DR [PDR], clinically significant macular edema [CSME], or both who had evidence of retinal scatter and focal laser treatment). Four hundred thirty-one non-Indigenous Australians (13.9%) and 645 Indigenous Australians (37.1%) self-reported diabetes, of whom 93% (1004/1076) had retinal images that were gradable for DR. The sampling weight-adjusted prevalence of any DR and VTDR among non-Indigenous adults with self-reported diabetes was 28.5% (95% confidence interval [CI], 22.6-35.3) and 4.5% (95% CI, 2.6-7.9), respectively. Among adults 40 years of age and older, the sampling weight-adjusted prevalence of any DR and VTDR was 39.4% (95% CI, 33.1-46.1) and 9.5% (95% CI, 6.8-13.1), respectively. Longer diabetes duration was associated significantly with VTDR in the Indigenous Australian population (odds ratio [OR], 1.08 per 1-year increase; P= 0.005) and non-Indigenous Australian population (OR, 1.05 per 1-year increase; P= 0.03). The treatment coverage of PDR and CSME was 75% (56/75) in Indigenous Australians and 79% (15/19) in non-Indigenous Australians. Diabetic retinopathy was attributed as the main cause of vision loss (<6/12 in the better eye) in 9% and 19% of non-Indigenous and Indigenous Australian adults with known diabetes, respectively. Three quarters of non-Indigenous and Indigenous Australian adults with PDR or CSME have received laser treatment. The prevalence of VTDR in Indigenous and non-Indigenous Australians in the present study was lower than that found in previous population-based reports, nevertheless, approximately 1 in 10 Indigenous adults with known diabetes experience VTDR. This highlights that intensified prevention strategies are required to delay or prevent avoidable vision loss resulting from DR in Indigenous Australian communities.

Non-mydriatic fundus photography: a practical review for the neurologist

Declining proficiency in direct ophthalmoscopy by non-ophthalmologists has spurred a search for alternative methods of ocular fundus examination. Recent technological advances have improved the ease of use and quality of...

Non-Mydriatic Fundus Camera Screening for Referral-Warranted Diabetic Retinopathy in a Northern California Safety-Net Setting.

To compare nonmydriatic fundus photography (nFP) screening for diabetic retinopathy (DR) with clinical dilated fundus examination (DFE) in a safety-net setting. This was a retrospective, institutional cohort study of 6,911 patients undergoing nFP screening for DR between 2008 and 2012. A subset of 1,521 patients underwent DFE, and clinical DR grade was compared with nFP DR grade. nFP screening demonstrated 17% prevalence of any DR, with moderate nonproliferative diabetic retinopathy (NPDR) or worse present in 5% of patients. Thirteen percent of photos were unreadable. When compared with DFE, sensitivity and specificity of nFP to detect moderate NPDR or worse were 91% and 97%, respectively. Area under the receiver operating characteristic curve was 0.97. The authors' study found 17% of patients screened with nFP had referral-warranted DR. These results demonstrate a use-case of telemedicine to screen large numbers of patients in a safety-net setting, but they also highlight the need for adequate specialty resources to care for referred patients. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:636-642.].

Nonmydriatic ultrawide field retinal imaging system and nonmydriatic two-field digital fundus photography system in a large-scale diabetic retinopathy screening

Objective To compare the consistency and difference of nonmydriatic ultrawide field retinal imaging system versus nonmydriatic 2-field 45°digital fundus photography system in a large-scale diabetic retinopathy (DR) screening. Methods A total of 733 with type 2 diabetic patients (1466 eyes) underwent nonmydriatic ultrawide field retinal imaging and nonmydriatic 2-field 45°digital fundus photography examination. Two independent readers graded images respectively to determine the stage of DR. A third masked retinal specialist adjudicated discrepancies. Using nonmydriatic 2-field 45°digital fundus photography examination as the standard, the consistency of nonmydriatic ultrawide field retinal imaging was evaluated. The statistic index included sensitivity, specificity, Youden index and Kappa value. The difference of two methods was analyzed by comparative t-test. Results Based on nonmydriatic ultrawide field retinal imaging, the results were as follows: non DR (NDR) in 1062 eyes (74.1%), DR in 340 eyes (23.7%), ungradable in 32 eyes (2.2%). Among 340 DR eyes, there were mild nonproliferative DR (NPDR) in 48 eyes, moderate NPDR in 216 eyes, severe NPDR in 57 eyes, proliferative DR (PDR) in 19 eyes. Based on nonmydriatic 2-field 45°digital fundus photography, the results were as follows: NDR in 1080 eyes (75.3%), DR in 270 eyes (18.8%), ungradable in 84 eyes (5.6%). Among 270 DR eyes, there were NPDR in 36 eyes, moderate NPDR in 175 eyes, severe NPDR in 53 eyes, PDR in 6 eyes. Compared with nonmydriatic 2-field 45°digital fundus photography for screening DR, the sensitivity was 98.0%, the specificity was 95.0%, and the kappa value was 0.87. For screening severe NPDR and PDR, the sensitivity was 100.0%, the specificity was 99.0%, and the kappa value was 0.94. The DR detection rate and the ratio of the picture can't interpretation between two methods both had significant difference (P=0.00). Conclusions In rapid large-scale DR screening, there is high consistency between nonmydriatic ultrawide field retinal imaging versus nonmydriatic 2-field 45°digital fundus photography. Nonmydriatic ultrawide field retinal imaging is proved to be more adaptive, and more comprehensive and precise. Key words: Diabetic retinopathy/diagnosis; Fluorescein angiography

Identification of Diabetic Retinopathy and Ungradable Image Rate with Ultrawide Field Imaging in a National Teleophthalmology Program

To compare diabetic retinopathy (DR) identification and ungradable image rates between nonmydriatic ultrawide field (UWF) imaging and nonmydriatic multifield fundus photography (NMFP) in a large multistate population-based DR teleophthalmology program. Multiple-site, nonrandomized, consecutive, cross-sectional, retrospective, uncontrolled imaging device evaluation. Thirty-five thousand fifty-two eyes (17 526 patients) imaged using NMFP and 16 218 eyes (8109 patients) imaged using UWF imaging. All patients undergoing Joslin Vision Network (JVN) imaging with either NMFP or UWF imaging from May 1, 2014, through August 30, 2015, within the Indian Health Service-JVN program, which serves American Indian and Alaska Native communities at 97 sites across 25 states, were evaluated. All retinal images were graded using a standardized validated protocol in a centralized reading center. Ungradable rate for DR and diabetic macular edema (DME). The ungradable rate per patient for DR and DME was significantly lower with UWF imaging compared with NMFP (DR, 2.8% vs. 26.9% [P < 0.0001]; DME, 3.8% vs. 26.2% [P < 0.0001]). Identification of eyes with either DR or referable DR (moderate nonproliferative DR or DME or worse) was increased using UWF imaging from 11.7% to 24.2% (P < 0.0001) and from 6.2% to 13.6% (P < 0.0001), respectively. In eyes with DR imaged with UWF imaging (n= 3926 eyes of 2402 patients), the presence of predominantly peripheral lesions suggested a more severe level of DR in 7.2% of eyes (9.6% of patients). In a large, widely distributed DR ocular telehealth program, as compared with NMFP, nonmydriatic UWF imaging reduced the number of ungradable eyes by 81%, increased the identification of DR nearly 2-fold, and identified peripheral lesions suggesting more severe DR in almost 10% of patients, thus demonstrating significant benefits of this imaging method for large DR teleophthalmology programs.

Ocular Comorbidities and the Relationship between Eye Diseases and Systemic Disorders.

Ocular Comorbidities and the Relationship between Eye Diseases and Systemic Disorders.

Serum Magnesium Concentration Is Inversely Associated with Albuminuria and Retinopathy among Patients with Diabetes.

Aim. To investigate the association between serum magnesium levels and microvascular complications among patients with diabetes. Methods. Patients with diabetes were recruited between April 2012 and January 2015. All patients received an assay of serum magnesium concentration, were screened for 24 h albumin excretion rate, and underwent nonmydriatic fundus photography. Albuminuria and retinopathy were defined accordingly. A total of 3,100 patients with normal serum magnesium levels were included in this study. Results. Patients with albuminuria and/or retinopathy had lower levels of serum magnesium than patients without these complications (P < 0.001). The prevalence of isolated albuminuria, isolated retinopathy, and combined albuminuria and retinopathy decreased as the concentration of serum magnesium increased. Multiple logistic regression analysis indicated that the odds ratio for isolated albuminuria, isolated retinopathy, and concomitant albuminuria and retinopathy decreased by approximately 20% for every 0.1 mmol/L increase in serum magnesium concentration. Conclusion. Serum magnesium levels were negatively associated with the risk of diabetic microvascular complications among patients with serum magnesium levels within the normal range.

Human Visual System-Based Fundus Image Quality Assessment of Portable Fundus Camera Photographs.

Telemedicine and the medical "big data" era in ophthalmology highlight the use of non-mydriatic ocular fundus photography, which has given rise to indispensable applications of portable fundus cameras. However, in the case of portable fundus photography, non-mydriatic image quality is more vulnerable to distortions, such as uneven illumination, color distortion, blur, and low contrast. Such distortions are called generic quality distortions. This paper proposes an algorithm capable of selecting images of fair generic quality that would be especially useful to assist inexperienced individuals in collecting meaningful and interpretable data with consistency. The algorithm is based on three characteristics of the human visual system--multi-channel sensation, just noticeable blur, and the contrast sensitivity function to detect illumination and color distortion, blur, and low contrast distortion, respectively. A total of 536 retinal images, 280 from proprietary databases and 256 from public databases, were graded independently by one senior and two junior ophthalmologists, such that three partial measures of quality and generic overall quality were classified into two categories. Binary classification was implemented by the support vector machine and the decision tree, and receiver operating characteristic (ROC) curves were obtained and plotted to analyze the performance of the proposed algorithm. The experimental results revealed that the generic overall quality classification achieved a sensitivity of 87.45% at a specificity of 91.66%, with an area under the ROC curve of 0.9452, indicating the value of applying the algorithm, which is based on the human vision system, to assess the image quality of non-mydriatic photography, especially for low-cost ophthalmological telemedicine applications.

Ocular Fundus Photography as an Educational Tool.

The proficiency of nonophthalmologists with direct ophthalmoscopy is poor, which has prompted a search for alternative technologies to examine the ocular fundus. Although ocular fundus photography has existed for decades, its use has been traditionally restricted to ophthalmology clinical care settings and textbooks. Recent research has shown a role for nonmydriatic fundus photography in nonophthalmic settings, encouraging more widespread adoption of fundus photography technology. Recent studies have also affirmed the role of fundus photography as an adjunct or alternative to direct ophthalmoscopy in undergraduate medical education. In this review, the authors examine the use of ocular fundus photography as an educational tool and suggest future applications for this important technology. Novel applications of fundus photography as an educational tool have the potential to resurrect the dying art of funduscopy.

Retinopathy and the Risk of Cardiovascular Disease in Patients With Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort Study)

Patients with chronic kidney disease (CKD) experience other diseases such as cardiovascular disease (CVD) and retinopathy. The purpose of this study was to assess whether retinopathy predicts future CVD events in a subgroup of the participants of the Chronic Renal Insufficiency Cohort (CRIC) study. In this ancillary investigation, 2,605 participants of the CRIC study were invited to participate, and nonmydriatic fundus photographs were obtained in 1,936 subjects. Using standard protocols, presence and severity of retinopathy (diabetic, hypertensive, or other) and vessel diameter caliber were assessed at a central photograph reading center by trained graders masked to study participant's information. Patients with a self-reported history of cardiovascular disease were excluded. Incident CVD events were adjudicated using medical records. Kidney function measurements, traditional and nontraditional risk factors, for CVD were obtained. Presence and severity of retinopathy were associated with increased risk of development of any CVD in this population of CKD patients, and these associations persisted after adjustment for traditional risk factors for CVD. We also found a direct relation between increased venular diameter and risk of development of CVD; however, the relation was not statistically significant after adjustment for traditional risk factors. In conclusion, the presence of retinopathy was associated with future CVD events, suggesting that retinovascular pathology may be indicative of macrovascular disease even after adjustment for renal dysfunction and traditional CVD risk factors. Assessment of retinal morphology may be valuable in assessing risk of CVD in patients with CKD, both clinically and in research settings.

Association between diabetic retinopathy and subclinical atherosclerosis in China: Results from a community-based study.

To evaluate the association of diabetic retinopathy with subclinical atherosclerosis in middle-aged and elderly Chinese with type 2 diabetes. A cross-sectional community-based study was performed among 1607 patients aged 40 years or older in Shanghai. Non-mydriatic digital fundus photography examination was used in diabetic retinopathy detection. Presence of elevated carotid intima-media thickness or carotid plaque was defined as subclinical atherosclerosis. The prevalence of diabetic retinopathy was 15.1% in total patients. Patients with diabetic retinopathy were more likely to have elevated carotid intima-media thickness, carotid plaque and subclinical atherosclerosis than those without diabetic retinopathy (37.9% vs 30.7%, 57.6% vs 49.6% and 64.6% vs 57.1%, respectively). The presence of diabetic retinopathy was significantly associated with increased odds of subclinical atherosclerosis (odds ratio = 1.93, 95% confidence interval = 1.03-3.60) after full adjustments. The presence of diabetic retinopathy was significantly associated with subclinical atherosclerosis in middle-aged and elderly patients with type 2 diabetics in China.

An evaluation of fundus photography and fundus autofluorescence in the diagnosis of cuticular drusen

PurposeTo examine non-mydriatic fundus photography (FP) and fundus autofluorescence (FAF) as alternative non-invasive imaging modalities to fluorescein angiography (FA) in the detection of cuticular drusen (CD).MethodsAmong 2953 adults from the...

Comparison Among Methods of Retinopathy Assessment (CAMRA) Study: Smartphone, Nonmydriatic, and Mydriatic Photography

We compared smartphone fundus photography, nonmydriatic fundus photography, and 7-field mydriatic fundus photography for their abilities to detect and grade diabetic retinopathy (DR). This was a prospective, comparative study of 3 photography modalities. Diabetic patients (n = 300) were recruited at the ophthalmology clinic of a tertiary diabetes care center in Chennai, India. Patients underwent photography by all 3 modalities, and photographs were evaluated by 2 retina specialists. The sensitivity and specificity in the detection of DR for both smartphone and nonmydriatic photography were determined by comparison with the standard method, 7-field mydriatic fundus photography. The sensitivity and specificity of smartphone fundus photography, compared with 7-field mydriatic fundus photography, for the detection of any DR were 50% (95% confidence interval [CI], 43-56) and 94% (95% CI, 92-97), respectively, and of nonmydriatic fundus photography were 81% (95% CI, 75-86) and 94% (95% CI, 92-96%), respectively. The sensitivity and specificity of smartphone fundus photography for the detection of vision-threatening DR were 59% (95% CI, 46-72) and 100% (95% CI, 99-100), respectively, and of nonmydriatic fundus photography were 54% (95% CI, 40-67) and 99% (95% CI, 98-100), respectively. Smartphone and nonmydriatic fundus photography are each able to detect DR and sight-threatening disease. However, the nonmydriatic camera is more sensitive at detecting DR than the smartphone. At this time, the benefits of the smartphone (connectivity, portability, and reduced cost) are not offset by the lack of sufficient sensitivity for detection of DR in most clinical circumstances.