Diabetic Ocular Complications Research Articles

Omega-3-Index bei Patient*innen mit schweren diabetischen Augenkomplikationen

Summary Background The aim of the study was to assess the omega‑3 index and the proportions of other relevant fatty acids (FAs) in patients undergoing vitrectomy due to severe diabetic ocular complications. According to evidence, an optimal omega‑3 index range is 8–11% and a high level of saturated FAs correlate with advanced diabetic retinopathy (DR). Methods Patients with diabetes mellitus (DM) undergoing vitrectomy due to diabetic macular edema or vitreous hemorrhage secondary to proliferative DRP were recruited for this study. Prior to surgery, the omega‑3 index, defined as the proportion of omega‑3 FAs in the membranes of erythrocytes, and the proportions of omega‑6, omega‑9, saturated and trans FAs were assessed using “high-sensitivity” gas chromatography with flame ionization detection. Results In total, 12 patients with DM type 1 (n = 2) and type 2 (n = 10) were enrolled. Their age was 69 ± 12 years and their HbA1c averaged 7.6 ± 1.2%. The omega‑3 index was 4.5 ± 1.2%. There was a moderate negative correlation between HbA1c and the omega‑3 index (r = −0.51, p = 0.09). The proportions of other FAs were within the normal ranges. However, the proportions of omega‑6 and saturated FAs were in the upper range (33.3 ± 2.2% and 41.1 ± 1.3%, respectively). Conclusion Patients with severe diabetic ocular complications who require vitreoretinal surgery are generally under-supplied with omega‑3 FAs and over-supplied with omega‑6 and saturated FAs. Patients with diabetes might consequently benefit from early omega‑3 FA supplementation and a reduction of saturated FAs in order to prevent or at least slow down the development of DRP and ultimately preserve vision.

Computer aided diagnosis of diabetic retinopathy based on multi-view joint learning

Diabetic retinopathy (DR) is a kind of ocular complication of diabetes, and its degree grade is an essential basis for early diagnosis of patients. Manual diagnosis is a long and expensive process with a specific risk of misdiagnosis. Computer-aided diagnosis can provide more accurate and practical treatment recommendations. In this paper, we propose a multi-view joint learning DR diagnostic model called RT2Net, which integrates the global features of fundus images and the local detailed features of vascular images to reduce the limitations of single fundus image learning. Firstly, the original image is preprocessed using operations such as contrast-limited adaptive histogram equalization, and the vascular structure of the extracted DR image is segmented. Then, the vascular image and fundus image are input into two branch networks of RT2Net for feature extraction, respectively, and the feature fusion module adaptively fuses the feature vectors’ output from the branch networks. Finally, the optimized classification model is used to identify the five categories of DR. This paper conducts extensive experiments on the public datasets EyePACS and APTOS 2019 to demonstrate the method’s effectiveness. The accuracy of RT2Net on the two datasets reaches 88.2% and 85.4%, and the area under the receiver operating characteristic curve (AUC) is 0.98 and 0.96, respectively. The excellent classification ability of RT2Net for DR can significantly help patients detect and treat lesions early and provide doctors with a more reliable diagnosis basis, which has significant clinical value for diagnosing DR.

Role of Optical Coherence Tomography Angiography in Predicting Risk of Progression of Diabetic Retinopathy

Purpose: To determine the role of Optical Coherence Tomography Angiography (OCTA)in predicting risk of progression of diabetic retinopathy. Study Design: Descriptive observational study. Place and Duration of Study: Jinnah Post graduate Medical Center, Karachi, from June 2022 to June 2023. Methods: Patients with type 1 or 2 diabetes were included. Base line investigations were done including Central subfield thickness and OCTA at first visit. Second visit was conducted at 6th month and patients were followed for 24 months.OCT images of poor quality, motion artifact, inaccurate partition of tissue layers and blurry images were excluded. Results: Among 97 enrolled patients, 88 cases finished the complete 24-months follow up. Out of 88 patients, 16 (18.18%) patients showed progression of diabetic retinopathy (DR), 9 (10.22%) patients developed DME, two showed both DR and DME .In univariate analysis, greater FAZ area, reduced FAZ circularity, Fractal dimension (FD) and vessel density (VD) of the deep capillary plexus (DCP) were significantly related to the advancement in DR. Among these, FAZ area, VD, and FD remained significant in the multivariate analysis. Whereas, only decreased VD and FD of superficial capillary plexus (SCP) were significantly related to advancement in DR and DME. Conclusion: Changes in OCTA parameters is significantly associated with progression of diabetic ocular complications including diabetic retinopathy and diabetic macular edema. High risk subjects can be identified by this method for more rigorous treatment.

A novel approach for intelligent diagnosis and grading of diabetic retinopathy

Diabetic retinopathy (DR) is a severe ocular complication of diabetes that can lead to vision damage and even blindness. Currently, traditional deep convolutional neural networks (CNNs) used for DR grading tasks face two primary challenges: (1) insensitivity to minority classes due to imbalanced data distribution, and (2) neglecting the relationship between the left and right eyes by utilizing the fundus image of only one eye for training without differentiating between them. To tackle these challenges, we proposed the DRGCNN (DR Grading CNN) model. To solve the problem caused by imbalanced data distribution, our model adopts a more balanced strategy by allocating an equal number of channels to feature maps representing various DR categories. Furthermore, we introduce a CAM-EfficientNetV2-M encoder dedicated to encoding input retinal fundus images for feature vector generation. The number of parameters of our encoder is 52.88 M, which is less than RegNet_y_16gf (80.57 M) and EfficientNetB7 (63.79 M), but the corresponding kappa value is higher. Additionally, in order to take advantage of the binocular relationship, we input fundus retinal images from both eyes of the patient into the network for features fusion during the training phase. We achieved a kappa value of 86.62% on the EyePACS dataset and 86.16% on the Messidor-2 dataset. Experimental results on these representative datasets for diabetic retinopathy (DR) demonstrate the exceptional performance of our DRGCNN model, establishing it as a highly competitive intelligent classification model in the field of DR. The code is available for use at https://github.com/Fat-Hai/DRGCNN.

IDF23-0118 Knowledge, Attitudes and Practices of Diabetic Patients on Ocular Complications of Diabetes in Lomé (Togo)

IDF23-0118 Knowledge, Attitudes and Practices of Diabetic Patients on Ocular Complications of Diabetes in Lomé (Togo)

Involvement of Vasoactive Intestinal Peptide Family Members in Diabetic Keratopathy

Diabetic keratopathy (DK) is a common ocular complication of diabetes, characterized by alteration of the normal wound-healing mechanism, reduction of epithelial hemidesmosomes, disruption of the basement membrane, impaired barrier function, reduced corneal sensitivity, corneal ulcers, and corneal edema. The limited number of clinical studies do not allow a full characterization of the pathophysiology of DK and, until now, effective therapeutic approaches have not been available. However, in recent years, neuropeptides gained great attention for their biochemical characteristics and therapeutic potential. This review focuses on the role of neuropeptides vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating polypeptide (PACAP) in the eye and, in particular, in the cornea, in physiological conditions, or during DK, by providing an overview of this diabetes mellitus complication.

Analysis of the photographers' quality control in the diabetic retinopathy screening at the IOBA's Reading Center

Aims/Purpose: Diabetic retinopathy (DR) is the most frequent ocular complication of diabetes and one of the leading causes of avoidable blindness. Teleophthalmology screening by taken retinal images is an effective tool in its early detection and delivering prompt treatment. IOBA's Reading Center (RC) of the University of Valladolid is in charge for the Regional Health System (SACYL) DR screening program. Retinographies are taken at Primary Care Centers, under mydriasis, following the three‐field Joslin Vision Network protocol by certified photographers. Quality control (QC) is an indispensable process in a RC to ensure an accurate retinography reading. An upper limit of 5% of photographs taken with low quality has been set as acceptable. This study aimed to analyse the quality of the retinographies taken in the DR screening at the IOBA's RC during 2021 and 2022.Methods: A retrospective study was designed analysing the quality outcomes of DR screening. Certified in image reading Optometrists determined if images received at the RC had enough quality according to seven factors (halo >1/3, inadequate vessels/parenchyma sharpness, inadequate central, nasal, temporal or fundus reflex image and inadequate disk sharpness). Statistical analysis was performed using SPSS 26 (Chicago, USA). Chi‐square test was used to compare frequencies between 2021 and 2022 outcomes.Results: 4474 retinographies were taken during 2021 and 6345 during 2022. 14 photographers took part in the program (8 in both years, 2 left in 2021, and 4 joined in 2022). All analysed factors showed less than 3% of incorrect images. 6.1% of images showed at least one error in 2021 and 4.4% in 2022 (p < 0.01). Every analysed factor showed a significant improvement (p < 0.02) between 2021 and 2022 except for disk sharpness in both eyes (p > 0.05).Conclusions: The quality of the images of the IOBA RC is adequate for the SACYL DR screening program showing values below the fixed upper limit in all the analysed factors with a significant decrease in almost all values that can be attributed to increased experience of capture personnel.

Correlation of Neutrophil Lymphocyte ratio with HbA1c in patients of type 2 Diabetes Mellitus attending Medical Department of a Tertiary Care Centre

Background: Type 2 diabetes mellitus is associated with chronic low-grade inflammation. Neutrophil lymphocyte is an indicator of subclinical inflammation. One of the novel inflammatory markers is neutrophil to lymphocyte ratio. We find only less studies that are directly accessing the relation between NLR and HbA1c, in the present study we aim to correlate neutrophil lymphocyte ratio with glycemic control in patients having type 2 diabetes.
 Methods: Hospital based observational cross section study was carried out at department of medicine at Bharatpur Period August 2023 to December 2023. 176 patients with type 2 diabetes mellitus as per ADA criteria aged more than 18 years were included in the study. Microsoft excel and SPSS version 20.0 were used for collection and analysis of the data, p<0.05 was considered as significant.
 Results: Out of 176 cases having mean age 55.78±9.111, Mean BMI of all participant was 28.37±4.061, mean absolute Neutrophil count was 7.36±7.123 10³/μl and Mean neutrophil lymphocyte ratio count was 4.03±1.545, in which 147 patients (83.5%) had NLR within normal limit, and remaining 29 patients (16.5%) had NLR within more than 3.53. In our study 123 patients (69.9%) had HbA1C more than 9.0. The association of NLR with HbA1c which was significant association (p=0.047) noted between two parameters indicating higher frequency of NLR had a positive correlation with HbA1c and was found to be an independent predictor of poor glycemic control in patients with type 2 diabetes mellitus.
 Conclusions: Our study concluded that the association of NLR with HbA1c which was significant association. The Association of HbA1c with absolute neutrophil count was which significant and association of HbA1c with absolute lymphocyte count was which significant. Type 2 DM patients with raised NLR should be evaluated for cardiovascular, renal and ocular complications of diabetes. NLR may be useful as an easily measurable, noninvasive, widely available and cost-effective parameter for the disease monitoring tool during follow up of diabetic patients.

Okulistyczne aspekty terapii inhibitorami kotransportera sodowo-glukozowego 2. (SGLT-2) – nową grupą leków hipoglikemizujących

Sodium glucose cotransporter 2 is the major protein responsible for glucose reabsorption in the kidneys. Its inhibitors – gliflozins – constitute a new group of hypoglycaemic drugs. The aim of the study is a literature review of ophthalmic aspects of diabetes therapy with the use of this newly introduced group of drugs. Literature data report the expression of the sodium glucose cotransporter 2 not only in the kidneys, but also in non-renal tissues, e.g. in the retina and the lens. Moreover, they indicate its participation in the pathogenesis of diabetic retinopathy. In turn, sodium glucose cotransporter 2 inhibitors, according to the available literature, reduce edema and reduce the loss of pericytes of the retina, and thus may prevent pathological changes occurring in the retina in the course of diabetic retinopathy. The results of clinical trials provide evidence of their effectiveness in the treatment of ocular complications of diabetes, i.e. in preventing the development of diabetic retinopathy, reducing diabetic macular edema, and even inhibiting cataract progression. In addition, the literature provides evidence suggesting a beneficial effect of this new group of hypoglycemic drugs on diabetic retinopathy beyond the control of concentration of blood glucose per se, such as 1. improved energy metabolism, reduction of hypoxia, anti-inflammatory and anti-oxidant effects in the retina by inducing mild ketonemia, 2. as well as a reduction of production of reactive oxygen species via the ERK/1/2/cPLA2/AA/ROS cell pathway. Due to the innovativeness of the topic, the number of literature data in its scope is limited. Therefore, it should be keep in mind that the conclusions may not be complete.

Mass cytometry reveals the corneal immune cell changes at single cell level in diabetic mice.

Diabetic ocular complications include sight-threatening consequences and decreased corneal sensitivity, characterized by decreased tear production, corneal sensitivity and delayed corneal epithelial wound healing. The pathogenesis of diabetic corneal disorders remains largely unknown. Growing evidence implies the participation of immune cells in the development of diabetic corneal diseases. Nonetheless, the immunological changes that result in diabetic corneal problems are largely unknown. Mass cytometry by time of flight (CyTOF) was used to investigate immune cell cluster alterations associated with diabetic corneal disorders. CyTOF test was performed on corneal cells at a single level from 21-week-old diabetic (db/db) and non-diabetic (db/m) mice. A panel of 41 immune-related markers monitored different immune cell types in diabetic corneas. To investigate the proportion of each immune cell subpopulation, an unsupervised clustering method was employed, and T-distributed stochastic neighbor embedding was used to visualize the distinctions between different immune cell subsets. Through CyTOF test, we identified 10 immune cell subsets in the corneal tissues. In a novel way, we discovered significant immune alterations in diabetic corneas, including pronounced alterations in T cells and myeloid cell subgroups in diabetic corneas linked to potential biomarkers, including CD103, CCR2, SiglecF, Ly6G, and CD172a. Comprehensive immunological profiling indicated remarkable changes in the immune microenvironment in diabetic corneas, characterized by a notable decrease in CD103+CD8+ tissue-resident memory T (TRM) cells and Tregs, as well as a dramatic increase of γδT cells and subsets of CD11b+Ly6G+ myeloid-derived suppressor cells (MDSCs). CyTOF analysis revealed significant alterations in the immune microenvironment during the development of diabetic corneal complications. This study mapped the immune microenvironment landscape of type 2 diabetic corneas, providing a fundamental understanding of immune-driven diabetic corneal disorders.

Lo screening nella retinopatia diabetica

Diabetic retinopathy (DR) is the main ocular complication of diabetes. Among all the causes of blindness, it is the only one whose global pre-valence has increased over the past 30 years. DR prevalence is expected to increase in the upcoming years. Therefore, it is essential to establish cost-effective screening programs for early diagnosis of DR, which using new imaging systems, telemedicine and artificial intelligence prevent its evolution to advanced sight-threatening stages.

Extracellular vesicles derived from mouse adipose-derived mesenchymal stem cells promote diabetic corneal epithelial wound healing through NGF/TrkA pathway activation involving dendritic cells

Diabetic keratopathy (DK) is a common ocular complication of diabetes in which the dendritic cells (DCs)-mediated inflammatory response plays an important role. Nerve growth factor (NGF)/Tropomyosin receptor kinase A (TrkA)-mediated inhibition of the nuclear factor kappa B (NF-κB) pathway can reduce inflammatory cytokine production. Extracellular vesicles (EVs) derived from mouse adipose-derived mesenchymal stem cells (mADSC-EVs) have been explored extensively as treatments for degenerative eye disease. However, mADSC-EVs is poorly studied in the DK models. In this study, we investigated the anti-inflammatory effects of mADSC-EVs and explored the underlying mechanisms in vitro and in vivo DK models. Our results showed that mADSC-EVs have significant therapeutic effects including increasing tear volume and the ratio of lacrimal gland/body weight, promoting corneal nerve regeneration, and sensation recovery in streptozotocin (STZ)-induced DK mice. In addition, mADSC-EVs significantly reduced the inflammatory response involving DCs, consistently up-regulated protein expression of the NGF/TrkA pathway, and importantly, reduced lipopolysaccharide (LPS)-mediated IL-6 and TNF-α expression and directly dependent on TrkA in the induced culture of bone marrow-derived DCs (BMDCs). Taken together, our findings revealed that mADSC-EVs promoted diabetic corneal epithelial wound healing through NGF/TrkA pathway activation involving DCs. Given the significant therapeutic efficacy of mADSC-EVs and its clinical application, mADSC-EVs appears to be a promising new therapy for DK.

The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada

BackgroundDiabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries.MethodsFollowing an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers.ResultsWe carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels.ConclusionWorking with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.

Diabetic Macular Oedema Guidelines: An Australian Perspective.

The number of people living with diabetes is expected to rise to 578 million by 2030 and to 700 million by 2045, exacting a severe socioeconomic burden on healthcare systems around the globe. This is also reflected in the increasing numbers of people with ocular complications of diabetes (namely, diabetic macular oedema (DMO) and diabetic retinopathy (DR)). In one study examining the global prevalence of DR, 35% of people with diabetes had some form of DR, 7% had PDR, 7% had DMO, and 10% were affected by these vision-threatening stages. In many regions of the world (Australia included), DR is one of the top three leading causes of vision loss amongst working age adults (20-74 years). In the management of DMO, the landmark ETDRS study demonstrated that moderate visual loss, defined as doubling of the visual angle, can be reduced by 50% or more by focal/grid laser photocoagulation. However, over the last 20 years, antivascular endothelial growth factor (VEGF) and corticosteroid therapies have emerged as alternative options for the management of DMO and provided patients with choices that have higher chances of improving vision than laser alone. In Australia, since the 2008 NHMRC guidelines, there have been significant developments in both the treatment options and treatment schedules for DMO. This working group was therefore assembled to review and address the current management options available in Australia.

Ocular complications of diabetes mellitus in a pediatric population and proposals for screening and follow-up programs.

Diabetes mellitus (DM) is one of the world's greatest health emergencies of the 21st century. Ocular complications of DM are commonly chronic and progressive, but vision loss can be effectively prevented or delayed with early detection and timely treatment. Therefore, regular comprehensive ophthalmologic examinations are mandatory. Ophthalmic screening and dedicated follow-up for adults with DM are well established, whereas, there is no consensus on optimal recommendations for the pediatric population, reflecting the lack of clarity about the current burden of disease in this age group. To determine the epidemiology of ocular complications of diabetes and to assess optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) macular features in a pediatric population with DM. To review ophthalmological screening and follow-up plans for the diabetic pediatric population. Observational study. Retrospective consecutive cohort study of all 165 diabetic patients (330 eyes) aged 0-18 years, examined between January 2006 and September 2018 at the Pediatric Department of 'S. Maria della Misericordia' Udine Hospital who underwent at least one complete ophthalmologic examination at the Ophthalmology University Clinic at the Udine Hospital. OCT and OCTA data were available for 37 patients (72 eyes, 2 excluded). The associations between ocular complications and selected potential risk factors were evaluated by univariate analyses. No patient had signs of ocular diabetic complications or any macular morphological or micro-vascular impairment, regardless of any potential risk factor. The prevalence of strabismus and refractive errors in the study group, was found to be similar to non-diabetic pediatric populations. Screening and follow-up of ocular diabetic complications in children and adolescents could be performed less frequently than in adults with diabetes. There is no need to screen potentially treatable visual disorders in diabetic children earlier or more frequently than in the healthy children thus reducing time spent in hospital and permitting a better tolerance to medical examinations in diabetic pediatric patients. We described the OCT and OCTA patterns in a pediatric population with DM.

Recent advances in thermogels for the management of diabetic ocular complications

Diabetes when left untreated can lead to various complications in the eye – at its most severe, leading to vision loss. Injectable thermogels provide a minimally-invasive platform that facilitates the treatment and recovery of these patients.

Mechanistic investigations of diabetic ocular surface diseases.

With the global prevalence of diabetes mellitus over recent decades, more patients suffered from various diabetic complications, including diabetic ocular surface diseases that may seriously affect the quality of life and even vision sight. The major diabetic ocular surface diseases include diabetic keratopathy and dry eye. Diabetic keratopathy is characterized with the delayed corneal epithelial wound healing, reduced corneal nerve density, decreased corneal sensation and feeling of burning or dryness. Diabetic dry eye is manifested as the reduction of tear secretion accompanied with the ocular discomfort. The early clinical symptoms include dry eye and corneal nerve degeneration, suggesting the early diagnosis should be focused on the examination of confocal microscopy and dry eye symptoms. The pathogenesis of diabetic keratopathy involves the accumulation of advanced glycation end-products, impaired neurotrophic innervations and limbal stem cell function, and dysregulated growth factor signaling, and inflammation alterations. Diabetic dry eye may be associated with the abnormal mitochondrial metabolism of lacrimal gland caused by the overactivation of sympathetic nervous system. Considering the important roles of the dense innervations in the homeostatic maintenance of cornea and lacrimal gland, further studies on the neuroepithelial and neuroimmune interactions will reveal the predominant pathogenic mechanisms and develop the targeting intervention strategies of diabetic ocular surface complications.

Research progress on the pathogenesis of diabetes-related dry eye

In recent years, with the further understanding of medical circles on diabetic ocular complications, the ocular surface abnormalities of diabetes has drawn increasing concerns. Nearly 50% of diabetic patients suffer from dry eye symptoms. The main manifestations of diabetes related dry eye were abnormal lacrimal secretion, poor lacrimal stability, decreased corneal sensitivity, persistent corneal epithelial defect and even corneal ulcer, which were mainly related to the changes of structure and function of lacrimal gland, the decrease of goblet cells in conjunctiva, the abnormality of meibomian gland function and the degeneration of corneal nerve caused by diabetes. In this paper, we summarized and analyzed the recent research progress on the effect of diabetes on lacrimal film, corneal innervation and lacrimal gland innervation, and the correlation between oxidative stress, advanced glycation end products and diabetes-related dry eye, to explore the pathogenesis of diabetes-related dry eye and to provide reference for clinical diagnosis, treatment and research.

THE TOXIC EFFECT OF HYPERGLYCAEMIA IN THE PATHOGENESIS OF SELECTED CHRONIC COMPLICATIONS OF DIABETES MELLITUS: A MINI-REVIEW

Diabetes mellitus is a group of metabolic diseases that, due to the long-term pathological effect of hyperglycaemia on tissues, lead to the development of typical chronic organ complications. Chronic hyperglycaemia leads to increased activity of the polyol pathway with subsequent accumulation of sorbitol and fructose, increased formation and accumulation of end products of advanced glycation, alteration of protein kinase C activity, excessive formation of reactive oxygen species and associated high level of oxidative stress. One of the most feared complications of diabetes mellitus is vision impairment and blindness. In this review, we address the most important metabolic pathways leading to the development of diabetic retinopathy and diabetic cataract, the ocular complications of diabetes with the greatest risk of vision loss.

Artificial intelligence for diabetic retinopathy screening

AbstractDiabetes constitutes a significant problem for global health and wellbeing. The number of people living with diabetes raised from 108 million in 1980 to 422 million in 2014. By 2035, 592 million people will have diabetes, with the largest rise in low‐ and middle‐income regions. Diabetic retinopathy (DR) is one of the major complications of diabetes, estimated to be the leading cause of blindness among working‐age adults globally. The increasing worldwide population, coupled with increasing prevalence of diabetes and increased incidence of diabetic retinopathy all lead to increasing number of patients with ocular complications of diabetes. Only a few countries were able to successfully establish and continue diabetic retinopathy screening on national level, most prominently – United Kingdom and Singapore. The NHS Diabetic Eye Screening Programme, a continuation of an English screening programme set up in 2006, reported in 2014 that DR is no longer the leading cause of certifiable blindness in England and Wales for the first time in 50 years. The advent of deep‐learning based DR detection revealed a significant improvement in the accuracy of the newly developed or improved systems. It requires a careful balance between sensitivity and specificity, imaging modality, gradeability of the images, all of which will need to be weighed against the potential cost. Deep learning DR detection has been found to be cost‐effective in developed countries, like Singapore and United Kingdom. However, the feasibility of implementing AI DR screening in countries without a robust teleophthalmology screening programme setup beforehand and other resource‐limited settings should still be evidenced. IDx‐DR is the first autonomous diagnostic software and one of the very first AI‐based software's in medicine to receive Federal Drug and Administration (FDA) approval. Eyeart was approved by FDA for the similar purpose in 2020. In European Union, there are more than 10 different AI‐based devices for DR screening registered, however in different classes, I and IIa. There are also significant shortcomings in current studies of AI in DR, including that great majority of them are sponsored or dependent on the respective algorithm's' company. Independent studies, particularly comparisons or studies establishing objective criteria through which the respective algorithms could be compared are rare.