Preproliferative Diabetic Retinopathy Research Articles

Prevalence of Diabetic Retinopathy and Associated Risk Factors in Diabetic Type II Patients in Ajdabiya, Libya

Diabetic retinopathy (DR) is One of the most well-known microvascular complications of diabetes mellitus (DM) and is a frequent side effect of untreated diabetes that can lead to blindness and visual impairment. This study was conducted to assess the prevalence of diabetic retinopathy and associated factors among type 2 diabetic patients. A cross sectional study was done at Ajdabiya diabetic center from November 2023 to January 2024. Subjects and Methods: 52 patients (104 eyes) with T2DM were included in this study, their fasting blood sugar and glycosylated hemoglobin level, lipid profile measured.in addition to fundus examination (done by noncontact +90-diopter lens), fundus photographs taken by Non-Mydriatic Fundus Camera TFC-1000. Around 61 eyes (58.7%) had diabetic retinopathy, 27 eyes (26%) had back ground DR, 6 eyes (5.8 %) had pre-proliferative DR, 4 eyes (3.8%) had proliferative DR, 2 eyes (1.9%) had advanced diabetic eye disease, 22 eyes (21.2%) had CSME. Their ages ranges between 36–74 years with mean (58.90) years, (26.9%) were males, (73.1%) were females. There was a significant association between the development of DR and duration of DM (p=0.003), The FBS levels were also determined to be a significant risk factor for DR (p = 0.031), also LDL with (p=0.039). No other factors were found to have a significant association with DR. In this study more than half of diabetic patients had diabetic retinopathy. There was a significant association between the development of DR and duration of DM, FBS, LDL levels, there was no significant relation between diabetic retinopathy and hypertension, HgA1c Serum cholesterol or triglyceride levels or previous cataract surgery.

Hyperglycemia and circadian disruption lead to retinal dysfunction in a stabilized colony of the fat sand rat Psammomys obesus

PurposeThe Fat Sand Rat (Psammomys obesus) recapitulates several features of human pre-proliferative diabetic retinopathy, but data are restricted to wild animals, incompatible with stringent biomedical research criteria. To overcome this barrier, we characterized retinal changes in a colony of P. obsesus maintained under strictly controlled housing conditions. MethodsAnimals were maintained on low or high caloric energy diets, and raised under either standard (12 h light/12 h dark) or shortened (5 h light/5 h dark) photoperiods. Visual responses were tested by electroretinography, while structural/molecular changes were assayed by immunochemistry and molecular biology (RNAseq and qPCR). ResultsWhereas high calorie diet alone did not induce hyperglycemia, coupled with short photoperiod >80 % animals developed severe hyper-insulinemia by 15 weeks, and 16 % animals further developed hyperglycemia. In these groups, electroretinography showed significant declines in visual responses in both hyper-insulinemic and hyperglycemic animals, especially in photopic (cone) responses. Transcriptomics analysis of hyperglycemic compared to low caloric controls revealed major upregulation in pathways involved in glial activation, extracellular matrix remodeling, inflammation, cytokine production, partial ischemic responses and angiogenesis. Western blotting against rhodopsin and cone opsin also showed decreased levels in both groups, overall decreases being greater for cones than rods in hyperglycemic animals. ConclusionsP. obesus maintained in rigorously monitored captive conditions, albeit showing attenuated responses to dietary overload compared to wild counterparts, nevertheless do develop some retinal features of diabetic retinopathy-like degeneration. Such a colony with known sanitary status opens their broader use for biomedical research.

Аnalysis of clinical cases of diabetic retinopathy progression in pregnant women with type 1 diabetes

Аnalysis of clinical cases of diabetic retinopathy progression in pregnant women with type 1 diabetes

Retinal Functional Impairment in Diabetic Retinopathy.

Diabetic retinopathy (DR) is a neurodegenerative disease of the retina. The aim of our study was to analyze latency changes in a full-field electroretinogram (ERG) in patients with type 2 diabetes. This prospective study included 15 diabetic patients without DR, 16 diabetic patients with non-proliferative DR, 14 patients with pre-proliferative DR, 15 patients with proliferative DR, and 14 age-matched controls. All the participants underwent ophthalmologic examination and full-field ERGs. The ERGs were recorded with the Metrovision MonPackOne system. The latencies were analyzed for "a"- and "b"-waves in the dark-adapted (DA) 0.01 ERG, DA 3.0 ERG, DA oscillatory potentials, light-adapted (LA) 3.0 ERG, and 30 Hz flicker ERG. The delayed responses of healthy subjects compared to diabetic patients without DR were the DA oscillatory potentials (25.45 ± 1.04 ms vs. 26.15 ± 0.96 ms, p = 0.027). When comparing diabetic patients without DR and with non-proliferative DR, we did not obtain statistically significant delays. Significant delays in the DA 0.01 "b"-wave (61.91 ± 5.52 ms vs. 66.36 ± 8.12 ms, p = 0.029), DA 3.0 "b"-wave (41.01 ± 2.50 ms vs. 44.16 ± 3.78 ms, p = 0.035), and LA 3.0 "a"-wave (16.21 ± 0.91 ms vs. 16.99 ± 1.16 ms, p = 0.045) were found between non-proliferative DR and pre-proliferative DR. When comparing the groups of patients with pre-proliferative DR and proliferative DR, the LA 3.0 ERG "b"-wave (32. 63 ± 2.53 ms vs. 36.19 ± 3.21 ms, p < 0.0001), LA 30 Hz flicker ERG "a"-wave (19.56 ± 3.59 vs. 21.75 ± 4.74 ms, p= 0.025), and "b"-wave (32.23 ± 4.02 vs. 36.68 ± 3.48 ms, p = 0.017) were delayed. the electrophysiological findings from our study indicate that there is a substantial dysfunction of the neural retina in all stages of DR.

Анализ эффективности анти-VEGF терапии диабетического макулярного отека в авитреальных глазах

Aim. To analyze the clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in avitreal eyes. Methods. 34 patients (38 eyes) with vitreous loss and DME on the background of preproliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) were examined in the main study group. The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injections of Lucentis 0.5 mg (IVIL) were carried out according to «three monthly injections» scheme, then – to «on demand» scheme. Results. Complete regression of DME in avitreal eyes occurred in 74 % of cases; in eyes with native vitreous body – in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed that number of IVIL was significantly less in patients with DME on the background of PPDR than PDR. Conclusion. Presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in DME treatment is comparable in eyes with native vitreous body and avitreal eyes. Key words: diabetes mellitus; diabetic macular edema; preproliferative diabetic retinopathy; proliferative diabetic retinopathy; avitria; Lucentis intravitreal injections.

Analysis of clinical progression of diabetic retinopathy in pregnant women with type 1 diabetes

This article presents clinical cases of progression of diabetic retinopathy (DR) in pregnant women with type 1 diabetes. The manifestation of pre-proliferative DR was related to the formation of focal macular edema in both eyes with nonperfusion areas of perimacular localization. Both eyes underwent laser coagulation of the retina. Following one month, the regression of macular edema in the left eye and hemorrhagic phenomena in both eyes with the appearance of new nonperfusion areas were observed. DR progression during pregnancy and in the postpartum period is determined by a number of factors, including compensation for diabetes mellitus, stabilization of retinopathy, and the presence of concomitant pathologies. In the aggressive course of proliferative DR, local traction retinal detachment and partial hemophthalmos of the left eye were revealed. Three stages of panretinal laser coagulation of both eyes were conducted, along with an endovitreal intervention with silicone tamponade on the left eye. At 28 weeks of gestation, progression of retinal neovascularization with extensive areas of nonperfusion in the posterior pole was observed in the right eye. Compaction of the laser coagulation areas of the retina in the right eye was performed.

Associations of Diabetic Retinopathy Severity With High Ambulatory Blood Pressure and Suppressed Serum Renin Levels.

The relationships between serum renin levels, severity of diabetic retinopathy (DR), and 24-hour blood pressure (BP) have not been previously reported. To explore causes for DR and the relationships of 24-hour ambulatory BP, and hormone levels with the severity of DR. The diabetic patients were classified as having no DR, simple DR, or severe DR (preproliferative DR plus proliferative DR) based on funduscopic examination, and we measured 24-hour BP, serum active renin (ARC), aldosterone (SAC), adrenocorticotropic hormone, and cortisol levels in each group. Compared to those with no DR or simple DR, patients with severe DR showed significantly higher 24-hour BPs, including daytime and nighttime systolic and diastolic BP levels, independent of diabetic duration and HbA1c levels. The variability of nighttime systolic BP was greater in patients with severe DR than in those with nonsevere DR, although nocturnal BP reduction was similar between the groups. The ambulatory BPs were significantly inversely associated with ARC. The ARC was significantly lower in severe DR patients than in those with no DR or simple DR (3.2 [1.5-13.6] vs 9.8 [4.6-18.0] pg/mL, P < .05), but there were no differences in SAC in patients taking calcium channel blockers and/or α-blockers. No associations were found between DR severity and other hormone levels. Severe DR was associated with higher 24-hour BPs and suppressed ARC. These findings suggest that mineralocorticoid receptor overactivation may play a role in higher BP levels and severe DR in diabetic patients.

Optical Identification of Diabetic Retinopathy Using Hyperspectral Imaging.

The severity of diabetic retinopathy (DR) is directly correlated to changes in both the oxygen utilization rate of retinal tissue as well as the blood oxygen saturation of both arteries and veins. Therefore, the current stage of DR in a patient can be identified by analyzing the oxygen content in blood vessels through fundus images. This enables medical professionals to make accurate and prompt judgments regarding the patient's condition. However, in order to use this method to implement supplementary medical treatment, blood vessels under fundus images need to be determined first, and arteries and veins then need to be differentiated from one another. Therefore, the entire study was split into three sections. After first removing the background from the fundus images using image processing, the blood vessels in the images were then separated from the background. Second, the method of hyperspectral imaging (HSI) was utilized in order to construct the spectral data. The HSI algorithm was utilized in order to perform analysis and simulations on the overall reflection spectrum of the retinal image. Thirdly, principal component analysis (PCA) was performed in order to both simplify the data and acquire the major principal components score plot for retinopathy in arteries and veins at all stages. In the final step, arteries and veins in the original fundus images were separated using the principal components score plots for each stage. As retinopathy progresses, the difference in reflectance between the arteries and veins gradually decreases. This results in a more difficult differentiation of PCA results in later stages, along with decreased precision and sensitivity. As a consequence of this, the precision and sensitivity of the HSI method in DR patients who are in the normal stage and those who are in the proliferative DR (PDR) stage are the highest and lowest, respectively. On the other hand, the indicator values are comparable between the background DR (BDR) and pre-proliferative DR (PPDR) stages due to the fact that both stages exhibit comparable clinical-pathological severity characteristics. The results indicate that the sensitivity values of arteries are 82.4%, 77.5%, 78.1%, and 72.9% in the normal, BDR, PPDR, and PDR, while for veins, these values are 88.5%, 85.4%, 81.4%, and 75.1% in the normal, BDR, PPDR, and PDR, respectively.

Частота и клинические характеристики эпиретинальных мембран при диабетической ретинопатии

Purpose. The study of the frequency and clinical varieties of epiretinal fibrosis (ERF) in the macula in diabetic retinopathy (DR). Material and methods. Clinical material: 90 patients with DR (90 eyes). 29 eyes had nonproliferative DR, 31 eyes had preproliferative DR, and 30 eyes had proliferative DR. Optical coherence tomography of the macular zone of the retina was performed using the CIRRUS HD-OCT MODEL 500 device. The presence and characteristics of ERF were assessed. Results. The presence of ERF was found in 65 eyes (72.2%). With nonproliferative DR it was found in 10 eyes (32.2%), within the parafoveal zone. At the preproliferative stage of DR – in 25 eyes (80.6%), in the macula – in 16 eyes, in 9 cases – outside the vascular arcades. In proliferative DR, ERF occurred in all 30 eyes (100%). In 15 eyes – ERF without vascularization, in 10 eyes ERF captured the macula and vascular arcades. There were both planar and traction variants (49 and 16 eyes, respectively). Its fixation was the most common in the fovea zone (7 eyes). ERF vascularization was observed in 10 eyes with a pronounced stage of proliferative DR (of these, in 7 cases vascularized ERF was localized in the macular area, in 3 eyes it was localized in the area of vascular arcades). Conclusion. The presence of ERF was detected in the majority of patients with DR of various stages (72.2%), with a traction component it was found in 16 eyes. With the aggravation of the stage of DR, an increase in the frequency of ERF was noted. ERF, as a rule, captured the foveal region, it was characterized by a different area of coverage of the parafovea in cases of accessible visualization of the ocular fundus. Keywords: epiretinal fibrosis, diabetic retinopathy, macula

Клиническая эффективность лечения диабетического макулярного отека в авитричных глазах путем применения анти-VEGF терапии

Purpose. To analyze clinical efficacy of anti-VEGF therapy for diabetic macular edema (DME) in eyes with vitreous loss. Material and methods. 34 patients (38 eyes) with vitreous loss and DME were examined: on the background of pre-proliferative diabetic retinopathy (PPDR) (18 eyes) and proliferative diabetic retinopathy (PDR) (20 eyes) (the main group). The comparison group consisted of 40 patients (40 eyes) with native vitreous body and DME on the background of PPDR (20 eyes) and PDR (20 eyes). Intravitreal injection of Lucentis 0.5 mg (IVIL) was carried out according to scheme «three monthly injections», then — to scheme «on demand». Results. Complete regression of DME in eyes with vitreous loss occurred in 74 % of cases; in eyes with native vitreous body — in 75 %. The duration of postoperative reaction in eyes with vitreous loss was up to 10–14 days, compared with 1–3 days in eyes with native vitreous body. The results of the study revealed, that number of IVIL was significantly less in patients with DME on the background of PPDR, than with PDR. Conclusions. The presence of local neuroepithelial detachment on the background of diffuse DME is prognostically favorable factor for anti-VEGF therapy. The effectiveness of IVIL in treatment of DME is comparable in eyes with native vitreous body and vitreous loss. Keywords: diabetes mellitus, diabetic macular edema, pre-proliferative diabetic retinopathy, proliferative diabetic retinopathy, vitreous loss, Lucentis intravitreal injection

People With Type 1 Diabetes of African Caribbean Ethnicity Are at Increased Risk of Developing Sight-Threatening Diabetic Retinopathy.

There is limited information on the effect of ethnicity on the development of referable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabetes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service. Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years. The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09-1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00-1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00-1.01, P = 0.0001) emerged as independent risk factors for STDR. We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.

Psychological Domain of Elderly Patients with Diabetic Retinopathy

The continuing increase in the prevalence of diabetic retinopathy among various segments of the population and, especially in older age, combined with a change in the psychological state of such patients. However, the study of the holistic psychological (cognitivedepressive) domain in elderly patients with various stages of diabetic retinopathy, comparable in cardiovascular pathology, which is an independent risk factor for both diabetic retinopathy and cognitive impairment, depression not carried out.Purpose: to assess the psychological domain in patients 60–74 years old suffering from diabetic retinopathy standardized for concomitant cardiovascular pathology. In the Tambov branch of the Tambov branch of S.N. Fedorov NMRC “MNTK “Eye Microsurgery” in 2019–2020, cognitive impairment and depression were studied in 68 patients with non-proliferative, 62 patients with preproliferative and 70 elderly patients with proliferative stage on the Mini-Mental-State-Examination and Center for Epidemiologic Studies — Depression scale, respectively. The diagnosis of diabetic retinopathy established based on the results of a comprehensive ophthalmological examination. The control consisted of 59 patients with the absence of diabetic retinopathy. Patients with non-proliferative stage had mild (21.5 ± 0.3 points), and with preproliferative (17.9 ± 0.4 points) and proliferative stage (16.2 ± 0.3 points) moderate cognitive impairment. The association of cognitive impairment found with preproliferative and proliferative diabetic retinopathy. The level of depression in the non–proliferative stage was 22.4 ± 0.4 points, in the preproliferative stage — 24.8 ± 0.3 points and in the proliferative stage — 26.9 ± 0.5 points versus 19.2 ± 0.3 points in the control with a significant difference in all cases. The values of the relative risk of diabetic retinopathy stages were 1,337, 2,408 and 2,796, respectively. The revealed deterioration of the cognitive-depressive domain in elderly patients with diabetic retinopathy is important for improving compliance, the effectiveness of treatment of diabetic retinopathy and the psychological continuum.

Investigation of diabetic retinopathy progression in women with diabetes mellitus during pregnancy

The study evaluates the transient and stationary diabetic retinal changes in pregnant women with diabetes mellitus (DM) based on the analysis of individual clinical cases of diabetic retinopathy (DR) progression. The study examined 24 pregnant women with DM. The examination was carried out in each trimester of pregnancy and 6 months after delivery. In 10 pregnant women DR was not detected, and 14 (58%) were diagnosed with DR. Progression of DR during pregnancy was observed in 9 patients with pre-proliferative and proliferative DR (PPDR and PDR) and uncompensated glycemia, 3 patients developed macular edema (ME) in both eyes. Panretinal laser coagulation (PRLC) was performed in patients with ongoing DR progression. In the postpartum period, the manifestations of DR did not regress. ME turned out to be transient in one patient with PPDR. Three clinical cases of DR manifesting in the first trimester of pregnancy are presented: PPDR with transient ME, PDR with ME, non-proliferative DR with a stable course. 1. DR detected at the beginning of gestation in women with decompensated glycemic status progressed in 64% of cases. 2. Progression of DR during pregnancy was noted in patients with PPDR and PDR. 3. Progression of DR during pregnancy is more often true than transient. 4. Detection of PPDR and PDR during pregnancy is a direct indication for laser coagulation of the retina.

Non-Perfusion Area Index for Prognostic Prediction in Diabetic Retinopathy.

Fundus fluorescent angiography is a standard examination in Japan that can directly visualize the circulatory failure in diabetic retinopathy but is not used in Western countries. In this study, we examine the relationship between the non-perfusion area in fundus fluorescent angiography and the progression of diabetic retinopathy. We evaluated 22 eyes between 22 patients who had their first fundus fluorescent angiography during a clinical episode at Keio University Hospital from January 2012 to May 2015, were diagnosed as having preproliferative diabetic retinopathy, and could be followed for at least three years. The non-perfusion area index (%) in nine segmented fundi in the initial fundus fluorescent angiography was calculated, and the progression to proliferative diabetic retinopathy over three years was evaluated. Three out of the 22 eyes (13.6%) developed proliferative diabetic retinopathy over three years. The non-perfusion area index for the initial fundus fluorescent angiography was significantly associated with progression to proliferative diabetic retinopathy. The non-perfusion area index in the posterior pole was most strongly correlated with the progression to proliferative diabetic retinopathy. Thus, the non-perfusion area index in the posterior pole among those with preproliferative diabetic retinopathy may predict the progression to proliferative diabetic retinopathy in the subsequent three years.

Исследование частоты развития транзиторной ретинопатии у беременных женщин, страдающих сахарным диабетом

Purpose. Assessment of the incidence progression of transient retinopathy (TR) in pregnant women with diabetes mellitus (DM). Material and methods. 24 pregnant women with DM were examined in each trimester of pregnancy and 3 months after delivery. In 10 pregnant women, diabetic retinopathy (DR) was not detected, in 14 (58 %) DR was diagnosed. With the progression of DR panretinal photocoagulation (PRP) was performed. Results. Progression of DR during pregnancy was observed in 9 (64 %) patients with preproliferative and proliferative DR and uncompensated glycemia, macular edema (ME) developed in both eyes in 3 patients. According to optical coherence tomography angiography (OCT-A), in all these patients, a progressive expansion of retinal nonperfusion zones in the superficial or deep plexus during pregnancy was detected. In all patients with progression of DR, the symptoms of retinopathy persisted in the postpartum period. “Transient” was focal macular edema in one patient with preproliferative DR, which regressed after delivery. Conclusions. 1. DR, detected at the beginning of pregnancy, progressed in 64% of pregnant women against the background of glycemic status decompensation. 2. TR occurred in one case and was manifested by transient macular edema. 3. According to our data, DR manifesting during pregnancy is most often true. 4. Identification of non-perfusion zones in the superficial and deep retinal plexus using the OCT-A allows differential diagnosis of DR and TR in pregnant women with DM. Keywords: transient retinopathy, diabetic retinopathy, pregnancy, optical coherence tomography angiography.

Влияние диабетической ретинопатии на внутриглазное давление при терапии кортикостероидами

Purpose. Evaluation the impact of various types of diabetes mellitus, diabetic retinopathy and frequency of IVI injections of Ozurdex ® on ophthalmic hypertension and its correction. Material and methods. 179 intravitreal injections of Ozurdex ® in 148 patients (men – 66, women – 82) at the age of 53.5 (39/69) years have been performed. 123 patients (123 eyes) have undergone one surgery, 25 patients (25 eyes) have undergone two or more surgeries. The patients have been divided according to the types of diabetes and stages of retinopathy: non-proliferative diabetic retinopathy 19.5%, preproliferative diabetic retinopathy 44%, proliferative diabetic retinopathy 36.5% of patients, respectively. IOP level has been investigated before IVI, the next day, and 1 month after injection. In cases of ocular hypertension, local carbonic anhydrase inhibitors were used both mono and in combination with betaadrenoblockers according to the standard scheme. Results. Ophthalmic hypertension has been detected in 33% of patients, after the first injection in 91% of cases, and after the second injection in 9% of cases, and has been stabilized with medication. Patients who have undergone laser photocoagulation did not require combined drug therapy. The mean values of the ophthalmotonus of all patients tended to decrease (p&lt;0.01). Cataract has been diagnosed in 57% of cases, phacoemulsification after the first IVI has been performed in 7%, and in 15% of cases after the second injection. The correlation coefficient between the IOP level before and after treatment was r = –0.0221. There was no statistical relationship between the development of ophthalmic hypertension and the number of Ozurdex ® injections received. Conclusion. The rise in intraocular pressure, after the intravitreal injection of the Ozurdex ® implant, is diagnosed 10% more often in patients with type I diabetes and in 54% of cases it was the share of preproliferative diabetic retinopathy. Ophthalmic hypertension was amenable to drug therapry within 3–11 months and compensated independently in half of patients. No correlation between hypertension and the number of Ozurdex ® injections was found. Key words: macular edema, intraocular pressure, endovitreal treatment, intravitreal biodegradable Dexamethasone implant (DexDDS)

Characteristics Associated with Early Worsening of Retinopathy in Patients with Type 2 Diabetes Diagnosed with Retinopathy at Their First Visit: A Retrospective Observational Study.

Materials and Methods Our study design was a retrospective observational study. Subjects with type 2 diabetes diagnosed with either simple or preproliferative diabetic retinopathy by ophthalmologists at their first visit and followed up for 6–18 months thereafter were included and divided into worsening and nonworsening groups. Thereafter, baseline characteristics and changes in HbA1c and therapy over a year were investigated. Results Among the 88 subjects with simple diabetic retinopathy, 16% improved to no retinopathy, 65% retained their simple diabetic retinopathy, 18% worsened to preproliferative diabetic retinopathy, and 1% worsened to proliferative diabetic retinopathy. Among the 47 subjects with preproliferative diabetic retinopathy, 9% improved to simple diabetic retinopathy, 72% retained their preproliferative diabetic retinopathy, and 19% worsened to proliferative diabetic retinopathy. Patients with simple diabetic retinopathy had an odds ratio of 1.44 for worsening retinopathy with a 1% increase in baseline HbA1c. Meanwhile, the odds ratios for worsening retinopathy with a 1% decrease in HbA1c from baseline at 3, 6, and 12 months were 1.34, 1.31, and 1.38, respectively. Among patients with simple diabetic retinopathy, significantly more new interventions were introduced in the worsening group than in the nonworsening group. Conclusions Increased baseline HbA1c, a substantial decrease in HbA1c, and intensified therapy were identified as risk factors for early worsening of diabetic retinopathy in patients with simple diabetic retinopathy at the first visit. Patients should therefore be intimately followed for retinopathy after their first visit.

Using artificial intelligence as an initial triage strategy in diabetic retinopathy screening program in China

Objective: To investigate the diagnostic accuracy and efficiency of an artificial intelligence (AI) triaging model in a diabetic retinopathy (DR) screening program. Methods: A DR screening program was conducted in Kashi City and Kizilsu Kirghiz Autonomous Prefecture of the Xinjiang Uyur Autonomous Region from May to July 2018, and 8 005 patients with diabetes mellitus were included. Fundus images, one centered at optic disc and one centered at macula, were taken for both eyes. A previously validated AI algorithm was applied as the first step to identify the patients with all 4 images. If the images were classified as gradable and negative DR, an AI-generated report was immediately provided without sending to manual grading, and 1/3 of these patients were randomly sampled for manual grading and quality control (group A). For the patients with at least one image classified as ungradable or positive for any DR, all images were sent for manual grading (group B). Finally, 300 patients were randomly selected from group A and group B respectively for accuracy assessment, where the patients and their images were classified by a specialist panel for referral DR (pre-proliferative DR, or proliferative DR, and/or diabetic macular edema). Results: Among 8 005 patients for DR screening [including 3 220 males and 4 785 females, aged (58.3±10.6) years], after AI triaging, 5 267 (65.8%) potentially received reports from AI system and 2 738 (34.2%) required manual grading. In group A, the accuracy and specificity of AI classification and manual grading on referral DR were all 100%. In group B, the accuracy of AI and manual grading were 75.8% and 90.3%, respectively, while the sensitivity of AI and manual grading was 100% and 79.1%, respectively. Conclusion: AI alleviates 60% of the workload of manual grading without missing any referral patients with the aid of the current AI triaging model.

Low circulating dihomo-gamma-linolenic acid is associated with diabetic retinopathy: a cross sectional study of KAMOGAWA-DM cohort study

Diabetic retinopathy (DR), one of the major complications of diabetes, can cause blindness and reduce quality of life. Dyslipidemia is reported to be associated with DR, whereas arachidonic acid may have a protective effect against DR. We aimed to investigate the association of circulating n-3 and n-6 polyunsaturated fatty acids (PUFAs) with DR. In this cross-sectional study, 190 Japanese patients with type 2 diabetes were classified as no diabetic retinopathy (NDR), simple diabetic retinopathy (SDR), or proliferative diabetic retinopathy (PDR) including pre-proliferative diabetic retinopathy. Circulating fatty acids (FAs) were measured by gas chromatograph-mass spectrometry. Logistic regression analysis was performed to investigate the association between the levels of FAs and the presence of DR. The average age, body mass index and the duration of diabetes were 62.7 ± 12.1 years, 25.0 ± 4.5 kg/m2, and 9.8 ± 8.7 years, respectively. Twenty-seven patients were diagnosed with DR. Circulating levels of dihomo-gamma-linolenic acid (DGLA) in the NDR (n = 163), SDR (n = 13) and PDR (n = 14) groups were 28.3 ± 11.0 μg/mL, 24.4 ± 9.7 μg/mL, and 21.8 ± 6.2 μg/mL, respectively (p = 0.032). The logarithm of circulating DGLA levels was associated with the presence of DR after adjusting for covariates (OR of 1-unit increment: 0.79, 95% CI: 0.62-1.00, p = 0.049). Circulating DGLA was negatively associated with the presence of DR.

Hyperspectral Ophthalmoscope Images for the Diagnosis of Diabetic Retinopathy Stage.

A methodology that applies hyperspectral imaging (HSI) on ophthalmoscope images to identify diabetic retinopathy (DR) stage is demonstrated. First, an algorithm for HSI image analysis is applied to the average reflectance spectra of simulated arteries and veins in ophthalmoscope images. Second, the average simulated spectra are categorized by using a principal component analysis (PCA) score plot. Third, Beer-Lambert law is applied to calculate vessel oxygen saturation in the ophthalmoscope images, and oxygenation maps are obtained. The average reflectance spectra and PCA results indicate that average reflectance changes with the deterioration of DR. The G-channel gradually decreases because of vascular disease, whereas the R-channel gradually increases with oxygen saturation in the vessels. As DR deteriorates, the oxygen utilization of retinal tissues gradually decreases, and thus oxygen saturation in the veins gradually increases. The sensitivity of diagnosis is based on the severity of retinopathy due to diabetes. Normal, background DR (BDR), pre-proliferative DR (PPDR), and proliferative DR (PDR) are arranged in order of 90.00%, 81.13%, 87.75%, and 93.75%, respectively; the accuracy is 90%, 86%, 86%, 90%, respectively. The F1-scores are 90% (Normal), 83.49% (BDR), 86.86% (PPDR), and 91.83% (PDR), and the accuracy rates are 95%, 91.5%, 93.5%, and 96%, respectively.