Prevalence Of Non-proliferative Diabetic Retinopathy Research Articles

Evaluation and Optimization of Diabetic Retinopathy Screenings for Uninsured Latinx Patients in a Resource-Limited Student-Run Free Clinic.

Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Student-run free clinics represent a valuable opportunity to provide DR screenings to high-risk populations. We characterized the patient population, evaluated the performance, and conducted a needs assessment of DR screenings at the University of California, San Diego Student-Run Ophthalmology Free Clinic, which provides care to predominantly uninsured, Latino patients. Retrospective chart review was conducted of all patients seen at the free clinic since 2019 with a diagnosis of type II diabetes. Date and outcome of all DR-related screenings or visits from 2015 onward, demographics information, and DR risk factors such as A1c and insulin dependence were recorded. Predictors of diabetic retinopathy and frequency of DR screenings for each patient were analyzed using multiple logistic regression, t-test for equality of means, and Pearson's correlation. Of 179 uninsured diabetic patients receiving care at the free clinic, 71% were female and average age was 59. 83% had hypertension, 93% had hyperlipidemia, and 79% had metabolic syndrome. Prevalence of non-proliferative DR was 34% and that of proliferative DR was 15% in diabetic patients. The free clinic capacity in recent years plateaued at just under 50% of patients seen for DR screening or visit per year, though average wait time was over 2 years between visits. Patients with higher no-show rates had less frequent DR screenings. Chronic kidney disease and poor glycemic control were the strongest predictors of DR. The student-run free ophthalmology clinic has been effective in providing screening and follow-up care for DR patients. Creation of a protocol to identify which patients are at highest risk of DR and should be seen more urgently, addressing no-shows, and implementation of a tele-retina program are potential avenues for improving clinic efficiency in a resource-limited setting for vulnerable populations.

Prevalence of Diabetic Retinopathy in Adult Diabetics at National Institute of Diabetes and Endocrinology in Cairo

Background Type 2 diabetes is the most common type of diabetes, accounting for around 90% of all diabetes worldwide. The prevalence of type 2 diabetes is high and increasing across all regions worldwide. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus. It is one of the leading causes of blindness in the working age population and has a great economic impact on society especially on healthcare systems. Optical coherence tomography (OCT) and fundus photography are noninvasive examinations that help the clinician to observe signs of neurodegenerative changes in the retina and detects neuroretinal changes in the early stages of DR and DME. Aim of the Work The aim of our study was to estimate the prevalence and severity of diabetic retinopathy among patients with diabetes mellitus type 2 over 30 years old they will be screened clinically and by fundus photography and optical coherence topography at national institute of diabetes and endocrinology. Patients and Methods This study included 600 eyes from 300 patients. Diabetics were recruited from patients recruited from National institute of Diabetes and endocrinology in the ophthalmic clinic. It was designed as cross sectional hospital based study. This study conducted to estimate the prevalence and severity of diabetic retinopathy and diabetic macular edema among patients with diabetes mellitus type 2 over 30 years old. Using fundus photography and optical coherence topography (SD-OCT) at National Institute of Diabetes and Endocrinology. Results The findings of our study showed that the prevalence of DR irrespective to type was 34% of studied eyes. Also it revealed that 22.3% of studied eyes had diabetic macular edema. Non-proliferative diabetic retinopathy in our study was more common than proliferative diabetic retinopathy. The prevalence of nonproliferative diabetic retinopathy in DR patients in our study was (72.5%) but proliferative diabetic retinopathy (27.5%) in DR patients. The commonest type was mild NPDR (33.3%). There is a strong relation between duration of DM, control of HbA1c, age, treatment with insulin and DR and DME. The longer duration of DM and high levels of HbA1c considered main risk factors of DR and DME. Conclusion The prevalence of DR and DME were 34%and 22.3%, respectively of studied eyes in ophthalmology clinic in National Institute of Diabetes and Endocrinology. These data highlight the substantial public health burden of DR and DME. Old age, Insulin treatment, poor control and the longest duration of DM patients groups are more liable to develop DR and DME.

Assessment of Prevalence and Risk Factors for Diabetic Retinopathy in Patients with Type 1 and Type 2 Diabetes Examined at a Tertiary Care.

Introduction: Diabetic retinopathy (DR) is a microvascular complication of diabetes mellitus and the leading cause of visual impairment and blindness. The aim of the study was to estimate and compare the prevalence of DR and to determine an association between DR and systemic risk factors in hospitalized type 1 (DMT1) and type 2 (DMT2) diabetic patients. Material and methods: We analyzed 260 patients with diabetes, 43 with DMT1 and 217 with DMT2. The following data were collected: age, gender, type and duration of diabetes, glycemic control, blood pressure, estimated glomerular filtration rate, ophthalmologic examinations and routine biochemical parameters. Results: Out of the total number of 260 patients, 77 (29.6%) had non-proliferative DR (NPDR), 21 (8.1%) had proliferative DR (PDR), 29 (11.1%) had diabetic macular edema (DME), and 69 (23.5%) had diabetic cataracts. Forty-three (16.5%) patients were previously diagnosed with DMT1 and 217 (83.5%) with DMT2. The duration of diabetes was not significantly longer in DMT1 (12.8±11.2 years) in comparison to DMT2 (11.07±8.1 years). The prevalence of NPDR and PDR did not differ statistically in either groups. DME was more prevalent in DMT2 than in DMT1 (P<0.05). Diabetic cataract was found in 26.7% vs. 6.7% of patients with DMT2 and DMT1, respectively (p<0.01). The duration of diabetes significantly correlated with NPDR and PDR in DMT1 (r=o.31, p<0.05; r=0.55, p<0.001, respectively). In DMT2, significant correlations were found between the duration of diabetes and cataract, NPDR, PDR and DME (r=0.31, p<0.001; r=0.43 p<0.01, r=0.16 p<0.05 and r=0.20 p<0.01, respectively). Fasting plasma glucose (FPG) significantly correlated with PDR (r=0.258, p<0.05), while HbA1c with DME (r= 0.15 p<0.05). Conclusion: The duration of diabetes and hyperglycemia were associated with DR in both types of diabetes.

Epidemiology of Common Ocular Manifestations among Patients on Haemodialysis in West Bank, Palestine.

This study aimed to assess the prevalence of ocular manifestations and associated factors in patients on haemodialysis. A cross-sectional study of patients on haemodialysis from a haemodialysis unit in Nablus, Palestine, was conducted. Medical examination for ocular manifestations (intraocular pressure, cataract, retinal changes and optic neuropathy) was performed using Tono-Pen, portable slit-lamp and indirect ophthalmoscope. Predictor variables were age, gender, smoking, medical comorbidities (diabetes, hypertension, ischaemic heart disease [IHD], peripheral arterial disease [PAD]) and use of antiplatelet or anti-coagulation medications. A total of 191 patients were included in this study. The prevalence of any ocular manifestation in at least one eye was 68%. The most common ocular manifestations were retinal changes (58%) and cataract (41%). The prevalence of non-proliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR) and NPDR or PDR was 51%, 16% and 65%. Two patients had PDR in one eye and NPDR in the other, and therefore, they were counted only once making the total for this category 71 rather than 73 patients. An increase in age by one year increased the odds of having cataract by 1.10 (95% confidence interval [CI] = 1.06-1.14). Patients with diabetes had higher odds of having cataract (odds ratio [OR] = 7.43, 95% CI: 3.26-16.95) and any retinal changes (OR = 109.48, 95% CI: 33.85-354.05) than patients without diabetes. Patients with diabetes and IHD or PAD had higher odds of having NPDR than those with diabetes without IHD or PAD (OR = 7.62, 95% CI: 2.07-28.03). Retinal changes and cataract are common ocular manifestations among patients on haemodialysis. The findings emphasise the importance of periodic screening for ocular problems in this vulnerable population, especially older patients and those with diabetes, to prevent visual impartment and associated disability.

The obesity paradox: Retinopathy, obesity, and circulating risk markers in youth with type 2 diabetes in the TODAY Study

AimTo understand the relationship of obesity and 27 circulating inflammatory biomarkers to the prevalence of non-proliferative diabetic retinopathy (NPDR) in youth with type 2 diabetes. MethodsYouth with type 2 diabetes who participated in the TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study were followed for 2–6.5 years. Digital fundus photographs were obtained in the last year of the study. Blood samples during the study were processed for inflammatory biomarkers, and these were correlated with obesity tertiles and presence of retinopathy. ResultsHigher BMI was associated with an increase in circulating levels of metabolic biomarkers including high sensitivity C-reactive protein (hsCRP), plasminogen activator inhibitor 1 (PAI-1), fibrinogen, LDL-cholesterol (LDL-C) and Apolipoprotein B (ApoB), tumor necrosis factor receptors 1 and 2 (TNFR-1 and -2), interleukin 6 (IL-6), E-selectin, and homocysteine, as well as a decrease in the metabolic risk markers HDL-cholesterol (HDLC), and insulin-like growth factor binding protein 1 (IGFBP-1). Although NPDR risk decreased with increasing obesity, it was not associated with any of the measured biomarkers. ConclusionsCirculating levels of measured biomarkers did not elucidate the “obesity paradox” of decreased NPDR in the most obese participants in the TODAY study.Trial Registration: clinicaltrials.govNCT00081328.

Clinical and Molecular Characteristics of Diabetic Retinopathy and Its Severity Complications among Diabetic Patients: A Multicenter Cross-Sectional Study.

Background: Diabetic retinopathy (DR) is a complication associated with uncontrolled DM. It is a leading preventable cause of visual impairment in the world and a cause of blindness in those under 75 years old in developing countries. We aimed to explore the prevalence and associated risk factors of DR among diabetic patients in the West Bank. Materials and Methods:A quantitative multicenter cross-sectional study was conducted in all West Bank cities. Nearly, 385 patients underwent a comprehensive eye examination in addition to blood and urine tests. A previously validated questionnaire for ocular examination classification was used together with a socio-demographic and past medical history information sheet. Results: The prevalence of all DR in the West Bank was 41.8%. The prevalence of non-proliferative diabetic retinopathy (NPDR) was 50.3% (38.5% for mild NPDR, 10.6% for moderate NPDR and 1.2% for severe NPDR). The prevalence of proliferative diabetic retinopathy (PDR) was 9.9% and 39.7% for diabetic macular edema (DME) (17.4% for mild, 15.5% for moderate and 6.8% for severe DME). The prevalence of vision-threatening PDR and DME was 49.7% for both. In a univariate analysis, DR was significantly associated with body mass index; BMI (p = 0.035), DM duration (p = 0.002), Low-density lipoprotein (LDL) (p = 0.034), glutamic-oxaloacetic transaminase (GOT) level (p = 0.016) andblood urea (BU) (p = 0.044). A multivariate analysis showed a strong significant association between DR andpatients who had DM for 10-19years (adjusted odds ratio; AOR (95%CI); 1.843 (1.05–3.22)), abnormal levels of LDL (AOR (95%CI); 0.50 (0.30–0.83)), abnormal levels of GOT (AOR (95%CI); 0.49 (0.27–0.89)), and overweight (AOR (95%CI); 0.39 (0.19–0.80)). Conclusions: We found that the prevalence of DR in Palestine was higher than the global prevalence. Referral coordination between ophthalmologists and internal physicians is necessary to better follow up with DR patients. An interventional educational program by clinicians and public health professionals is recommended.

Screening for diabetic retinopathy and reduced vision among Indigenous Australians in Top End primary care health services: a TEAMSnet sub-study.

Diabetic retinopathy (DR) prevalence is higher in Indigenous Australians than in other Australians and is a major cause of vision loss. Consequently, timely screening and treatment is paramount, and annual eye screening is recommended for Indigenous Australians. To assess the prevalence of DR, reduced vision and DR treatment coverage among Indigenous Australian adults with diabetes attending Top End indigenous primary care health services. A cross-sectional DR screening study conducted from November 2013 to December 2015 in two very remote Northern Territory Aboriginal primary healthcare services. In 287 subjects, the prevalence of non-proliferative DR, proliferative DR and clinically significant diabetic macular oedema was 37.3%, 5.4% and 9.0% respectively. Treatment coverage for PDR was 60% (of 10 patients) and for CSMO was 17% (of 23 patients). Vision data were available from 122 participants at one site. The proportion with normal vision, reduced vision, impaired vision and blindness was 31.1%, 52.5%, 15.6% and 0.8% respectively. Overall, ungradable monocular image sets (46%) were associated with poorer quality images and missing protocol images (both P < 0.001). Ungradable images for DR were associated with presence of small pupils/media opacities (P < 0.001). Ungradable images for diabetic macular oedema were associated with poorer image quality (P < 0.001), cataracts (P < 0.001) and small pupils (P = 0.04). A high prevalence of DR, CSMO and impaired vision was noted in Indigenous Australians with diabetes. Screening in primary care is feasible, but more effective screening methods are needed.

A study on the severity of diabetic retinopathy and macular edema in diabetes mellitus patients on hemodialysis

Introduction: Diabetes Mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. Microvascular abnormalities of DM include both nephropathy and retinopathy. Diabetic retinopathy (DR) tends to deteriorate with failing renal function. Diabetic nephropathy constitutes the most common cause of End Stage Renal Disease (ESRD). ESRD patients require Renal Replacement Therapy (RRT) for survival. Hemodialysis is one of the major methods of RRT. Aim: Aim of the study is to study the prevalence and severity of DR and Diabetic Macular Edema (DME) in diabetic patients on hemodialysis. Study Design: A cross sectional observational study. Methodology:105 diabetic patients undergoing hemodialysis for ESRD were subjected to detailed ophthalmic examination with a special emphasis on fundus examination for DR and macularedema. The severity of diabetic retinopathy and macular edema were graded according to International Clinical Diabetic Retinopathy Severity Scale and International Clinical Diabetic Macular Edema Severity Scale respectively. Results: In the present study prevalence of DR was 89.8% and prevalence of DME was 23%. Prevalence of Non-Proliferative Diabetic Retinopathy (NPDR) 61.4% was more than Proliferative Diabetic Retinopathy (PDR) 38.6 percent. Conclusion: The visual morbidity due to PDR and DME was high among the diabetic patients undergoing hemodialysis.

Regional differences in the prevalence of diabetic retinopathy: a multi center study in Brazil

BackgroundDiabetic retinopathy has a significant impact in every healthcare system. Despite that fact, there are few accurate estimates in the prevalence of DR in Brazil’s different geographic regions, particularly proliferative DR and diabetic macular edema. This study aims to determine the prevalence of diabetic retinopathy in Brazil’s five continental regions and its determinant factors.MethodsThis multi center, cross-sectional, observational study, conducted between August 2011 and December 2014, included patients with type 1 diabetes from the 5 Brazilian geographic regions (South, Southeast, North, Northeast and Midwest). During a clinical visit, a structured questionnaire was applied, blood sampling was collected and each patient underwent mydriatic binocular indirect ophthalmoscopy evaluation.ResultsData was obtained from 1644 patients, aged 30.2 ± 12 years (56.1% female, 54.4% Caucasian), with a diabetes duration of 15.5 ± 9.3 years. The prevalence of diabetic retinopathy was 242 (36.1%) in the Southeast, 102 (42.9%) in the South, 183 (29.9%) in the North and Northeast and 54 (41.7%) in the Midwest. Multinomial regression showed no difference in the prevalence of non-proliferative diabetic retinopathy in each geographic region, although, prevalence of proliferative diabetic retinopathy (p = 0.022), and diabetic macular edema (p = 0.003) was higher in the Midwest. Stepwise analyses reviled duration of diabetes, level of HbA1c and hypertension as independent variables.ConclusionsThe prevalence of non proliferative diabetic retinopathy in patients with type 1 diabetes was no different between each geographic region of Brazil. The Midwest presented higher prevalence of proliferative diabetic retinopathy and diabetic macular edema. Duration of DM and glycemic control is of central importance to all. Hypertension is another fundamental factor to every region, at special in the South and Southeast. Glycemic control and patients in social and economic vulnerability deserves special attention in the North and Northeast of Brazil.

Is There any Correlation Between Diabetic Retinopathy and Risk of Cardiovascular Disease?

There are growing evidence that indicate a relation between diabetic microangiopathy and cardiovascular disease with different mechanism. To investigate the association of diabetic retinopathy (DR) with the risk of cardiovascular disease (CVD) in type 2 diabetic patients. 180 type 2 diabetic patients who were free of CVD at baseline were enrolled. Patients were classified according to fundoscopy to no diabetic retinopathy (NDR), non proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). CVD risk at 10 years was estimated using the UK Prospective Diabetes Study risk engine and patients were classified as high risk (20%), moderate risk (10-20%) and low risk (10%). Prevalence of DR was 30.5%. Risk of CVD was significantly higher in PDR vs NDR (18.7±10.0% vs. 11.3±8.4%, p= 0.01) .The prevalence of NPDR (32% vs. 17.8%, p=0.002) and PDR (20% vs. 4.1%, p=0.04) was more in high risk group for CVD in comparison with low risk group for CVD. After adjustment for traditional risk factor for CVD, the risk for CVD remained markedly increased in the presence of DR. DR is associated with estimated risk of CVD in type 2 diabetic patients.

CSME: To Treat or Not to Treat!

To find out the prevalence of diabetic retinopathy (DR) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM).The study group consists of diabetic patients applying to the Diabetes Outpatient Clinic of Istanbul Medical Faculty and who had ophthalmological examination between the years 2003 and 2004. Three hundred and seventy patients with T1DM (mean chr. age 26.9 ± 11.3 years, mean duration of DM 8.5 ± 7.0 years) and 1332 patients with T2DM (mean chr. age 58.5 ± 10.9 years, mean duration of DM 10.2 ± 7.4 years) were included.Diabetic retinopathy was diagnosed in 42.8% of patients (33.2% in T1DM, 45.5% in T2DM). The prevalence of nonproliferative DR was 4.7% in patients with duration of T1DM ≤5 years and 45.8% with duration of T1DM >20 years. These prevalences were 18.7 and 60.6% in patients with T2DM, respectively. As to the prevalence of proliferative DR in patients with duration of DM ≤ 5 years, 0.7% in T1DM, and 0.4% in T2DM; in patients with duration of DM > 20 years it was 20.8 and 9.1%, respectively. Both in T1DM and T2DM the presence and the severity of DR was increasing as the duration of DM increases (p = 0.00).High prevalence of diabetic retinopathy in T1DM and T2DM patients with duration of diabetes 5 years or less is noticeable. Starting the screening early preferably at the time of diagnosis, regular follow-up together with good metabolic control will serve to prevent the sight-threatening diabetic retinopathy.

Short report: suboptimal diabetes care in high‐risk diabetic patients attending a specialist retina clinic

Individuals with diabetic retinopathy (DR) represent a high-risk group who would benefit from intensive metabolic control and risk factor management. This brief report examines quality of care among diabetic patients attending a tertiary retinal clinic. A cross-sectional survey, notes review, and slit-lamp examination was conducted in 139 diabetic patients attending a specialist retinal clinic to assess the quality of comprehensive diabetes care. DR was graded according to the Early Treatment Diabetic Retinopathy Study scale. The prevalence of non-proliferative DR (NPDR) and proliferative DR (PDR) was 39.6 and 35.2%, respectively. The prevalence of microalbuminuria in patients with no DR, NPDR and PDR was 32, 54.1 and 68.8%, respectively. Glycaemic control was suboptimal (mean HbA(1c) 8.0 +/- 1.8%) and 15.8% were current smokers. Drugs affecting the renin-angiotensin system were used by only 61.9% of patients with both DR and microalbuminuria, and aspirin by only 35.3%. These data suggest that diabetes care in this high-risk population with established microvascular complications was suboptimal. Specialist clinics dealing with diabetic complications may be a setting where quality improvement strategies to reduce morbidity and mortality should be focused.

Duration of diabetes and prevalence of diabetic retinopathy: Istanbul Diabetic Retinopathy Study—IDRS results 1

Summary Aim To find out the prevalence of diabetic retinopathy (DR) in patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Materials and methods The study group consists of diabetic patients applying to the Diabetes Outpatient Clinic of Istanbul Medical Faculty and who had ophthalmological examination between the years 2003 and 2004. Three hundred and seventy patients with T1DM (mean chr. age 26.9 ± 11.3 years, mean duration of DM 8.5 ± 7.0 years) and 1332 patients with T2DM (mean chr. age 58.5 ± 10.9 years, mean duration of DM 10.2 ± 7.4 years) were included. Results Diabetic retinopathy was diagnosed in 42.8% of patients (33.2% in T1DM, 45.5% in T2DM). The prevalence of nonproliferative DR was 4.7% in patients with duration of T1DM ≤5 years and 45.8% with duration of T1DM >20 years. These prevalences were 18.7 and 60.6% in patients with T2DM, respectively. As to the prevalence of proliferative DR in patients with duration of DM ≤ 5 years, 0.7% in T1DM, and 0.4% in T2DM; in patients with duration of DM > 20 years it was 20.8 and 9.1%, respectively. Both in T1DM and T2DM the presence and the severity of DR was increasing as the duration of DM increases (p = 0.00). Conclusion High prevalence of diabetic retinopathy in T1DM and T2DM patients with duration of diabetes 5 years or less is noticeable. Starting the screening early preferably at the time of diagnosis, regular follow-up together with good metabolic control will serve to prevent the sight-threatening diabetic retinopathy.