Prevalence Of Retinopathy Research Articles

Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes

Type 2 diabetes (T2D) is increasing globally. Diabetic retinopathy (DR) is a leading cause of blindness in adults with T2D; however, the global burden of DR in pediatric T2D is unknown. This knowledge can inform retinopathy screening and treatments to preserve vision in this population. To estimate the global prevalence of DR in pediatric T2D. MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, the Web of Science, and the gray literature (ie, literature containing information that is not available through traditional publishing and distribution channels) were searched for relevant records from the date of database inception to April 4, 2021, with updated searches conducted on May 17, 2022. Searches were limited to human studies. No language restrictions were applied. Search terms included diabetic retinopathy; diabetes mellitus, type 2; prevalence studies; and child, adolescent, teenage, youth, and pediatric. Three teams, each with 2 reviewers, independently screened for observational studies with 10 or more participants that reported the prevalence of DR. Among 1989 screened articles, 27 studies met the inclusion criteria for the pooled analysis. This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines for systematic reviews and meta-analyses. Two independent reviewers performed the risk of bias and level of evidence analyses. The results were pooled using a random-effects model, and heterogeneity was reported using χ2 and I2 statistics. The main outcome was the estimated pooled global prevalence of DR in pediatric T2D. Other outcomes included DR severity and current DR assessment methods. The association of diabetes duration, sex, race, age, and obesity with DR prevalence was also assessed. Among the 27 studies included in the pooled analysis (5924 unique patients; age range at T2D diagnosis, 6.5-21.0 years), the global prevalence of DR in pediatric T2D was 6.99% (95% CI, 3.75%-11.00%; I2 = 95%; 615 patients). Fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy (0.47% [95% CI, 0%-3.30%; I2 = 0%] vs 13.55% [95% CI, 5.43%-24.29%; I2 = 92%]). The prevalence of DR increased over time and was 1.11% (95% CI, 0.04%-3.06%; I2 = 5%) at less than 2.5 years after T2D diagnosis, 9.04% (95% CI, 2.24%-19.55%; I2 = 88%) at 2.5 to 5.0 years after T2D diagnosis, and 28.14% (95% CI, 12.84%-46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. The prevalence of DR increased with age, and no differences were noted based on sex, race, or obesity. Heterogeneity was high among studies. In this study, DR prevalence in pediatric T2D increased significantly at more than 5 years after diagnosis. These findings suggest that retinal microvasculature is an early target of T2D in children and adolescents, and annual screening with fundus photography beginning at diagnosis offers the best assessment method for early detection of DR in pediatric patients.

Prevalence of Diabetic Retinopathy and Use of Common Oral Hypoglycemic Agents Increase the Risk of Diabetic Nephropathy-A Cross-Sectional Study in Patients with Type 2 Diabetes.

This study investigated the effect of amino acid metabolism on the risk of diabetic nephropathy under different conditions of the diabetic retinopathy, and the use of different oral hypoglycemic agents. This study retrieved 1031 patients with type 2 diabetes from the First Affiliated Hospital of Liaoning Medical University in Jinzhou, which is located in Liaoning Province, China. We conducted a spearman correlation study between diabetic retinopathy and amino acids that have an impact on the prevalence of diabetic nephropathy. Logistic regression was used to analyze the changes of amino acid metabolism in different diabetic retinopathy conditions. Finally, the additive interaction between different drugs and diabetic retinopathy was explored. It is showed that the protective effect of some amino acids on the risk of developing diabetic nephropathy is masked in diabetic retinopathy. Additionally, the additive effect of the combination of different drugs on the risk of diabetic nephropathy was greater than that of any one drug alone. We found that diabetic retinopathy patients have a higher risk of developing diabetic nephropathy than the general type 2 diabetes population. Additionally, the use of oral hypoglycemic agents can also increase the risk of diabetic nephropathy.

A Research Study on the Prevalence of Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes Mellitus Patients Presenting to a Tertiary Care Hospital

Objectives: To quantify the prevalence of type II diabetes patients with recently diagnosed diabetic retinopathy. Materials & Methods: The design of this study was cross sectional study design and this study was conducted in Pakistan institute of medical science. There were 113 cases in total of the freshly diagnosed diabetes mellitus type II patients, of age from 30 to 60 years. The patients who had hypertension, diabetes type I, or a history of retinal surgery were not allowed to participate. Following a fundoscopic examination of all patients, the absence or presence of the retinopathy and grades of the retinopathy were noted. Results: The patients' average ages were 45.46±7.40 years. The male to female ratio of these 113 patients was 1.6:1, with 69 (61.06 percent) men and 44 (38.94 percent) women. 18 individuals (15.93%) had retinopathy, according to the results, while 95 patients (84.07%) had none. Practical Implication: This study would assist us in screening these high-risk patients. Additionally, a comprehensive ophthalmic examination at diagnosis time of the diabetes and the periodic screening for detection of retinopathy early so that the early therapeutic measures could be taken for prevention of their further complications could be arranged for all freshly diagnosed diabetic type-2 patients. These programs could be organized at regional and national levels. Conclusion: This study's findings, which include the relatively high prevalence of the diabetic retinopathy in the freshly diagnosed Diabetes mellitus type II patients at 15.93 percent, which highlights the need for each patient to undergo a thorough Ophthalmic examination at the time of being labelled as diabetic. Keywords: Diabetes, freshly diagnosed, Diabetic Retinopathy Prevalence, retinopathy, Diabetes Mellitus Type II.

Recent advances in the management of proliferative diabetic retinopathy.

The prevalence of diabetic retinopathy continues to rise. This review highlights advances in imaging, medical, and surgical management of proliferative diabetic retinopathy (PDR) in recent years. Ultra-widefield fluorescein angiography has been shown to better characterize which patients have predominantly peripheral lesions and who may advance to more advanced forms of diabetic retinopathy. This was well demonstrated in DRCR Retina Network's Protocol AA. Protocol S demonstrated that antivascular endothelial growth factor (VEGF) treatment alone can be useful in the management of select PDR patients - particularly those without high-risk features. However, a growing body of literature highlights how lapse in care is a significant concern in PDR patients, and tailoring one's approach to treatment based on patient needs is recommended. In patients with high-risk features or where there is concern for lost-to-follow-up, incorporation of panretinal photocoagulation in the treatment paradigm is recommended. Protocol AB highlighted how patients with more advanced disease may benefit from earlier surgical intervention for earlier visual recovery but that continued anti-VEGF treatment may result in similar visual outcomes over a longer period. Finally, earlier surgical intervention for PDR without vitreous hemorrhage (VH) or retinal detachment is being considered a potential option to minimize treatment burden. Recent advances in imaging, as well as medical and surgical treatment options for PDR, have provided a deeper understanding of PDR management, which can be optimized for the individual patient.

Prevalence of diabetic retinopathy in Brazil: a systematic review with meta-analysis

AimsTo evaluate the prevalence of diabetic retinopathy (DR) in Brazilian adults with diabetes mellitus via a systematic review with meta-analysis.MethodsA systematic review using PubMed, EMBASE, and Lilacs was conducted, searching for studies published up to February 2022. Random effect meta-analysis was performed to estimate the DR prevalence.ResultsWe included 72 studies (n = 29,527 individuals). Among individuals with diabetes in Brazil, DR prevalence was 36.28% (95% CI 32.66–39.97, I2 98%). Diabetic retinopathy prevalence was highest in patients with longer duration of diabetes and in patients from Southern Brazil.ConclusionThis review shows a similar prevalence of DR as compared to other low- and middle-income countries. However, the high heterogeneity observed—expected in systematic reviews of prevalence—raises concerns about the interpretation of these results, suggesting the need for multicenter studies with representative samples and standardized methodology.

Abstract P1-12-06: Prevalence and Spectrum of Manifestations of Tamoxifen Retinopathy as Assessed by Multimodal and Ultra-widefield Retinal Imaging

Abstract Introduction Tamoxifen, a selective estrogen antagonist, is part of standard adjuvant therapy for hormone receptor-positive breast cancer. In addition to known systemic toxicities, well-described retinotoxic effects include peripheral and macular crystalline deposits, pseudocystic foveal cavitations, as well as an increased risk of developing punctate pigmentary changes. However, the true prevalence of retinal toxicity is unclear, with the literature reporting rates between 1.5% and 11%, with significant geographic and temporal discrepancies depending on choice of screening modality. Advances in retinal imaging, specifically spectral domain and swept-source optical coherence tomography (OCT), have led to more sensitive diagnosis of toxicity. However, the field of view of commercially available OCT is limited 30 degrees, whereas ultra-widefield (UWF) imaging can image up to 200 degrees of the retina, albeit with a superficial rather than a cross-sectional view. Therefore, UWF imaging may visualize previously underreported signs of toxicity in the peripheral retina such as pigmentary changes better than macula-focused imaging alone like OCT. As such, the goals of the present study were to: 1) determine the prevalence of tamoxifen retinopathy in our cohort, a major northeastern metropolitan area, based on multimodal retinal imaging including macular OCT, fundus photos, and autofluorescence; 2) determine whether the additional field of view captured in UWF imaging contributes to the diagnosis of tamoxifen retinopathy by assessing for peripheral findings, most specifically pigmentary retinopathy. Methods This is a retrospective study of patients who visited the retina service of a single academic tertiary referral center between September 2012 and November 2021. Female patients initiated on tamoxifen for at least 6 months before their first retinal exam were identified. Patients with poor image quality, prior vitreoretinal surgery, retinal laser, or confounding pathology such as severe diabetic retinopathy were excluded. Two independent graders performed blinded review of OCT images for evidence of macular toxicity and UWF images for signs of central and peripheral toxicity, and the prevalence of the latter was compared to age- and gender-matched controls. A two-tailed t-test was used to compare ages of patients in the two cohorts. A one-tailed two proportion Z-test was used to determine if eyes in the tamoxifen cohort exhibited a greater rate of peripheral pigmentary changes. Results 252 eyes from 128 patients were included in the tamoxifen cohort, and 244 eyes from 125 patients in the control cohort. The average age at first retinal imaging in the tamoxifen cohort (61.1 ± 1.1, n=128) versus the control cohort (61.0 ± 1.3, n = 125) was not significantly different (p=0.95). 4 eyes (1.6%) from 2 patients (1.6%) had evidence of definitive tamoxifen retinopathy. One patient had crystalline maculopathy bilaterally visible on OCT and UWF imaging and another had macular pseudocystic cavitations bilaterally on OCT. Neither patient had peripheral findings on UWF. 31 eyes (12.4%) among 16 (12.5%) patients in the tamoxifen cohort displayed peripheral reticular pigmentary changes, compared to 59 eyes (24.2%) among 30 patients (24.0%) in the control group. The rate of peripheral pigmentary change in the tamoxifen cohort was not significantly greater than in the control group (p=0.99). Conclusion Only 2 patients had definitive tamoxifen retinopathy findings, which were both concentrated in the macula and clearly visible on OCT imaging. Given the absence of meaningful UWF changes, macular OCT may be the most valuable tool in diagnosing tamoxifen retinopathy. Our prevalence (1.6%) diverges from higher prevalences reported by studies screening with advanced retinal imaging (10-12%), though notably reflects a very different ethnic and geographic population compared with other work. Further large population studies are needed. Citation Format: Ethan Zhao, Kyle Kovacs. Prevalence and Spectrum of Manifestations of Tamoxifen Retinopathy as Assessed by Multimodal and Ultra-widefield Retinal Imaging [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-12-06.

Insulin resistance and hepatic steatosis in type 1 diabetes mellitus and their association with diabetic chronic complications.

The aim of this study was to evaluate insulin resistance and hepatic steatosis and their association with diabetes duration, control and chronic complications in patients with type 1 diabetes. We studied medical records of 181 consecutive hospitalized adult patients with type 1 diabetes. Estimated glucose disposal rate (eGDR), Insulin Sensitivity Score (ISS), Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) were calculated. Patients in the 1st tertile of eGDR (<4.1 mg/kg-1-min-1) and ISS (<4.8) had higher prevalence of ischemic cardiovascular disease (ICVD) (P<0.001), hepatic steatosis, higher gamma glutamyl transpeptidase, HSI, FLI compared with participants from the 2nd and 3rd tertile of eGDR and ISS. Compared with those without steatosis, patients with ultrasound-diagnosed steatosis (30.5%) had a lower ISS (4.4±1.9 vs. 6.3±2.4, P<0.001), eGDR (4.5±3.0 vs. 5.8±2.7, P=0.01), higher FLI (72.5±25.1 vs. 51.0±27.2, P<0.001), HSI (37.5±6.1 vs. 35.2±4.7, P=0.03) and prevalence of ICVD (71.7 vs. 45.7%, P=0.004) and retinopathy (69.6 vs. 52.4%, P=0.03). Factors independently associated with hepatic steatosis were only ICVD (OR=2.584, P=0.029), ISS (OR 0.148, P<0.001), aspartate aminotransferase (OR=1.025, P=0.038) and male gender (OR=2.726, P=0.016). Insulin resistance and hepatic steatosis are common in type 1 diabetes and have a significant association with ICVD, independently of diabetes duration, control and insulin doses.

Association of diabetes, fasting glucose, and the risk of glaucoma: a systematic review and meta-analysis.

We designed this systematic review to summarize the diabetes-related glaucoma articles produced from 2011 to 2022. We further aimed to perform a meta-analysis to determine the vital association between these two parameters. Data sources like PubMed, MEDLINE, and EMBASE were used to find the relevant research. Reviews, case reports, and editorial letters were excluded. Articles inspection was conducted by the main author who extracted the study title and abstract in the first screening by using keywords to find the eligible articles. Heterogeneity was accessed by using the Cochrane Q test and I2 test. 10 studies were reported with 2,702,136 cases of diabetes. Out of these, 64,998 incidents of glaucoma were observed. The pooled prevalence of diabetic retinopathy was 11.7% associated with glaucoma. A significant I2 value was achieved (100%) with Cochran's Q of 183.6. In conclusion, we found diabetes duration, elevated IOP, and fasting glucose levels are one of the leading risk factors for glaucoma. Fasting glucose levels and diabetes are also major contributors to elevated IOP levels.

Prevalence of Retinopathy of Prematurity in Premature Neonates Visiting Sir Gangaram Hospital Lahore

Background: Retinopathy of prematurity (ROP) is a serious problem which affects the premature infants. It is becoming a public health issue in developing countries like Pakistan. Antenatal visits, delivery and NICU management plays an important role in prevention of ROP. Objective: The aim of this study was to find out the prevalence of retinopathy of prematurity in premature neonates visiting Sir Ganga Ram hospital Lahore. Study Design: observational study. Settings: Study was carried out in Out-patient of Ophthalmology Department, A public sector Sir Ganga Ram Hospital, Lahore Pakistan. Duration: The duration of the study was one year from September 2020 to August 2021. Methods: All the preterm babies referred from pediatric department were part of study. A total of 160 babies were examined in this study. The data was presented in the form of frequency and percentages using SPSS software. Results: In this study out of 160 patients 75(46.87%) were male and 85(53.12%) were females. The prevalence of retinopathy of prematurity was observed in 43(26.87%) babies. Weight of patients less than 1kg was 11(25.58%) between 1-1.5 kg was noted in 28(65.11%) patients and &gt;2 kg weight was noted in 4(9.30%) patients. Babies with ROP, 23(53.48%) recovered without any intervention, 9(20.93%) required intervention and recovered after 3 months follow up, 6(13.95%) kept under observation and recovered after 4 months and 5(11.62%) babies lost follow up. Practical implication: this study will help in early diagnosis and prevention of disease and help to formulate and introduce newer guidelines for prevention, early identification and prompt treatment starting from basic levels to prevent development of ROP of any stage. Conclusion: The study concluded that the prevalence of retinopathy of prematurity in premature neonates visiting Sir Ganga Ram hospital Lahore is 27%. Keywords: Retinopathy of Prematurity(ROP), Neonates, Preterm, screening, blindness

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.

Post-Load Insulin Secretion Patterns are Associated with Glycemic Status and Diabetic Complications in Patients with Type 2 Diabetes Mellitus.

To examine whether the different patterns of post-load insulin secretion can identify the heterogeneity of type 2 diabetes mellitus (T2DM). Six hundred twenty-five inpatients with T2DM at Jining No. 1 People's Hospital were recruited from January 2019 to October 2021. The 140 g steamed bread meal test (SBMT) was conducted on patients with T2DM, and glucose, insulin, and C-peptide levels were recorded at 0, 60, 120, and 180 min. To avoid the effect of exogenous insulin, patients were categorized into three different classes by latent class trajectory analysis based on the post-load secretion patterns of C-peptide. The difference in short- and long-term glycemic status and prevalence of complications distributed among the three classes were compared by multiple linear regression and multiple logistic regression, respectively. There were significant differences in long-term glycemic status (e. g., HbA1c) and short-term glycemic status (e. g., mean blood glucose, time in range) among the three classes. The difference in short-term glycemic status was similar in terms of the whole day, daytime, and nighttime. The prevalence of severe diabetic retinopathy and atherosclerosis showed a decreasing trend among the three classes. The post-load insulin secretion patterns could well identify the heterogeneity of patients with T2DM in short- and long-term glycemic status and prevalence of complications, providing recommendations for the timely adjustment in treatment regimes of patients with T2DM and promotion of personalized treatment.

Prevalence and Risk Factors of Hydroxychloroquine Retinopathy in Rheumatic Patients with Dry Eye Symptoms

Purpose: Hydroxychloroquine is widely used for long-term treatment of rheumatic diseases, but the drug can trigger irreversible toxic retinopathy. We studied the prevalence of, and the risk factors for, hydroxychloroquine retinopathy in rheumatic patients with dry eye symptoms and we introduce a representative case.Methods: We retrospectively studied a cohort of 133 rheumatological patients who had taken hydroxychloroquine for at least 12 months and who visited our ophthalmology clinic with dry eye symptoms from April 2016 to December 2021. Hydroxychloroquine retinopathy was diagnosed via fundus photography, spectral-domain optical coherence tomography, the Humphrey visual field test, autofluorescence fundus photography, and multifocal electroretinography. The principal outcomes were the prevalence of retinopathy at the first screening and the risk factors.Results: Of the 133 patients, hydroxychloroquine retinopathy was diagnosed in seven (5.2%) at the first screenings. The Mann-Whitney U-test revealed that older age; higher daily doses; longer dosing duration; greater cumulative doses; and higher daily and cumulative doses/kg were statistically significant in terms of retinopathy development. On multivariate logistic regression analysis, the average daily dose (odds ratio [OR] 6.02; 95% confidence interval [CI] 1.64-22.12, 100 mg increments) and duration of dosing (OR 3.39; 95% CI 1.19-9.62, 5 years increments) remained statistically significant (P = 0.021, P = 0.007 respectively)Conclusions: Ophthalmologists should enquire about any history of hydroxychloroquine therapy, and perform a retinal examination, when encountering dry eye in patients with rheumatic disease. Early detection of hydroxychloroquine retinopathy followed by discontinuation of hydroxychloroquine is the only way to prevent visual loss. High daily drug doses and long dosing durations are risk factors for retinopathy.

Association of Triglyceride Glucose Index with Prevalence and Incidence of Diabetic Retinopathy in a Singaporean Population.

To examine the association of triglyceride glucose (TyG) index (product of fasting triglyceride and glucose) with prevalence and incidence of diabetic retinopathy (DR) in type 2 diabetes. 1339 patients from an ongoing Singapore Study of Macro-angiopathy and Micro-Vascular Reactivity in Type 2 Diabetes (SMART2D) were included in this study. Fasting triglyceride and glucose levels were quantified and color fundus photographs were assessed for DR presence and severity. Logistic regression models were used to evaluate associations of TyG index with DR prevalence and incidence (median follow-up period = 3.2 years). Mean TyG index was higher in patients with DR than no DR (9.24±0.7 versus 9.04± 0.6, p<0.001). TyG index was significantly associated with DR prevalence (OR=1.4, CI 1.1-1.7, p=0.002) and incidence (OR=1.8, CI 1.04-2.9, p=0.03), after adjusting for confounders. In a stratified analysis, the association between TyG index and DR prevalence reached significance only in the subgroup with HbA1c levels < 7.0% (OR=2, CI 1.1-3.8, p=0.03). TyG index significantly predicted DR prevalence and incidence with area under receiver operating curve as 0.77 (CI 0.74-0.80, p <0.001) and 0.66 (CI 0.57-0.76, p value <0.01), respectively. TyG index is a good predictor for DR prevalence and incidence. It can also be a secondary treatment target for patients with optimally controlled levels of HbA1c.

Prevalence and risk factors of diabetic retinopathy in Basrah, Iraq

This study aimed to measure the prevalence and risk factors of diabetic retinopathy (DR) among patients with diabetes mellitus aged 20 to 82 years attending the Faiha Diabetes, Endocrine, and Metabolism Center (FDEMC) in Basrah. A cross-sectional study was conducted at FDEMC, including 1542 participants aged 20 to 82 from January 2019 to December 2019. Both eyes were examined for evidence of DR by a mobile nonmydriatic camera, and statistical analysis was performed to measure the prevalence rates (95% CI) for patients with different characteristics. The mean age of participants was 35.9, with 689 males (44.7%; 95% CI: 42.2-47.2%) and 853 females (55.3%; 95% CI: 52.8-57.8%). The prevalence rate of DR was 30.5% (95% CI: 28.1-32.8%), and 11.27% of cases were proliferative retinopathy. DR significantly increased with age (p-value=0.000), it was higher in females (p-value=0.005), and significantly increased with a longer duration of diabetes (p-value<0.001), hyperglycemia (p-value<0.001), hypertension (p-value=0.004), dyslipidemia (p-value<0.001), nephropathy (p-value<0.001) and smoking (p-value<0.001). There was no statistical association between DR and the type of diabetes or obesity. One-third of the participants in this study had DR. Screening and early detection of DR using a simple tool such as a digital camera should be a priority to improve a person's health status.

A study on the prevalence of retinopathy in newly diagnosed Type 2 diabetes mellitus in a tertiary care center of Tamil Nadu

Background: Type 2 diabetes mellitus (Type 2 DM) is one of the leading risk factors for cardiovascular diseases. Although the awareness of the need for screening and treatment for Type-2 DM is widely prevalent, the awareness of complications arising out of it is not widespread. This article highlights the occurrence of diabetic retinopathy (DR) among newly detected diabetic patients. Aims and Objectives: The aim of the study was to study the prevalence of DR in patients who are diagnosed as having Type 2 diabetes mellitus for the first time. Materials and Methods: The present study involved 501 newly diagnosed Type 2 DM patients. Their history was recorded and the investigations done included haemoglobin (Hb), glycated Hb percent (HbA1c), fasting blood sugar, and post-prandial blood sugar. These patients underwent fundus examination through direct ophthalmoscope and slitlamp examination. Results: Out of the 501 patients in the study, 59.5% (298) had good knowledge about diabetes, but only 3.8% knew about retinopathy. A total of 71.5% of patients did not have periodic eye examination; the most common barrier identified was lack of awareness about the necessity for this (58.5%), 5.6% among the total population had an eye disease. Mild non-proliferative DR (NPDR) was found among 10 females and it was observed in eight males. Moderate NPDR was identified in three males and two females and while no severe cases were reported among the men, two were noted among the women. Conclusion: The study highlights the prevalence of retinopathy in newly diagnosed Type 2 DM population in tertiary care center hospital in Salem district. The study also highlights the importance of detection of Type 2 DM before the occurrence of complications which arise due to diabetes and screening for microvascular complications is necessary at the time of diagnosis of DM and periodically.

CLINICAL STUDY OF RETINAL CHANGES IN PREGNANCY INDUCED HYPERTENSION

Background:Pregnancy induced hypertension, is the commonest form of life-threatening complications of pregnancy. Pregnancy is described as the only physiological state in which most physiological parameters are abnormal. The anatomical, physiological and biochemical adaptations that take place in a woman during the short span of human pregnancy are profound. Compared with normotensive gravidas, patients with elevated blood pressure have significantly greater maternal and foetal mortality and morbidity. The clinical and laboratory characteristics of hypertension associated with pregnancy are difficult to differentiate from those of hypertension independent of pregnancy. Objective: The objective of this study was to study the prevalence and risk factors of ocular fundus changes among pregnant women with PIH. Materials and Methods: A hospital‐based, cross‐sectional study was carried out among 130 pregnantwomen with PIH. History of symptoms related to the eyes, age, and gravida was recorded. Torchlight was used to examine the anterior segment. One percentage of tropicamide was used to dilate pupils. Direct ophthalmoscope was used to examine the fundus. Blood pressure was measured as per the standard guidelines. Urine sample was taken to look for the presence of proteins in urine. Results: The majority belonged to 18 to 35years (50%) and the majority (54.6%) had gestational age &gt;37 weeks. The majority (75.38%) had gestational hypertension. The prevalence of retinopathy among pregnant women with PIH was 13.7% Grade I retinopathy was most commonly seen in 7.7% of cases followed by Grade II retinopathy in 2.7% of the cases, grade 3 in 1.4% and grade 4 in 0.6%. one patient had exudative retinal detachment. Age was not found to be associated with retinopathy among pregnant women with PIH. The prevalence of retinopathy among women with preeclampsia was 31.7% and in eclampsia was 40 %, compared to only 7.07% in women with gestational hypertension and this difference was statistically significant (P &lt; 0.05). The prevalence of retinopathy among women with blood pressure &gt;150/100 mmHg was 45.4% compared to only 2.6% in women with bloodpressure&lt;150/100 mmHg and this difference was statistically significant (P &lt; 0.05). The prevalence of retinopathy among women with severe proteinuria (+++) was 66.6% compared to 44.5% in women with moderate proteinuria (++), 22.7% among women with mild proteinuria (+) and only 5.5% in women without proteinuria. These differences were statistically significant (P &lt; 0.05) Conclusion: The prevalence of retinopathy among pregnant women with PIH was high. High blood pressure and severe proteinuria and preeclampsia were significantly associated with retinopathy.

Health Care Disparities in Diabetes and Diabetic Retinopathy

ABSTRACT Purpose To investigate prevalence of diabetes (DM), diabetic retinopathy (DR), and areas with highest rates of undetected DR. To quantify and map locations of disparities as they relate to poverty and minority populations. Methods Retrospective cohort study from large regional health data repository (HealthLNK). Geographic Information System (GIS) analysis mapped rates of DM and DR in Chicago area ZIP Codes. Results Of 1,086,921 adults who met the inclusion criteria, 143,790 with DM were identified. ZIP Codes with higher poverty rates were correlated with higher prevalence of DM and DR (Pearson’s correlation coefficient 0.614, p < .05, 0.333, p < .05). Poverty was negatively correlated with likelihood of DR diagnosis (−0.638, p < .05). Relative risks of DM and DR were calculated in each ZIP Code and compared to actual rates. 36 high-risk ZIP Codes had both high-risk of DM and low DR detection. In high-risk ZIP Codes 85.4% of households self-identified as ethnic minority and 33.0% were below the Federal Poverty Level (FPL). Both percentages were significantly higher than the Chicago average of 50.5% minority and 19.9% below FPL (p < .05). 67 ideal ZIP Codes had both low risk of DM and high DR detection. In ideal ZIP Codes 32.6% of households self-identified as minority, and 10.2% were below the FPL (p < .05). Conclusions A health care disparity exists with regards to DM and DR. High-risk ZIP Codes are associated with higher poverty and higher minority population, and they are highly concentrated in just 17% of the ZIP codes in the Chicago area.

Clinical and biochemical profile of childhood-adolescent-onset type 1 diabetes and adult-onset type 1 diabetes among Asian Indians.

To compare the clinical and biochemical profile and prevalence of complications among childhood/adolescent-onset (CAO; onset of diabetes< 20years of age) and adult-onset (AO; onset of diabetes- ≥ 20years of age) type 1 diabetes (T1D), seen at a tertiary care diabetes center in south India. Data of 5578 individuals with T1D, diagnosedbased on a history of diabetic ketoacidosis or ketonuria, fasting C-peptide < 0.3pmol/mL and stimulated C-peptide values < 0.6pmol/mL, and requirement of insulin right from the time of diagnosis, presenting to our center between 1991 and 2021, were retrieved fromour electronic medical records. Retinopathy was assessed by retinal photography, chronic kidney disease (CKD) by urinary albumin excretion ≥ 30µg/mg of creatinine and/or eGFR < 60mL/min, and neuropathy by vibration perception threshold >= 20v on biothesiometry. Overall, 3559 (63.8%) of individualswith T1D, belonged to CAO group and 2019 (36.2%) to AO category. AO had higher prevalence of all microvascular complications compared to CAO at every diabetes duration interval, even after adjusting for A1c. Among the AO group, prevalence of retinopathy, CKD, and neuropathy was higher in the GAD negative group. Among CAO there were no differences between the GAD negative and GAD positive groups with respect to prevalence of complications of diabetes. AO with T1D had higher prevalence of microvascular complications compared to CAO. Among AO, GAD negative individuals had higher percentage of retinopathy and CKD compared to GAD positive group.

Retinopathy of prematurity in preterm infants: A prospective study of prevalence and predictors in Northern India

ObjectivesTo determine the prevalence and predictors of Retinopathy of prematurity (ROP) and severe ROP. MethodsA prospective observational study (April 2019–May 2020) was conducted at a tertiary care center in preterm newborns with; 1) birth-weight <2000 g or gestation <34 weeks and 2) gestation 34–36 weeks with risk factors that predispose to ROP. ResultsA total of 340 preterm newborns were screened. ROP was diagnosed in 63 (18.5%), of which 8 (2.4%) had severe ROP. 30.2%, 63.5%, and 9.5% babies had stage 1, 2, and 3 ROP, respectively. Perinatal risk factors for ROP were assessed using univariate analysis. In the binary logistic regression analysis, birth-weight<1250 g, gestation<30 weeks, weight-gain proportion at 4, 5 and 6 weeks, respiratory distress syndrome (RDS), surfactant administration, need for oxygen were significantly associated with ROP while birth-weight<1250 g, apnea, surfactant administration and oxygen duration≥80 h were associated with severe ROP (p < 0.005). Infants with poor postnatal weight-gain were found to be at risk for ROP. ROC plot depicted an absolute weight gain of 535 g at 6-weeks of age had a sensitivity of 58.7% and specificity of 32.9% for predicting ROP. ConclusionThe prevalence of ROP was 18.5%. Birth-weight<1250 g, gestation <30 weeks, weight-gain proportion at 4, 5 and 6 weeks, RDS, surfactant administration, need for oxygen were independent predictors for ROP, however birth-weight<1250 g, apnea, surfactant administration and oxygen duration ≥80 h were independent predictors for severe ROP. Preterm newborns with poor postnatal weight-gain are at risk for ROP.

Trends in the Prevalence and Treatment of Diabetic Macular Edema and Vision-Threatening Diabetic Retinopathy Among Commercially Insured Adults Aged

Examine the 10-year trend in the prevalence and treatment of diabetic macular edema (DME) and vision-threatening diabetic retinopathy (VTDR) among commercially insured adults with diabetes. We analyzed the 10-year trend (2009-2018) in health care claims for adults aged 18-64 years using the IBM MarketScan Database, a national convenience sample of employer-sponsored health insurance. We included patients continuously enrolled in commercial fee-for-service health insurance for 24 months who had a diabetes ICD-9/10-CM code on one or more inpatient or two or more different-day outpatient claims in the index year or previous calendar year. We used diagnosis and procedure codes to calculate the annual prevalence of patients with one or more claims for 1) any DME, 2) either DME or VTDR, and 3) antivascular endothelial growth factor (anti-VEGF) injections and laser photocoagulation treatment, stratified by any DME, VTDR with DME, and VTDR without DME. We calculated the average annual percent change (AAPC). From 2009 to 2018, there was an increase in the annual prevalence of patients with DME or VTDR (2.1% to 3.4%; AAPC 7.5%; P < 0.001) and any DME (0.7% to 2.6%; AAPC 19.8%; P < 0.001). There were sex differences in the annual prevalence of DME or VTDR and any DME, with men having a higher prevalence than women. Annual claims for anti-VEGF injections increased among patients with any DME (327%) and VTDR with DME (206%); laser photocoagulation decreased among patients with any DME (-68%), VTDR with DME (-54%), and VTDR without DME (-62%). Annual claims for DME or VTDR and anti-VEGF injections increased whereas those for laser photocoagulation decreased among commercially insured adults with diabetes.