Risk Of Diabetic Retinopathy Progression Research Articles

Dynamics of indicators of the vascular membrane of the ciliary body in predicting the risk of diabetic retinopathy in pregnant women with diabetes mellitus

BACKGROUND: According to statistics, microvascular complications of diabetes mellitus are registered in a third of patients during their lifetime, and diabetic retinopathy is the main cause of irreversible blindness in people of reproductive age. Changes in the vascular membrane of the eye in patients with diabetes mellitus are currently being studied as predictors of the progression of diabetic retinopathy. Further study of changes in the vascular membrane in pregnant women with type 1 and type 2 diabetes may help in identifying criteria for the manifestation and progression of diabetic microangiopathy. AIM: To develop a methodology for predicting the risk of diabetic retinopathy progression by analyzing the dynamics of the state of the vascular membrane of the ciliary body. METHODS: The study was conducted in each trimester of pregnancy. A pregnant patient with confirmed diabetes mellitus 1 or diabetes mellitus 2 underwent a comprehensive ophthalmological examination, including visometry with maximally corrected visual acuity, tonometry, biomicroscopy of the anterior segment of the eye, ophthalmoscopy under conditions of drug-induced mydriasis (phenylephrine) with a high-diopter lens (78–90 D), and optical coherence tomography of the anterior and posterior eye segments. RESULTS: With an increase in the thickness of the vascular layer of the ciliary body by ≥10% at one or more points compared with the study conducted in the first trimester of pregnancy, the patients exhibited diabetic retinopathy progression during subsequent routine examinations. Quantitative analysis of the vascular layer of ciliary body revealed the transition of diabetic retinopathy to its next stage; however, photoregistration of the fundus did not show obvious signs of transformation into another stage of the disease. CONCLUSION: Dynamic examination of the thickness of the vascular layer of the ciliary body during gestation and its increase by 10% from the initial one enables prediction of progression of diabetic retinopathy to the next stage.

Impact of Obstructive Sleep Apnea on Diabetic Retinopathy Progression and Systemic Complications

PurposeEvaluate the risk of diabetic retinopathy progression and systemic vascular events, including death, in patients with non-proliferative diabetic retinopathy (NPDR) with obstructive sleep apnea (OSA). DesignRetrospective cohort study. MethodsElectronic chart query using TriNetX (Cambridge, MA, USA), an electronic health records network comprising data from over 124 million patients. Patients with NPDR with and without OSA were identified. Patients were excluded if they had history of proliferative disease (PDR), diabetic macular edema (DME), or prior ocular intervention (intravitreal injection, laser, or pars plana vitrectomy). Propensity score matching was performed to control for baseline demographics and comorbidities. Rate of progressing to vision threatening complications (VTCs), need for ocular intervention, and systemic events was measured at 1, 3, and 5 years. Results11,931 patients in each group were analyzed after propensity score matching. There was elevated risk of PDR in the OSA cohort at 1 (RR: 1.34, P<0.001), 3 (RR: 1.31, P<0.001), and 5 years (RR: 1.28, P<0.001). There was elevated risk of DME in the OSA group at all timepoints: 1 (RR: 1.31, P<0.001), 3 (RR: 1.19, P<0.001), and 5 years (RR: 1.18, P<0.001). With respect to ocular interventions, there was an increased risk of intravitreal injection in OSA patients at 1 (RR: 1.59, P<0.001), 3 (RR: 1.58, P<0.001), and 5 years (RR: 1.54, P<0.001), and similar trends were noted with laser photocoagulation, but not vitrectomy. Regardingsystemic events, NPDR patients with OSA had a greater risk of stroke (1 year RR: 1.80, P<0.001; 3 year RR: 1.56, P<0.001; 5 year RR: 1.49, P<0.001), myocardial infarction (1 year RR: 1.51, P<0.001; 3 year RR: 1.46, P<0.001; 5 year RR: 1.43, P<0.001), and death (1 year RR: 1.31, P<0.001; 3 year RR: 1.19, P<0.001; 5 year RR: 1.15, P<0.001). ConclusionsThere is an increased rate of DR progression to VTCs, need for ocular intervention, and systemic complications, including death, for patients with OSA. We emphasize the need for improved screening measures of patients with NPDR and potential OSA.

A deep learning system for predicting time to progression of diabetic retinopathy.

Diabetic retinopathy (DR) is the leading cause of preventable blindness worldwide. The risk of DR progression is highly variable among different individuals, making it difficult to predict risk and personalize screening intervals. We developed and validated a deep learning system (DeepDR Plus) to predict time to DR progression within 5 years solely from fundus images. First, we used 717,308 fundus images from 179,327 participants with diabetes to pretrain the system. Subsequently, we trained and validated the system with a multiethnic dataset comprising 118,868 images from 29,868 participants with diabetes. For predicting time to DR progression, the system achieved concordance indexes of 0.754-0.846 and integrated Brier scores of 0.153-0.241 for all times up to 5 years. Furthermore, we validated the system in real-world cohorts of participants with diabetes. The integration with clinical workflow could potentially extend the mean screening interval from 12 months to 31.97 months, and the percentage of participants recommended to be screened at 1-5 years was 30.62%, 20.00%, 19.63%, 11.85% and 17.89%, respectively, while delayed detection of progression to vision-threatening DR was 0.18%. Altogether, the DeepDR Plus system could predict individualized risk and time to DR progression over 5 years, potentially allowing personalized screening intervals.

Bariatric surgery in individuals with type 2 diabetes is not associated with short or long-term risk of diabetic retinopathy progression: results from a nationwide cohort study.

Bariatric surgery is used to induce weight loss and glycemic stability in type 2 diabetes (T2D). It has been a concern that this may lead to early worsening of diabetic retinopathy (DR) due to a rapid decline in HbA1c. In this study, we evaluated the risk of short and long-term DR development and need for ocular intervention in an entire nation of individuals with T2D undergoing bariatric surgery. The study comprised a national, register-based cohort of individuals with T2D screened for DR. Cases were matched by age, sex and DR level at the date of surgery (index date) with non-bariatric controls. We extracted information on DR levels, in- and outpatient treatments, pharmaceutical prescriptions and laboratory values. We evaluated worsening of DR (incident and progressive DR) at follow-up (6 and 36months). Amongst 238,967 individuals with T2D, who attended diabetic eye screening, we identified 553 that underwent bariatric surgery (0.2%) and 2677 non-bariatric controls. Median age was 49years, and 63% were female. Cases had more comorbidities, lower HbA1c as well as more frequent use of glucose-lowering and antihypertensive medication than controls at index date. In a fully adjusted logistic regression model, the risk of DR worsening for cases was not significantly different compared to controls, neither short-term (OR 0.41 [CI 95% 0.13; 1.33], p = 0.14) nor long-term (OR 0.64 [CI 95% 0.33; 1.24], p = 0.18). In this nationwide study, bariatric surgery did not associate with increased risk of short- or long-term DR worsening.

26-LB: Identifying the Risk of Diabetic Retinopathy Progression Using Machine Learning on Ultrawide Field Retinal Images

Estimating the risk of diabetic retinopathy (DR) progression is one of the most important and difficult tasks when caring for individuals with diabetic eye disease. Current DR severity scales have informed clinicians on the progression risk and provided recommendations for follow-up and treatment. The use of artificial intelligence (AI) algorithms may improve in this process. In this study, we developed and validated machine learning (ML) models for DR progression from ultrawide field (UWF) retinal images, which were labeled for baseline DR severity and progression based on clinician review of the images and 3-year longitudinal follow-up using the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. This dataset has 8 classes: no DR nonprogression (14.62%), Mild nonproliferative DR (NPDR) progression (10.16%) /nonprogression (10.73%), Moderate NPDR progression (10.1%) /nonprogression (15.85%), Severe NPDR progression (11.27%) /nonprogression (10.68%), and proliferative DR (16.55%). A total of 9970 unique images were split into the train, the validation, and the test datasets based on 60-20-20 proportions. The class imbalance was addressed during model building through data augmentation. The ResNet model fine-tuned on this dataset has a classification test accuracy of 81% and an AUC of 0.967 on the test dataset. The objective of the model is to reduce false negatives, which refers to predicting a class that is less progressive than the true label. The predicted labels for 91% of the images were either correct labels or were the labels with greater progression than the original labels. These findings demonstrate the accuracy and feasibility of using machine learning models for identifying DR progression developed using UWF images. Potentially, the use of machine learning algorithms may further refine the risk of disease progression and personalize screening intervals that may reduce costs and improve vision-related outcomes. Disclosure A. Nigam: None. J. Sun: None. V. Subhash: None. P. S. Silva: Research Support; Optos plc., Optomed, Speaker's Bureau; Novartis, Roche Pharmaceuticals, Bayer Inc.

108-OR: Clinical and Biochemical Factors Are Inversely Correlated in Diabetic Retinopathy and Age-Related Macular Degeneration

Although diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the two most common sight-threatening conditions in the elderly population, our understanding of the associated risks for these diseases have not been studied. Thus, we examined the association between AMD and DR in people with type 1 and type 2 diabetes from the Joslin 50-Year Medalist Study, composed of individuals who have had insulin-dependent diabetes for 50 years or longer and Beetham Eye Institute. In Medalists, there was an inverse association between DR severity and the presence of AMD (N=1163, P=&amp;lt;0.0001, AMD: 23.4%, 18.6, 7.9% for no-mild, moderate-severe, and proliferative DR, respectively). Similarly, the presence of AMD was associated with milder DR in the BEI cohort (N=58, P=0.004). There were no eyes with neovascular (severe AMD). The presence of AMD was associated with older age (P=0.03), increased diabetes duration (P&amp;lt;0.0001), less severe DR (P&amp;lt;0.0001), and the absence of neuropathy (P=0.003). In contrast, younger age (P=0.02) and the presence of neuropathy (P&amp;lt;0.0001) were associated with the presence of proliferative DR. Higher vitreous retinol-binding protein 3 (RBP3) to vascular endothelial growth factor (VEGF) ratios were associated with AMD and less severe DR in both postmortem Medalist and surgical BEI samples (N=187, P&amp;lt;0.05, all). The presence of milder DR was associated with increased risk of AMD development (24.8%, 10.0%, 5.0% for no-mild, moderate-severe, and proliferative DR, respectively, P=0.047), and risk of DR progression was decreased in eyes with versus without AMD (P=0.04) in a subset of Medalists with longitudinal follow up (22.9%). These novel findings that the inverse risk of DR and AMD is not likely due to similar pathogenic mechanisms and ageing factors. Further studies are needed to clarify the interactions between AMD and DR, that may provide new pathways to target against their development. Disclosure W.Fickweiler: None. G.L.King: Research Support; Janssen Research &amp; Development, LLC. C.Jacoba: None. S.Jangolla: None. J.Gauthier: None. N.A.Ziemniak: None. I.Wu: None. J.D.Cavallerano: None. L.P.Aiello: Consultant; KalVista Pharmaceuticals, Inc., Novo Nordisk, MantraBio, Ceramedix, Research Support; Optos plc., Stock/Shareholder; KalVista Pharmaceuticals, Inc. J.Sun: Research Support; Adaptive Sensory Technology, Boehringer Ingelheim Inc., Roche Pharmaceuticals, Janssen Pharmaceuticals, Inc., Physical Sciences, Inc, Novo Nordisk, Optovue, Incorporated. Funding American Diabetes Association (7-21-PDF-022 to W.F.); National Eye Institute (R01EYE26080-01); National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK09433301); JDRF (17-2013-310); Dianne Nunnally Hoppes Fund; Beatson Pledge Fund

Addition of fenofibrate to statins is associated with risk reduction of diabetic retinopathy progression in patients with type 2 diabetes and metabolic syndrome: A propensity-matched cohort study

AimThis study aimed to determine the association between fenofibrate added to statin therapy and diabetic retinopathy progression. MethodsIn this propensity-matched study using the Korean National Health Insurance Service cohort (2002–2019), patients with type 2 diabetes and metabolic syndrome (≥ 30 years) receiving statin therapy were matched 1:2 by propensity score into the statin plus fenofibrate group (n = 22,395) and statin-only group (n = 43,191). The primary outcome was a composite of diabetic retinopathy progression including vitreous hemorrhage, vitrectomy, laser photocoagulation, intravitreous injection therapy and retinal detachment. ResultsThe median (quartiles) follow-up duration was 44.0 (27.6–70.6) months. For the primary outcome, the incidence rate per 1,000 person-years was 9.66 in the statin-only group and 8.68 in the statin-plus-fenofibrate group. The risk of the primary outcome was significantly lower (hazard ratio [HR]=0.88; 95% confidence interval [0.81;0.96] P = 0.005) in the statin-plus-fenofibrate group than in the statin-only group. Only patients with pre-existing retinopathy showed benefits from fenofibrate treatment (HR=0.83 [0.73;0.95] P = 0.006). In addition, the statin plus fenofibrate group exhibited significantly lower risks of vitreous hemorrhage (HR= 0.86 [0.75;0.995] P = 0.042), laser photocoagulation (HR=0.86 [0.77;0.96] P = 0.009) and intravitreous injection therapy (HR=0.73 [0.59;0.90] P = 0.003) than those in the statin-only group. There was no significant interaction between the different characteristics at baseline and the treatment effect. ConclusionThe addition of fenofibrate to statins was associated with significantly lower risk of diabetic retinopathy progression than statin therapy alone in patients with type 2 diabetes and metabolic syndrome.

Association of MMP-2 genes variants with diabetic retinopathy in Tunisian population with type 2 diabetes

AimsFew studies investigated the association of genetic difference in metalloproteinase-2 (MMP-2) gene with diabetic retinopathy but with mixed outcome. To investigate the association between a set of MMP-2 genetic variants and the risk of diabetic retinopathy in an Arab Tunisian population with type 2 diabetes. Subjects and methodsA retrospective case-control study comprising a total of 779 type 2 diabetes patients with or without diabetic retinopathy was conducted. Genotyping was prepared by TaqMan® SNP genotyping qRT-PCR. The variants used were rs243865 (C/T), rs243864 (T/G), rs243866 (G/T) and rs2285053 (C/T). ResultsThe minor allele frequency (MAF) of the rs243864 MMP-2 variant was significantly higher among diabetic retinopathy patients. Setting homozygous wild type genotype carrier as reference, the rs243864T/G allele was associated with increased risk of diabetic retinopathy under the dominant, recessive, and additive models which persisted when key covariates were controlled for, while a reduced risk of diabetic retinopathy progression was seen after adjustment between non-proliferative and proliferative diabetic patients. Furthermore, the heterozygous genotype GT of the rs243866 variant is positively associated with the risk of proliferative diabetic retinopathy in the additive model. A limited linkage disequilibrium (LD) was revealed between the four-matrix metalloproteinase-2 variants. Four-loci haplotype analysis identified, GCTC, TTTC, and GCTT haplotypes to be positively associated with the risk of diabetic retinopathy. ConclusionOur findings demonstrate that the MMP-2 variant rs243864 and 243866 are related to the susceptibility to diabetic retinopathy and the progression of the disease in an Arab Tunisian population with type 2 diabetes.

Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study.

The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study reported a 13.9% prevalence of diabetic retinopathy (DR) in youth with mean ± SD type 2 diabetes duration of 4.9 ± 1.5 years. After 7 years of additional follow-up, we report the risk factors for progression of DR in the TODAY cohort. Retinal photographs (n = 517) were obtained in 2010-2011 and again in 2017-2018 (n = 420) with standard stereoscopic seven-field digital fundus photography. Photographs were graded centrally using the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. A total of 367 patients with gradable fundus photographs in at least one eye at both assessments were included in analyses of progression of DR, defined as an increase of three or more steps on the ETDRS scale. With mean ± SD age of 25.4 ± 2.5 years and diabetes duration of 12.0 ± 1.5 years, there was a 49% prevalence of any DR among participants. Prevalence by DR stage was as follows: 39% for very mild or mild nonproliferative DR (NPDR), 6% moderate to severe NPDR, and 3.8% proliferative DR. Compared with nonprogressors, participants who progressed three or more steps had significantly lower BMI, higher HbA1c, higher blood pressure, increased triglycerides, decreased C-peptide, and higher prevalence of other comorbidities. Multivariate analysis demonstrated that HbA1c was the dominant factor impacting DR progression. Poor glycemic control of youth-onset type 2 diabetes imparts a high risk for progression of DR, including advanced, sight-threatening disease by young adulthood.

The Role of Ultra-Widefield Fundus Imaging and Fluorescein Angiography in Diagnosis and Treatment of Diabetic Retinopathy.

Early detection and treatment are important for preventing vision loss from diabetic retinopathy. Historically, the gold standard for grading diabetic retinopathy has been based on 7-field 30-degree color fundus photographs that capture roughly the central third of the retina. Our aim was to review recent literature on the role of ultra-widefield (allowing capture of up to 82% of the retina in one frame) fundus imaging in screening, prognostication, and treatment of diabetic retinopathy. Ultra-widefield fundus imaging can capture peripheral retinal lesions outside the traditional 7-field photographs that may correlate with increased risk of diabetic retinopathy progression. The speed and ability to image through undilated pupils make ultra-widefield imaging attractive for tele-ophthalmology screening. Ultra-widefield fluorescein angiography may help guide targeted laser treatment in eyes with proliferative diabetic retinopathy. Ultra-widefield imaging has potential to help shape new diabetic retinopathy screening, staging, and treatment protocols.

Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study

ObjectiveTo examine the association of physical activities (PA) with diabetic retinopathy (DR) progression based on a 10-year follow-up of a large cohort of working-aged diabetic populations in Australia.MethodsNine thousand and eighteen working-aged diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5–14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through the Medicare Benefits Schedule, which was available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence.ResultsIn the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend = 0.002; medium vs. low, hazard ratio (HR) = 0.78, 95% Confidence Interval (CI): 0.61–0.98; high vs. low, HR = 0.61, 95%CI: 0.36–0.84. In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC.ConclusionsHigher PA level was independently associated with a lower risk of DR progression among working-aged diabetic populations in this large cohort study.

Five-Year Patterns of Diabetic Retinopathy Progression in US Clinical Practice.

PurposeTo characterize the natural course of diabetic retinopathy (DR) in contemporary clinical practice.Patients and MethodsThis was a retrospective analysis of US claims data collected between January 1, 2006, and April 30, 2017. Patients aged ≥18 years with continuous medical and prescription insurance coverage for 18 months before DR diagnosis (index date) and for a follow-up period of 5 years were included (N=14,490). The time and risk of progressing to severe nonproliferative DR (NPDR) or proliferative DR (PDR) and of developing diabetic macular edema (DME) were evaluated over 5 years in patients stratified by DR severity at initial diagnosis.ResultsThe estimated probability of progressing to severe NPDR or PDR within 5 years of diagnosis was 17.6% for patients with moderate NPDR versus 5.8% for mild NPDR. The probability of developing DME within 5 years was 62.6%, 44.6%, and 28.4% for patients diagnosed with severe NPDR, moderate NPDR, and PDR, respectively, versus 15.6% for mild NPDR. Among those observed to progress, median time to severe NPDR or PDR was approximately 2.0 years in patients with moderate NPDR, whereas median time to DME was approximately 0.5 years in patients with severe NPDR, 1.3 years in moderate NPDR, and 1.6 years in PDR. Relative to mild NPDR, adjusted hazard ratios (95% confidence interval) for progression to severe NPDR or PDR within 5 years were 3.12 (2.61–3.72) in patients with moderate NPDR, and for incident DME were 5.92 (5.13–6.82), 3.54 (3.22–3.91), and 1.96 (1.80–2.14) in patients with severe NPDR, moderate NPDR, and PDR, respectively.ConclusionThe risk of DR progression and DME over 5 years was highest among patients diagnosed with moderate and severe NPDR, respectively. Our findings reinforce the importance of close monitoring for these patients to avoid unobserved disease progression toward PDR and/or DME.

Decreased Ratio of VEGF165b/VEGF in Aqueous Humor Predicts Progression of Diabetic Retinopathy

Background: Different splicing of vascular endothelial growth factor (VEGF) gene results in 2 families of VEGF, the proangiogenic isoforms (VEGF_xxxa) and the antiangiogenic isoforms (VEGF_xxxb). VEGF₁₆₅b is the major antiangiogenic isoform of VEGF and the most studied member of the VEGF_xxxb family so far. Objectives: To determine the concentration of VEGF₁₆₅b and VEGF in the aqueous humor (AH) in diabetic eyes with or without diabetic retinopathy (DR) and to address the predictive value of VEGF₁₆₅b/VEGF ratio for progression of DR. Methods: AH samples from 20 eyes in healthy controls (CON group), 40 eyes in diabetic patients without DR (nDR group), and 30 eyes in diabetic patients with mild nonproliferative DR (DR group) were collected. All of the patients were followed up for at least 5 years. VEGF₁₆₅b and VEGF levels of AH samples were measured by enzyme-linked immunosorbent assay (ELISA). The predictive value of the initial VEGF₁₆₅b/VEGF ratio for progression of DR was studied. Results: The mean concentration of VEGF₁₆₅b significantly decreased in diabetic eyes vs. controls. The mean concentration of VEGF significantly increased in the DR group vs. the CON group. The VEGF₁₆₅b/VEGF ratio was significantly lower in diabetic patients compared to the CON group. The VEGF₁₆₅b/VEGF ratio was significantly lower in diabetic patients compared to the control group. The mean follow-up was 66.1months (range 60–71 months). The risk of DR progression was greater with a lower VEGF₁₆₅b/VEGF ratio. Conclusion: The VEGF₁₆₅b/VEGF ratio is lower in the AH of DR patients and the decreased ratio of VEGF₁₆₅b/VEGF predicts DR progression.

Effect of Physical Activity on Reducing the Risk of Diabetic Retinopathy Progression: 10-Year Prospective Findings from the 45 and Up Study

Background: The aim of this study is to examine the association of physical activities (PA) with DR progression based on 10 years follow-up on a large cohort of working-age diabetic patients in Australia. Methods: Nine thousand and eighteen working-age diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through Medicare Benefits Schedule, which is available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence. Findings: In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend=0·002; medium vs. low, HR=0·78, 95%CI: 0·61-0·98; high vs. low, HR=0·61, 95%CI: 0·36-0·84). In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC. Interpretation: Higher PA level was independently associated with a lower risk of DR progression in working-age diabetic patients. Funding: Professor Mingguang He receives support from the University of Melbourne at Research Accelerator Program and the CERA Foundation. The Centre for Eye Research Australia (CERA) receives Operational Infrastructure Support from the Victorian State Government. The specific project is funded by Australia China Research Accelerator Program at CERA. Professor Mingguang He is also supported by the Fundamental Research Funds of the State Key Laboratory in Ophthalmology, National Natural Science Foundation of China (81420108008). The sponsor or funding organization had no role in the design or conduct of this research. Declaration of Interest: The authors have no financial or other conflicts of interest concerning this study. Ethical Approval: Ethics approval of the 45 and Up Study was obtained from the University of NSW Human Research Ethics Committee. Approval to use data from the 45 and Up Study for the current study was received from the Center for Eye Research Australia Ethics Committee.

Dipeptidyl peptidase‐4 inhibitors and risk of diabetic retinopathy progression in patients with type 2 diabetes: a population‐based cohort study

Dipeptidyl peptidase‐4 inhibitors and risk of diabetic retinopathy progression in patients with type 2 diabetes: a population‐based cohort study

Dynamic Responses in Retinal Vessel Caliber With Flicker Light Stimulation and Risk of Diabetic Retinopathy and Its Progression.

This study investigated the associations between the responses of retinal vessels to flickering light and the incidence and progression of diabetic retinopathy (DR). A prospective cohort study of adult subjects with diabetes mellitus. The dynamic vessel analyser (DVA) was used to measure retinal vascular dilatation in response to diffuse illuminance flicker. Diabetic retinopathy was graded from retinal photography at baseline and at 1 year. Incident DR and two-step change in DR were analyzed. There were 276 subjects in total, with a mean age of 59.8 ± 8.9 years. The majority were male (73%) and the mean glycated hemoglobin A1c (HbA1c) level and mean duration of diabetes were 7.7 ± 1.4% and 14.0 ± 10.5 years, respectively. After adjustments for age, sex, smoking, duration of diabetes, HbA1c, hypertension, and hyperlipidemia, the responses of retinal arterioles to flicker stimulation were lower in subjects with incident DR (P = 0.048). Subjects with greater arteriolar dilatory responses were less likely to have DR progression (odds ratio [OR] 1.85, [95% confidence interval [CI] 1.33-2.56], P = 0.012, per SD decrease). Subjects with greater venular dilatory responses were also less likely to have DR progression (OR 1.89, [95% CI 1.35-2.63], P = 0.003, per SD decrease). There were no significant associations between arteriolar or venular dilation response and incident proliferative DR (PDR) and DR regression. Reduced retinal arteriolar and venular dilatory responses to flickering light are associated with risk of DR progression at 1 year in adult patients with diabetes.

Application of Lignin Sorbents for Correction of Carbohydrate-Lipid Profile of Diabetic Patient's Blood Serum

Novel cost-effective sorbents based on hydrolytic lignin of cotton husk have been synthesized by two-step process including condensation of lignin with epichlorhydrin oligomer and subsequent amination of formed chloroderivative with polyamines. The results show the efficiency of lignin sorbents for the removal of water and lipid soluble toxic metabolites from blood serum of diabetic retinopathy patients. Due to high sorption activity of synthesized sorbents in relation to glucose and lipids, including triglycerides, cholesterol and its most atherogenic fractions (LDL-C, VLDL-C) their concentration reduced from pathological levels to physiological norm or the levels of optimum compensated diabetes. Considerable hypolipidemic and hypoglycemic effects of synthesized sorbents in comparison with enterosorbent Polyphepan have potential for prevention and treatment of diabetes. Sorption correction of pathological process decrease risk of diabetic retinopathy progression and can delay irreversible vision loss among working-age adults.

Diabetic retinopathy in pregnancy: a review.

The prevalence of diabetes in pregnancy is increasing. Pre-existing diabetes is present in 1 in 167 pregnancies in Australia, divided equally between type 1 and type 2 diabetes. Diabetic retinopathy is a leading cause of blindness in women during their childbearing years, and pregnancy increases the short-term risk of diabetic retinopathy progression. We examine the risk factors for progression of diabetic retinopathy during pregnancy including duration of diabetes, baseline level of retinopathy, level of glycaemic control and hypertension. We also examine current screening and management guidelines and their levels of evidence, current treatment options for diabetic retinopathy and avenues for further research.

Individualised risk assessment for diabetic retinopathy and optimisation of screening intervals: a scientific approach to reducing healthcare costs

ObjectiveTo validate a mathematical algorithm that calculates risk of diabetic retinopathy progression in a diabetic population with UK staging (R0–3; M1) of diabetic retinopathy. To establish the utility of the...

Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years

To determine whether peripheral diabetic retinopathy (DR) lesions identified on ultrawide field (UWF) imaging are associated with increased DR progression. Prospective, longitudinal cohort. Two hundred eyes of 100 participants previously enrolled in a comparative instrument validation study. Baseline mydriatic 7-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and UWF images were obtained. On UWF images, DR lesions with a greater extent outside versus inside standard ETDRS fields were defined as predominantly peripheral lesions (PPLs). Follow-up ETDRS photographs were obtained 4.2±0.3 years after baseline. Baseline and follow-up DR severity were graded from ETDRS photographs. Rates of 2-step or more progression and progression to proliferative DR (PDR) in eyes with PPLs compared with eyes without PPLs identified on UWF imaging at baseline. In eyes without PDR (n = 109) at baseline, 56 (51%) had at least 1 field with PPLs and 43 (39%) had DR progression. Compared with eyes without PPLs, eyes with PPLs had a 3.2-fold increased risk of 2-step or more DR progression (6 [11%] vs. 19 [34%]; P = 0.005) and a 4.7-fold increased risk for progression to PDR (3 [6%] vs. 14 [25%]; P = 0.005). These findings remained statistically significant after adjusting for gender, diabetes type, diabetes duration, hemoglobin A1c (HbA1c) levels, and baseline DR severity. Increasing extent of fields with PPLs increased the risk for 2-step or more DR progression (P = 0.004) and progression to PDR (P = 0.009). Presence and increasing extent of PPLs were associated with increased risk of DR progression over 4 years, independent of baseline DR severity and HbA1c levels. Increasing extent of PPLs substantially increased the risk of DR progression and progression to PDR, especially with less severe DR at baseline. These findings demonstrate that detailed peripheral retinal evaluation provides important information that is necessary to assess completely the risk of DR progression.