Severe Non-proliferative Retinopathy Research Articles

Blood Cadmium Affects the Association between Serum 25-Hydroxyvitamin D3 and Diabetic Retinopathy Severity in the U.S. Population with Type 2 Diabetes.

Serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations have been associated with diabetic retinopathy (DR) severity. Blood cadmium has also been reported to be associated with the presence of DR. Besides, cadmium can decrease the formation of calcitriol (active vitamin D) in blood. However, the effect of blood cadmium on the association between 25(OH)D3 and DR severity has not been studied comprehensively. Therefore, we designed this cross-sectional study to assess the effect modification of blood cadmium on the association between 25(OH)D3 and DR severity in the U.S. population with type 2 diabetes (T2D). This study was conducted using NHANES from 2005 to 2008. By having stratified participants based on blood cadmium category (low blood cadmium<2.76 nmol/L; high blood cadmium≥2.76 nmol/L), we evaluated the difference (interaction test) between the relationship of 25(OH)D3 with the severity of DR among low blood cadmium and high blood cadmium participants using multivariable logistic regression. In this cross-sectional study, a total of 283 participants were included. In the high blood cadmium group, the odds ratio for severe non-proliferative retinopathy (NPDR)/proliferative retinopathy (PDR) of high 25(OH)D3 (≥50 nmol/L) group was 0.26 (95% CIs: 0.09-0.69, p=0.01) compared with the reference group (low 25(OH)D3 group). Furthermore, there was evidence of interaction between 25(OH)D3 and blood cadmium on decreasing the incidence of severe NPDR/PDR. Our study indicated that blood cadmium might affect the association of 25(OH)D3 with DR severity in participants with T2D. More randomized controlled trials are needed to provide more evidence of such a finding.

A broad study of machine learning and deep learning techniques for diabetic retinopathy based on feature extraction, detection and classification

Diabetic Retinopathy (DR) is a micro vasculardisorder that affects the eyes and is a long term effectofDiabetesmellitus. The likelihood to develop diabetic retinopathy is directly proportional to the age and duration of the diabetes, as well as increase in the level of blood glucose level and fluctuation in blood pressure levels. A person who has diabetes has more probability to develop diabetic retinopathy. The ration of people with diabetes started to increase from 285 million in 2010 and will reach up to 439 million in the year of 2030.Out of the total number of people with Diabetic Retinopathy, approximately one-fourth of the people have vision-threatening disease. Earlier detection and classificationof Diabetic Retinopathy has to be taken much care in order to sustain a patient’s vision. The diabetic Retinopathy may be classified into various stages like Mild non-proliferative retinopathy, Moderate nonproliferative retinopathy, severe nonproliferative Retinopathy and Proliferative diabetic retinopathy. Theproblem associated with the manual detection of diabetic retinopathy is that the processing time is high, effortconsumingandrequiresanophthalmologist to examine the eye retinal fund us images. The manual analysis includes Visual Acuity testing, Tonometry and Pupil dilation. The vision lost due to Diabetic retinopathy is sometimes irreparable. Hence there is a need for earlier detection and treatment to reduce the risk of blindness.Hence there are various automated methods of diabetic retinopathy screening that have made good progress using image classification, pattern recognition, and machine learning. The input to the automated image classification model can be the color fundus photography or optical Coherence tomography images.

Proliferative diabetic retinopathy as the initial presenting feature of type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is an autoimmune disorder caused by the destruction of the pancreatic beta cells, which produce insulin. Individuals with T1DM usually require at least 3-5 years to develop microvascular complications in comparison to people with type 2 diabetes (T2DM), who may develop complications even before the diagnosis of diabetes. We discuss a patient who presented with proliferative diabetic retinopathy subsequently diagnosed with T1DM and diabetic neuropathy following investigations. Diabetic retinopathy or other microvascular complications as the presenting feature of T1DM is rarely known or reported in the literature. A 33-year-old healthcare worker had been seen by the opticians due to 1-week history of blurred vision. The ophthalmology assessment had confirmed proliferative retinopathy in the right eye and severe non-proliferative retinopathy in the left eye with bilateral clinically significant macular oedema. His BMI was 24.9 kg/m2. The nervous system examination revealed bilateral stocking type peripheral neuropathy. The random venous glucose was 24.9 mmol/L. Plasma ketones were 0.7 mmol/L and HbA1c was 137 mmol/mol. On further evaluation, the anti-glutamic acid decarboxylase (GAD) antibody was positive, confirming the diagnosis of T1DM. He was started on aflibercept injections in both eyes, followed by panretinal photocoagulation. Subsequent nerve conduction studies confirmed the presence of symmetrical polyneuropathy. The pathogenesis of the development of microvascular complications in T1DM is multifactorial. Usually, the development of complications is seen at least a few years following the diagnosis. The occurrence of microvascular complications at presentation is rare. This makes the management challenging and extremely important in preventing the progression of the disease. The pathogenesis of the development of microvascular complications in type 1 diabetes mellitus is multifactorial. The development of complications is seen at least a few years following the diagnosis. Occurrence of microvascular complications at presentation is rare. This makes the management challenging and extremely important to prevent the progression of the disease.

Antioquia, no more blind due to Diabetes. 25 years in blindness prevention

25 years ago, we started in Antioquia the campaign “No more blind from diabetes”. This campaign was possible due to the collaboration of the Hospital San Vicente Fundación, Antioquia University, the Ophthalmology programs of Pontificia Bolivariana University and CES University. This campaign is held annually around November 14. In 2022 we commemorated version No. 25. Results: We have evaluated approximately 15,000 patients to the present time, an average of 600 per year. Among all these patients 50% attend for the first time each year, 70% are females and 80% are type 2 diabetics. We found a prevalence of diabetic retinopathy (DR) of 15.5% and 64% of these patients are females. These patients have been diagnosed with diabetes for about 12 years and they have shown poor metabolic control of their diabetes with an average glycosylated Hemoglobin A1C (HbA1C) of 11.2% (normal range below 5.7%). The stage of the retinopathy showed that 70% of the patients had the non-proliferative form. We found that 1 out of 3 patients presented with severe visual loss due to severe non-proliferative retinopathy and macular edema. The main etiology of chronic vision loss in diabetic patients is diabetic macular edema found in 22% of the patients and the majority were females with type 2 diabetes over 60 years of age with an average HbA1C of 10%. Conclusions: This is the largest screening and ongoing test for DR done in Colombia, South America. This study focuses on the most vulnerable population and the results provide relevant information about the epidemiology of this disease. The results generate awareness about early diagnosis, medical care of its complications, education of the population, and the proper guidance for their treatment and rehabilitation.

Electro-physiological Changes in the Central Nervous System by Visual Evoked Potential in Diabetic Patients.

Increasing sedentary lifestyle in today's world has increased the prevalence of Diabetes Mellitus. Loss of vision due to diabetic retinopathy is a major public health burden. Visual evoked potential identifies the neuronal degenerative changes in chronic metabolic disorders specially Diabetes Mellitus. The study aimed at evaluating changes in visual evoked potential waves in diabetic patients. This is a cross sectional comparative study consisting of 90 participants, out of which 60 were diabetic patients and 30 were non-diabetic control group. Among diabetic patients, 30 were without retinopathy, 10 with mild non-proliferative retinopathy, 10 with moderate non-proliferative retinopathy and 10 with severe non-proliferative retinopathy. Visually evoked potential latencies and amplitudes were compared among diabetic patients and the control group and also among individuals with different grades of retinopathy. Delay in P100 latency and decrease in its amplitude were statistically significant in diabetic patients. The changes in P100 latency, P100 amplitude and N75 latency were also significant in different grades of retinopathy. There are statistically significant changes in visually evoked potential in diabetes patients. Visual evoked potential is a useful, non-invasive investigation which can establish the central nervous system neuropathy in diabetes at an early stage of the disease. So Diabetic retinopathy can be prevented due to early detection of neuropathy by visual evoked potential test Keywords: Diabetes mellitus; diabetic retinopathy; visual evoked potential.

Prevalence of Diabetic Retinopathy in the US in 2021

Diabetic retinopathy (DR) is a common microvascular complication of diabetes and a leading cause of blindness among working-age adults in the US. To update estimates of DR and vision-threatening diabetic retinopathy (VTDR) prevalence by demographic factors and US county and state. The study team included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). The study team used population estimates from the US Census Bureau. The study team included relevant data from the US Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System. Using bayesian meta-regression methods, the study team estimated the prevalence of DR and VTDR stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county and state. The study team defined individuals with diabetes as those who had a hemoglobin A1c level at 6.5% or more, took insulin, or reported ever having been told by a physician or health care professional that they have diabetes. The study team defined DR as any retinopathy in the presence of diabetes, including nonproliferative retinopathy (mild, moderate, or severe), proliferative retinopathy, or macular edema. The study team defined VTDR as having, in the presence of diabetes, severe nonproliferative retinopathy, proliferative retinopathy, panretinal photocoagulation scars, or macular edema. This study used data from nationally representative and local population-based studies that represent the populations in which they were conducted. For 2021, the study team estimated 9.60 million people (95% uncertainty interval [UI], 7.90-11.55) living with DR, corresponding to a prevalence rate of 26.43% (95% UI, 21.95-31.60) among people with diabetes. The study team estimated 1.84 million people (95% UI, 1.41-2.40) living with VTDR, corresponding to a prevalence rate of 5.06% (95% UI, 3.90-6.57) among people with diabetes. Prevalence of DR and VTDR varied by demographic characteristics and geography. US prevalence of diabetes-related eye disease remains high. These updated estimates on the burden and geographic distribution of diabetes-related eye disease can be used to inform the allocation of public health resources and interventions to communities and populations at highest risk.

Prevalence and risk factors of diabetic retinopathy among Chinese adults with type 2 diabetes in a suburb of Shanghai, China.

BackgroundTo investigate the prevalence and risk factors of diabetic retinopathy (DR) in a Chinese population with type 2 diabetes mellitus (T2DM) in a suburb (Qingpu) of Shanghai, China.MethodsA population-based cross-sectional study. A total of 7462 residents with T2DM in Qingpu were enrolled according to the resident health archives from January 2020 to December 2020. Blood and urine samples of the subjects were collected. Disc- and macula-centred retinal images were taken to assess DR. SPSS was used to analyse and investigate the prevalence and risk factors of DR.ResultsThe fundus images of 6380 (85.5%) subjects were of sufficiently good quality for grading. The average (range) age of 6380 subjects was 63.46±7.77 (28–92) years. Six hundred forty-four subjects were diagnosed with DR. The prevalence of DR was 10.1% (95% CI 9.4%-10.8%), with mild, moderate, and severe non-proliferative retinopathy and proliferative retinopathy being 2.1%, 6.3%, 1.3% and 0.4%, respectively. The prevalence of bilateral DR was 6.5%. Higher T2DM duration (OR, 1.057), fasting plasma glucose (OR, 1.063), glycated hemoglobinA1c (OR, 1.269), urea nitrogen (OR, 1.059), and urinary albumin (OR, 1.001) were associated with the higher DR prevalence.ConclusionThe prevalence of DR among Chinese adults with T2DM in Qingpu was 10.1%, in which non-proliferative DR was more common. Higher fasting plasma glucose and glycated hemoglobinA1c are well-known risk factors of DR, consistent with the findings in our study. Our study didn’t find the risk between lipid indicators and DR. However, several renal function indicators, like higher urea nitrogen and urinary albumin, were risk factors for DR in this study. Appropriate diagnosis and intervention should be taken in time to prevent and control DR development.

Management of Patients with Newly Diagnosed Diabetic Mellitus: Ophthalmologic Outcomes in Intensive versus Conventional Glycemic Control.

Background and ObjectiveDiabetic retinopathy, a microvascular complication of diabetes mellitus, is one of the most important causes of visual loss in developed countries. Our objective is to evaluate the efficacy of intensive versus conventional glycemic control of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in terms of ophthalmologic outcome, pathogenesis of the early worsening of diabetic retinopathy, risk factors for early worsening and diabetic retinopathy progression.MethodsA literature search on publications concerning glycaemic control in diabetic retinopathy and management of newly diagnosed diabetes mellitus by intensive versus conventional glycaemic control.ResultsA total of 22 articles were reviewed after curation by the authors for relevance. Nineteen articles are randomized control trial, 2 articles are observational studies and 1 is clinical trial. Fifteen articles investigated the glycaemic control in T1DM-related diabetic retinopathy and 8 on T2DM-related diabetic retinopathy. The level of glycemia (in terms of HbA1c level) is significantly related to the diabetic retinopathy progression in both T1DM and T2DM. Intensive glycemic control was found to reduce the development of severe diabetic retinopathy, including severe non-proliferative diabetic retinopathy, neovascularization, clinically significant macular edema and loss of vision. Early worsening of diabetic retinopathy commonly occurs during the first year of intensive treatment, especially those initially present with proliferative or severe non-proliferative retinopathy. However, most patients with early worsening can recover and their long-term ophthalmologic outcomes are better when compared to conventional glycemic control.ConclusionThe current guideline on HbA1c level is considered sufficient for the minimization of diabetic retinopathy progression. More frequent monitoring for early worsening should be recommended for newly diagnosed diabetes cases already presenting with retinopathy.

A prospective evaluation of retinopathy in diabetes patients with coexisting hypothyroidism

Background: Diabetes is the cause of 2.6% of global blindness which occur due to diabetic retinopathy caused by long term accumulated damage of small blood vessels in the retina. Hypothyroidism is common endocrine disorders that coexist with diabetes mellitus. Concurrent hypothyroidism, treated with thyroxin, appears to have a sparing effect on the risk of developing retinopathy among patients with type 2 diabetes.Material and method: This is a prospective observational study conducted in the department of ophthalmology. During our study period we have enrolled 240 patients with diabetes mellitus based on selection criteria and evaluated for diabetic retinopathy and hypothyroidism. A standard diagnostic criterion was followed for diagnosis of diabetes mellitus and all patients were assessed by two senior ophthalmologists for detection of retinopathy. Classification of diabetic retinopathy was based on the early treatment of diabetic retinopathy study (ETDRS).Result: Diabetic retinopathy was present in 12(30%) patients in type 2 diabetes mellitus group and 18(45%) patients in type 2 DM plus hypothyroidism group. In DM plus hypothyroidism patients, Mild nonproliferative retinopathy present in 4 (22.22%) patients, Moderate nonproliferative retinopathy 8(44.44%) patients, severe nonproliferative retinopathy 1(5.5%) patients, Early proliferative retinopathy 4(22.22%) patients and High-risk proliferative retinopathy 1(5.5%) patients.Discussion and conclusion: From present study we can conclude that that prevalence of hypothyroidism was higher among type 2DM mellitus patients in comparison to general population without type 2 DM. Diabetic retinopathy was more common on type 2 DM plus hypothyroidism group then type 2 diabetes mellitus group. We have observed that Moderate nonproliferative retinopathy is more common in both group but early proliferative retinopathy is more common in type 2 DM plus hypothyroidism group then yrs type 2 diabetes mellitus group.

Progression of Diabetic Retinopathy and Predictors of Its Development and Progression During Pregnancy in Patients With Type 1 Diabetes: A Report of 499 Pregnancies.

Pregnancy has been associated with development and progression of diabetic retinopathy (DR), but incidence of DR remains unclear. We assessed DR progression rate and its predictors during pregnancies in patients with type 1 diabetes. We report the retrospective data from pregnancies in patients with type 1 diabetes followed in Lille, France (1997-2015). Eye examination was performed every 3 months or every month in case of severe nonproliferative retinopathy or progression. Progression was defined by DR degradation (≥1 stage of the Early Treatment Diabetic Retinopathy Study [ETDRS] classification); it included DR development and worsening in patients without and with prepregnancy DR, respectively. A total of 499 pregnancies in 375 patients were included; prepregnancy retinopathy was present in 30.3%. Progression, development, and worsening rates were 21.8%, 24.4% of those without retinopathy, and 15.9% of those with retinopathy, respectively. Development of sight-threatening retinopathy was rare. Progression mainly occurred in early or midpregnancy. Elevated prepregnancy HbA1c and duration of diabetes ≥10 years were predictors of DR progression. Among pregnancies with prepregnancy DR, continuous subcutaneous insulin infusion (CSII) tended to decrease the risk of DR progression. Among CSII-treated patients, those with prepregnancy DR had a significantly decreased risk of DR progression. Among the 270 pregnancies of women with any DR during pregnancy who returned for a postpartum ophthalmologic examination, the rate of progression was only 4.1% and the rate of regression was 9.3%. This study provides epidemiologic data on progression of retinopathy during pregnancy and will be useful for future guidelines for retinopathy screening.

Changing trends in the prevalence of diabetic retinopathy in type 1 diabetes mellitus from 1990 to 2018: A retrospective study in a Portuguese population

PurposeTo estimate the prevalence of diabetic retinopathy /(DR) in a Portuguese population with type 1 diabetes (T1DM). MethodsRetrospective review of all patients with T1DM, whose reference center was Centro Hospitalar de São João, a tertiary center in Portugal, who were diagnosed between 1990 and 2018. DR was classified based on fundus examination in medical records as (0) no evidence of retinopathy, (1) mild non-proliferative retinopathy (NPDR); (2) moderate to severe non-proliferative retinopathy (NPDR) and (3) proliferative retinopathy (PDR). Patients were classified according to the eye with a worse retinopathy stage. Follow-up was considered as time between the diagnosis of diabetes and the last funduscopic evaluation. Results233 patients met the inclusion and exclusion criteria. The prevalence of any DR at less than 5, 10, 15, 20 and more than 20-years of DM was 1.8%, 10.4%, 34.8%, 54.1% and 71.2% respectively. The overall prevalence of DR was 43.3% (n = 101). At the last observation, 43 patients (18.5%) had mild NPDR, 34 patients (14.6%) had moderate to severe NPDR and 24 patients (10.3%) had PDR. The longer the disease duration, the higher the number of patients with DR. ConclusionThe prevalence of DR in our cohort was 34.8% after 15 years of systemic disease and 54.1% after 20 years, which is lower than what has been reported in the literature. Further multicentric prospective studies, are needed to clarify changes in the epidemiology of DR in type 1 diabetics.

Association of urinary albumin excretion with central foveal thickness and intravitreal conbercept treatment frequency in patients with diabetic macular edema.

To investigate the effect of albuminuria on diabetic macular edema (DME) and the possible association between baseline urinary albumin excretion (UAE) and intravitreal conbercept (IVC) treatment frequency in DME patients. In this hospital-based retrospective study, a total of 350 in-patients with type 2 diabetes mellitus were recruited and their clinical records were reviewed. Thereafter, 52 patients identified with severe non-proliferative diabetic retinopathy (NPDR) combined with albuminuria were divided into the microalbuminuria (UAE 30-300 mg/24h) and macroalbuminuria (UAE>300 mg/24h) groups, which were compared and analyzed by both independent sample t-test and Chi-square test. Correlations between the systemic variables and the central foveal thickness (CFT) were evaluated using Spearman's correlation and linear regression analyses. Of the 52 patients with center-involved DME, 43 received an initial combined injection of conbercept (0.5 mg/0.05 mL) and triamcinolone acetonide (1 mg/0.05 mL), followed by an IVC injection, as needed. The relationship between baseline UAE and number of IVC injections during the first year of treatment was analyzed using Spearman's partial correlation. Of 350 patients, a higher incidence of DME was observed in severe non-proliferative retinopathy (NPDR) patients than that observed in other groups. By dividing the 52 patients with severe NPDR into the micro- and macro-albuminuria subgroups, significant differences in CFT, systolic blood pressure, total cholesterol and serum creatinine levels, and UAE were revealed. Furthermore, a positive liner correlation between the UAE and CFT was found. Finally, the partial correlation coefficient adjusted for either the CFT or UAE indicated that both parameters directly correlated with the number of IVC injections administered during the 12mo of follow-up. Generally, macular edema occurred in patients with severe NPDR, for whom the UAE is an independent risk predictor of DME. The baseline UAE and CFT predicted the treatment frequency of IVC injections administered in the first year for eyes with DME.

Glioma-associated radiation retinopathy treated successfully with aflibercept.

Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6 years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12 months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9 months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treat macular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.

Diabetes and Pregnancy

Diabetes and Pregnancy

Retinopathy among patients with diabetes in Ramallah Governorate: a clinic-based study

BackgroundIn 2010, diabetes mellitus was the fourth cause of death in West Bank, causing 9% of deaths. Few reliable data on diabetes complications exist. We aimed to estimate prevalence of diabetic retinopathy and determinants in a clinic-based sample in Ramallah Governorate, West Bank. MethodsThe study was done in 11 clinics (four United Nations Relief and Works Agency [UNRWA], five Ministry of Health, two joint Ministry of Health and non-governmental organizations). It was approved by ethics committee at Institute of Community and Public Health (Birzeit University), Ministry of Health, and UNRWA and oral witnessed consent was obtained from patients. Patients with type 2 diabetes older than 25 years were identified in clinics or from clinic databases and were invited to participate in a slit lamp eye exam by a licensed ophthalmologist. Questionnaire, physical examination, and lab tests (glycated haemoglobin [HbA1c], lipid profile) were done. We classified retinopathy using International Clinical Diabetic Retinopathy Disease Severity Scale. Data were collected between Feb 28, 2012, and June 7, 2012, and analysed using the statistical package for social sciences (SPSS) version 22. FindingsMost eligible patients (517) consented to participate and were referred for eye exam; 376 (73%) underwent eye exam (127 men and 249 women). Mean age was 57·8 years (SD 9·0) and mean duration of diabetes was 8·9 years (SD 7·0). Only 21% (77) of patients had controlled diabetes (HbA1c<7%) and 37% (138) had never had an eye exam. The prevalence of retinopathy was 37% (138 patients, 52 [41%] men and 86 [35%] women). 26% (98) had mild-to-moderate non-proliferative retinopathy, 3% (11) had severe non-proliferative retinopathy, and 8% (29) had proliferative retinopathy. Multivariate regression showed that HbA1c, diabetes duration, and systolic blood pressure were associated with retinopathy (p<0·001). Patients with uncontrolled diabetes (HbA1c >7%) were four times more likely to have retinopathy compared with patients with controlled disease (odds ratio [OR] 4·16, 95% CI 1·76–9·85). Patients with diabetes duration more than 7 years were eight times more likely to have retinopathy than were patients whose diabetes duration was 7 years or less (OR 7·7, 95% CI 4·30–13·79). There was a 2% increase in risk of retinopathy per 1 mm Hg increase in systolic blood pressure (OR 1·02, 95% CI 1·01–1·04). InterpretationA third of patients with diabetes had retinopathy. Early regular screening might help early diagnosis and control of diabetic retinopathy, especially among high-risk patients (ie, those with uncontrolled diabetes, high systolic blood pressure, and long diabetes duration). FundingSwedish International Development Agency (SIDA); Umeå Centre for Global Health Research, Umeå University, Sweden.

Glycated hemoglobin A1C and vitamin D and their association with diabetic retinopathy severity

Objectives:This retrospective, population-based, cross-sectional study evaluated the association between vitamin D deficiency and retinopathy severity in diabetic patients with poorly or well controlled glycaemia. Other potential risk factors for diabetic retinopathy severity were also assessed.Methods:The National Health and Nutrition Examination Survey (NHANES) 2005–2008 data were used for the study. Outcomes assessed included retinopathy severity, HbA1c levels, socioeconomic, behavioral, and biological factors. Univariate and multivariate regression analysis was used to evaluate association of different parameters with retinopathy severity. The interaction among HbA1c control, vitamin D deficiency, and retinopathy severity were also explored.Results:The population included 842 adults (52.8% women) with mean age of 61.2 years. Retinopathy was detected in 301 subjects (35.7%). Mild non-proliferative retinopathy (NPR) was present in 195 subjects (23.2%), severe non-proliferative and proliferative retinopathy in 106 subjects (12.6%). Multivariate ordinal regression analysis found being male (odds ratio (OR): 1.602, P=0.001), increased duration of diabetes (OR: 1.072, P=3.77E−7) and poorly controlled HbA1c (OR: 3.522, P=2.00E−5) were associated with greater retinopathy severity. The association between vitamin D deficiency and retinopathy severity only found in diabetic patients with well controlled glycaemia.Conclusions:The findings of this study indicate that vitamin D deficiency associated with severe diabetic retinopathy in patients with well controlled diabetes. The findings provide possible relationship for the previous conflict results, and highlight the need for controlling modifiable risk factors to reduce the development of sever diabetic retinopathy.

Screening for Diabetic Eye Disease among Samoan Adults: A Pilot Study.

IntroductionThe purpose of this study was to determine the prevalence of diabetic retinopathy in Samoa by piloting a retinal photography screening programme.MethodsWe performed a cross-sectional study of patients with diabetes who presented to the Tupua Tamasese Meaole eye clinic in Apia, Samoa, between May 2011 and September 2011. Study approval was granted by the National Health Service Board of Samoa, the Monash University Human Research Ethics Committee, and the study adhered to the Tenets of the Declaration of Helsinki. Following informed consent, data collection included patient demographics [age, area of residence (rural or urban)], type of diabetes, length of time since diagnosis, most recent random blood sugar and blood pressure levels. The subjects had three 45-degree retinal photographs taken in each eye with the Canon CR6-45NM camera. All gradable photographs were assessed for the presence of diabetic retinopathy or macular oedema using the International Clinical Diabetic Retinopathy Severity Scale and the International Clinical Diabetic Macular Oedema Severity scale, respectively.ResultsTwo hundred and fourteen eyes from 107 subjects were examined during the study period, all of whom had type 2 diabetes mellitus. Diabetic retinopathy was present in 53.3% (114/214) of eyes, with 14.5% having proliferative retinopathy and 7.5% with severe non-proliferative retinopathy. Also, 25.2% (54/214) had some evidence of macular oedema with 11.7% (25/214) requiring treatment. A statistically significant relationship existed between the length of time since diagnosis and the severity of both retinopathy (p < 0.001) and macular oedema (p = 0.031). Blood pressure more than 150/85 mmHg was associated with higher levels of diabetic retinopathy (p = 0.03) and macular oedema (p = 0.02).ConclusionA comprehensive diabetic retinopathy screening programme is much needed in Samoa given the high prevalence of diabetic eye disease.

Tele-ophthalmology for diabetic retinopathy screening: 8 years of experience

Purpose To describe the results of a diabetic retinopathy screening program implemented in a primary care area. Methods A retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. Results The number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. Conclusions Diabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years.

Teleoftalmología para el cribado de la retinopatía diabética: experiencia de 8 años

PurposeTo describe the results of a diabetic retinopathy screening program implemented in a primary care area. MethodsA retrospective study was conducted using data automatically collected since the program began on 1 January 2007 until 31 December 2015. ResultsThe number of screened diabetic patients has progressively increased, from 7,173 patients in 2007 to 42,339 diabetic patients in 2015. Furthermore, the ability of family doctors to correctly interpret retinographies has improved, with the proportion of retinal images classified as normal having increased from 55% in 2007 to 68% at the end of the study period. The proportion of non-evaluable retinographies decreased to 7% in 2015, having peaked at 15% during the program. This was partly due to a change in the screening program policy that allowed the use of tropicamide. The number of severe cases detected has declined, from 14% with severe non-proliferative and proliferativediabetic retinopathy in the initial phase of the program to 3% in 2015. ConclusionsDiabetic eye disease screening by tele-ophthalmology has shown to be a valuable method in a growing population of diabetics. It leads to a regular medical examination of patients, helps ease the workload of specialised care services and favours the early detection of treatable cases. However, the results of implementing a program of this type are not immediate, achieving only modest results in the early years of the project that have improved over subsequent years.

National guidelines for treatment of diabetic retinopathy : Second edition of the national guidelines for treatment of diabetic retinopathy

The updated German clinical practice guidelines (second edition) describe the consensus recommendations for prevention and treatment of retinal complications secondary to diabetes. According to the updated numbers on epidemiology a further increase of persons affected is expected. The prevalence of diabetic retinopathy is estimated to be 9-16 % in type 2 diabetes and 24-27 % in type 1 diabetes. A prolongation of the screening interval from 1 to 2 years is recommended for those patients with a lower risk of progression, when retinopathy has not already occurred and no increased systemic risk factors are present. Standardized documentation forms are the foundation for improved communication between the disciplines. If diabetic retinopathy is present, control examinations follow the stipulations of the ophthalmologist. The guidelines define scenarios when the use of optical coherence tomography (OCT) is necessary, e. g. diagnosis and follow-up of macular edema. Besides focal and panretinal laser therapy, the efficacy and risks of intravitreal operative pharmacotherapy are discussed. Focal laser coagulation is recommended for therapy of macular edema without foveal involvement and for macular edema with foveal involvement patients should be informed about the effective alternative forms of treatment. Panretinal laser coagulation is recommended for first line treatment of proliferative diabetic retinopathy and is optional for severe non-proliferative retinopathy.