Severe NPDR Research Articles

CANBERRA, A Phase 2 Randomized Clinical Trial to Test the Therapeutic Potential of Oral Vicasinabin in Diabetic Retinopathy

ObjectiveNon-proliferative diabetic retinopathy (NPDR) is a progressive disease that can lead to blindness. Current therapies for NPDR are invasive and not extensively used or accessible until the disease progresses, pointing to the need for an early non-invasive treatment.The objective of CANBERRA was to assess the safety, tolerability, and efficacy of oral administration of vicasinabin (RG7774) on the severity of diabetic retinopathy (DR) in participants with moderately severe to severe NPDR and good vision. DesignCANBERRA was a global, multicentric randomized, double-masked, parallel-group, placebo-controlled, phase 2 study. The study duration was 36 months. 139 treatment-naïve participants with type 1 or type 2 diabetes mellitus and Diabetic Retinopathy Severity Scale (DRSS) levels of 47 or 53 in at least one eye. Eligible participants were randomized 1:1:1 to 36 weeks of daily oral placebo, vicasinabin 30mg, or vicasinabin 200mg. Participants were followed for an additional 12 weeks. Main OutcomeThe primary safety objective was to evaluate the safety and tolerability of vicasinabin by the frequency and severity of adverse events. The primary efficacy objective was to assess the effect of vicasinabin on the severity of DR, assessing the proportion of participants with at least 2-steps improvement in DRSS from baseline at week 36 in the study eye. ResultsResults are presented in the following order: placebo, vicasinabin 30mg, vicasinabin 200mg. 47, 48, and 44 participants were enrolled. Baseline characteristics were balanced. Adherence to treatment was approximately 90%, and pharmacokinetic analysis showed dose-dependent plasma exposure to vicasinabin. The primary efficacy endpoint was not met: the percentage of participants who improved their DRSS by at least two steps at week 36 from baseline were 7.9, 9.5, and 5.7, without statistically significant differences. The systemic and ocular safety profiles of vicasinabin were favorable, and adverse events distributed evenly across arms. Vicasinabin did not induce changes in glycemic control or any kidney function or cardiovascular parameters. Three patients in the placebo arm discontinued the study due to serious adverse events ConclusionsAt the doses tested, vicasinabin did not improve DRSS in participants with NPDR. The role of the cannabinoid system in diabetic retinopathy remains elusive

Prevalence and Risk Factors of Diabetic Retinopathy among Type 2 Diabetic Patients in Tertiary Care Hospital of Gandaki Province of Nepal

Background Diabetic retinopathy (DR) is one of the commonest causes of blindness in Nepal. This study aimed to determine the prevalence and risk factors of diabetic retinopathy in type 2 diabetic patients in a tertiary care hospital of Gandaki Province of Nepal. Methods This was a hospital based cross-sectional study conducted among 162 patients of type 2 diabetes aged 30 years and above. Standard proforma was used to collect socio-demographic and clinical variables of the patients. Detailed eye examination including fundus evaluation under mydriasis was done on all patients and diabetic retinopathy was classified according to Early Treatment of Diabetic Retinopathy Study Classification. Results The mean ±SD of age of the study sample was 61.99 ±11.69 years. The prevalence of diabetic retinopathy was 41.98%. Among the patients with diabetic retinopathy, the prevalence of mild NPDR, moderate NPDR, severe NPDR, very severe NPDR and PDR were 51.47%, 25%, 11.76%, 1.47%, and 10.29% respectively. There was statistically significant association of diabetic retinopathy with duration of diabetes and chronic kidney disease. However, there was no statistically significant association of diabetic retinopathy with gender, family history, hypertension, history of smoking, history of alcohol, treatment history and physical activity. Conclusions There is high prevalence of diabetic retinopathy among the diabetic patients. Longer duration of diabetes and chronic kidney disease were the significant risk factors for diabetic retinopathy. Early diagnosis and treatment of diabetic retinopathy is essential to reduce blindness in diabetic patients.

Assessment of Baseline Ultrawidefield Fluorescein Angiographic Quantitative Leakage Parameters with Ultrawidefield Fundus Features and Clinical Parameters in Diabetic Retinopathy in Protocol AA

PurposeEvaluate quantitative leakage parameters on ultra-widefield fluorescein angiography (UWF-FA) images and explore their association with Diabetic Retinopathy Severity Scale (DRSS), predominantly peripheral lesions (PPLs), visual acuity, and clinical characteristics. DesignA post-hoc analysis of baseline UWF-FA images in the DRCR Retina Network observational study Protocol AA. ParticipantsN = 575 eyes from 384 adults across 38 sites in the US and Canada with gradable UWF-FA. MethodsA machine learning-enhanced feature extraction platform provided initial leakage segmentation of UWF-FA images sequentially reviewed and corrected by two certified readers for segmentation accuracy. UWF-FA leakage was measured in five retinal zones: panretinal (whole retina), central macular (3-disc diameter fovea-centered circle), posterior pole (6-disc diameter fovea-centered circle), peripheral (outside 6-disc diameter circle) and widefield far peripheral (outside 9-disc diameter circle); associations with clinical factors were evaluated with marginal beta regression models. Main Outcome MeasuresUWF-FA leakage index, calculated as the area with leakage divided by the analyzable retinal area. ResultsThe mean quantitative leakage index was 3.5% for panretinal, 6.6% for macular, 4.8% for posterior pole, 3.3% for peripheral and 2.8% for wide-field far peripheral retinal zones. Panretinal leakage was associated with DRSS (mean 2.2% for no to mild NPDR, 3.4% for moderate NPDR, 4.2% for moderately severe NPDR, 4.8% for severe NPDR and 5.1% for PDR; P<.001), HbA1c (3.2% for HbA1c <8% vs. 3.8% for HbA1c ≥8%; P=.01 for continuous HbA1c), visual acuity (3.3% for 20/25 or better vs. 4.7% for 20/32 or worse; continuous P<.001), and UWF-FA-PPL types of IRMA (4.3% vs. 3.3%; P=.005) or NVE (5.7% vs. 3.4%; P=.003). DRSS was also statistically significant for leakage within all retinal zones (P<.001); eyes with non-central DME versus no DME had higher mean leakage in the central macular (11.2% vs. 5.9%; P=0.005) and posterior pole regions (9.2% vs. 4.2%; P=.002). ConclusionQuantitative UWF-FA leakage analysis identified associations between leakage and DRSS, visual acuity, and presence of DME. In the future, quantitative UWF-FA leakage parameters may be explored as potential biomarkers for disease progression risk.

Comparison of 21 artificial intelligence algorithms in automated diabetic retinopathy screening using handheld fundus camera

Background Diabetic retinopathy (DR) is a common complication of diabetes and may lead to irreversible visual loss. Efficient screening and improved treatment of both diabetes and DR have amended visual prognosis for DR. The number of patients with diabetes is increasing and telemedicine, mobile handheld devices and automated solutions may alleviate the burden for healthcare. We compared the performance of 21 artificial intelligence (AI) algorithms for referable DR screening in datasets taken by handheld Optomed Aurora fundus camera in a real-world setting. Patients and methods Prospective study of 156 patients (312 eyes) attending DR screening and follow-up. Both papilla- and macula-centred 50° fundus images were taken from each eye. DR was graded by experienced ophthalmologists and 21 AI algorithms. Results Most eyes, 183 out of 312 (58.7%), had no DR and mild NPDR was noted in 21 (6.7%) of the eyes. Moderate NPDR was detected in 66 (21.2%) of the eyes, severe NPDR in 1 (0.3%), and PDR in 41 (13.1%) composing a group of 34.6% of eyes with referable DR. The AI algorithms achieved a mean agreement of 79.4% for referable DR, but the results varied from 49.4% to 92.3%. The mean sensitivity for referable DR was 77.5% (95% CI 69.1–85.8) and specificity 80.6% (95% CI 72.1–89.2). The rate for images ungradable by AI varied from 0% to 28.2% (mean 1.9%). Nineteen out of 21 (90.5%) AI algorithms resulted in grading for DR at least in 98% of the images. Conclusions Fundus images captured with Optomed Aurora were suitable for DR screening. The performance of the AI algorithms varied considerably emphasizing the need for external validation of screening algorithms in real-world settings before their clinical application.

Association of diabetic retinopathy on all-cause and cause-specific mortality in older adults with diabetes: National Health and Nutrition Examination Survey, 2005–2008

To evaluate the effect of diabetic retinopathy (DR) status or severity on all-cause and cause-specific mortality among diabetic older adults in the United States using the most recent National Health and Nutrition Examination Survey (NHANES) follow-up mortality data. The severity of DR was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading scale. Multiple covariate-adjusted Cox proportional hazards regression models, Fine and Gray competing risk regression models, and propensity score matching (PSM) methods were used to assess the risk of all-cause and cause-specific mortality in individuals with diabetes. All analyses adopted the weighted data and complex stratified design approach proposed by the NHANES guidelines. Time to death was calculated based on the time between baseline and date of death or December 31, 2019, whichever came first. Ultimately 1077 participants, representing 3,025,316 US non-hospitalized individuals with diabetes, were included in the final analysis. After a median follow-up of 12.24 years (IQR, 11.16–13.49), 379 participants were considered deceased from all-causes, with 43.90% suffering from DR, including mild DR (41.50%), moderate to severe DR (46.77%), and proliferative DR (PDR) (67.21%). DR was associated with increased all-cause, cardiovascular disease (CVD) and diabetes mellitus (DM)-specific mortality, which remained consistent after propensity score matching (PSM). Results of DR grading assessment suggested that the presence of mild, moderate to severe NPDR was significantly associated with increased risk of all-cause and CVD-specific mortality, while the presence and severity of any DR was associated with increased DM-specific mortality, with a positive trend. The presence of DR in elderly individuals with diabetes is significantly associated with the elevated all-cause and CVD mortality. The grading or severity of DR may reflect the severity of cardiovascular disease status and overall mortality risk in patients with diabetes.

Association of Inflammatory Markers and Diabetic Retinopathy

Abstract Introduction: Diabetic retinopathy is a micro-angiopathy, the pathogenesis of which is manifold. Chronic inflammation releasing various mediators has been proposed to cause micro-angiopathy in long-term diabetics. These markers can be easily measured in serum and may serve as a risk factor for progression as well as allow newer modalities of management aimed at this pathology. Aims and Methodology: The aim of the study was to determine the association between different inflammatory markers and diabetic retinopathy. A total of 100 eyes in diabetic patients, 20 each with no retinopathy, mild NPDR, moderate NPDR, severe NPDR, and PDR were included. The serum levels of C-reactive protein (CRP) and absolute neutrophil count were recorded and compared across each of these groups. Results: The mean ANC among these groups, respectively, was 5525, 5162, 5374, 5239, and 5313 (per microlitre), and neither were these raised significantly nor was the difference between groups statistically significant. Mean CRP levels were within normal limits in all groups (2.56, 2.87, 4.06, 5.15, 6.97 mg/dl), although there was a steady increase with each grade of retinopathy, and this was found statistically significant. Conclusion: There was no association between absolute neutrophil count and diabetic retinopathy. Serum CRP levels may guide progression of retinopathy and can be monitored to help management protocols.

Study on the association between total vitamin D levels and diabetic retinopathy in type 2 diabetic mellitus

This study aims to recognize the interrelation among total vitamin D levels and diabetic retinopathy in diabetic mellitus particular type 2 variant.That was a cross-sectional look on 276 patients with diabetes mellitus. Cases were grouped similarly into with and without DR.Screening tactics like unique records, best-corrected visual acuity, fundoscopic examination, and blood investigations like fasting blood sugar, post prandial blood sugar, HbA1C vitamin-D were carried out. Diabetic retinopathy is graded the use of ETDRS.The relation of the period of diabetes to the severity of retinopathy showed an advantageous correlation, with a p-value &amp;#60;0.001. It has confirmed an inverse relationship among the severity of diabetic retinopathy and Vitamin D values. Sufferers with mild NPDR and moderate NPDR had Vitamin D insufficiency, which decreased to Vitamin D deficiency stages in severe NPDR and PDR.A relation change is observed among diabetic retinopathy and total Vitamin D levels. Henceforth, it is important to examine the affiliation of Vitamin D with the extent of DR, its use to forecast of the severity of DR, and as a device to restrict or prevent the development of retinopathy modifications.

Sight threatening diabetic retinopathy in patients with macular telangiectasia type 2

PurposeAlthough diabetes is highly prevalent in patients with macular telangiectasia type 2 (MacTel), progression to severe non-proliferative (NPDR) and proliferative diabetic retinopathy (PDR) is rarely reported. We report multimodal imaging features of sight-threatening diabetic retinopathy (STDR) in eyes with MacTel.MethodsRetrospective case series of seven participants of the MacTel Study at the Moorfields Eye Hospital NHS Foundation Trust study site and one patient from the Institute of Retina and Vitreous of Londrina, Brazil. Sight threatening diabetic retinopathy was defined as severe NPDR, PDR or diabetic macular edema.ResultsWe report imaging features of 16 eyes of eight patients (7/8, 87.5% female) with diagnoses of MacTel and type 2 diabetes mellitus with STDR. Mean (SD) age was 56 (8.3) years. Patients were followed-up for a mean time of 9.1 (4.7) years. A total of 10/16 (62.5%) eyes showed PDR and 2/16 (12.5%) eyes presented a macular epiretinal neovascularization.ConclusionsPeople with diabetes mellitus and MacTel may not be protected from STDR as previously reported. Although the two diseases rarely co-exist, regular monitoring for diabetic retinopathy progression is recommended according to baseline retinopathy severity grades in line with established international guidelines. The presence of MacTel may not modify extended screening intervals, but there is no current evidence. The limited case series in the literature support treatment for complications and should follow the standard of care for either condition. Due to dual pathology, reactivation may be difficult to diagnose on standard imaging and multimodal imaging is recommended.

Investigating the Utility of Near-Infrared Reflectance Imaging for Diabetic Retinopathy Screening.

We investigated the reliability of near-infrared reflectance (NIR) imaging as a method of assessing severity of diabetic retinopathy (DR). One hundred ninety-five NIR images were reviewed by two graders for the number of hyporeflective foci, presence or absence of vascular abnormalities, and presumptive DR stage; these were correlated to fundus photography-defined DR stage. Interrater reliability was confirmed via one-way random effects model of intraclass correlation coefficients. Analysis of variance was used in subgroup analysis, receiver operating characteristic (ROC) curves were created to validate reliability of the model, and logistic regression was used to model foci and vascular abnormalities as predictors for moderate or worse disease. A statistically significant difference in mean number of hyporeflective foci was found between no DR and moderate non-proliferative DR (NPDR; P < 0.0001), no DR and severe NPDR (P < 0.001), no DR and proliferative DR (PDR; P < 0.0001), mild and moderate NPDR (P = 0.008), mild and severe NPDR (P < 0.001), and mild NPDR and PDR (P < 0.001). The area under the ROC curve was 0.849 (CI: 0.792 to 0.905). The threshold for detection of moderate NPDR or worse was 4.75 foci, with a sensitivity of 79.0% and a false positive rate of 20.0%. Multivariate logistic regression model incorporating hyporeflective foci with vascular abnormalities (odds ratio [OR] = 1.592, 95% CI: 1.381 to 1.835; P < 0.001) was able to accurately predict moderate disease or worse, just moderate disease (OR = 1.045, 95% CI: 1.003 to 1.089; P = 0.035), severe disease (OR = 1.050, 95% CI: 1.006 to 1.096; P = 0.027), and proliferative disease (OR = 1.050, 95% CI: 1.008 to 1.095; P = 0.018). NIR imaging may be an adjunct tool in screening for DR. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Quantitative evaluation of ocular vascularity and correlation analysis in patients with diabetic retinopathy by SMI and OCTA

AimsTo find potential relation between retrobulbar vessels and fundus microvessels and to detect sensitive and effective clinical indicators in predicting the progress of diabetic retinopathy (DR), ocular hemodynamics were measured using superb microvascular imaging (SMI) and ultrawide-field optical coherence tomography angiography (UWF-OCTA).MethodsObservational, cross-sectional study evaluating ocular hemodynamics in patients with DR by SMI (Aplio i900, Canon Medical) and UWF-OCTA (BM-400 K BMizar, Tupai Medical Technology). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA) were measured by SMI. UWF-OCTA evaluated the fundus vascular parameters. A correlation analysis was used to determine the correlation between SMI and UWF-OCTA parameters.ResultsOne hundred thirty-nine eyes of 139 diabetic patients were included: 29 without DR (NDR), 36 with mild to moderate nonproliferative DR (M-NPDR), 37 with severe NPDR (S-NPDR), and 37 with proliferative DR (PDR). PSV and EDV of retrobulbar vessels decreased from NDR to S-NPDR while increasing PDR. RI of OA showed a decreasing trend in the progression of DR, but other vessels didn’t show the same trend. ROC curve analysis showed that CRAPSV, CRAEDV, PCAEDV, OAPSV, and OAEDV had diagnostic value distinguishing M-NPDR and S-NPDR. The correlation analysis observed a significant association between the SMI parameters of CRA and PCA and UWF-OCTA parameters. CRA hemodynamics were more associated with fundus vascular parameters, especially the retina, in the NDR group than in the M-NPDR group. In contrast, PCA consistently correlated with fundus vascular parameters, especially in the choroid, from the NDR to the M-NPDR group. However, OA showed a poor correlation with OCTA parameters.ConclusionThe velocity of retrobulbar vessels, mainly the CRA, may serve as a valuable predictor for assessing the progress of DR. The use of SMI in diabetic patients may help identify patients at risk of developing retinopathy.

MicroRNA-150 (miR-150) as a Potential Biomarker for Diabetic Retinopathy

Diabetic retinopathy (DR) is a known chronic complication of diabetes mellitus and is one of the leading causes of visual impairment. The chronic inflammation associated with DR poses large risks not only for the vasculature but also for the surrounding neuronal tissue. Potential biomarkers, especially those surrounding microRNAs (miRNAs), have been proposed to indicate the progression of DR. Levels of certain miRNAs have been shown to be either down or upregulated in type 1 diabetes patients and have shown correlations with specific types of DR. MicroRNA-150 (miR-150) has also been shown to have protective effects on cells in hypoxic environments, but when downregulated, miR-150 actually induces apoptosis. And, it has been shown to be downregulated in patients with type 1 and type 2 diabetes as well as patients with obesity. We hypothesize then that the levels of miR-150 from a peripheral blood sample should be indicative of the progression of DR and may be used for potential early intervention. In this project, we assessed miR-150 levels in the peripheral blood mononuclear cells (MNCs) of individuals with different severities of DR by isolating mononuclear cells and extracting RNA. We then reverse-transcribed the RNA into cDNA and used RT-qPCR to measure the levels of miR-150 in individuals with varying DR severity. MiR-150 levels in the MNCS were decreased in individuals with diabetes with no retinopathy, moderate NPDR and severe NPDR groups when compared to control individuals; however, there was a marginal increase in the miR-150 mild NPDR group. The data could show evidence that a peripheral blood draw could be used as a less invasive approach to assessing the severity of diabetic retinopathy in patients. This would change the disease management and future treatments individually.

Optical coherence tomography characteristics and factors affecting visual acuity in diabetic papillopathy.

To analyse baseline imaging characteristics and factors affecting poor visual acuity in diabetic papillopathy. This was a retrospective, observational study conducted at a tertiary eye care centre in eyes with a diagnosis of diabetic papillopathy. Demographic data including age, gender, duration of diabetes, type of diabetes, HbA1c values and other systemic co-morbidities were recorded. Baseline best corrected visual acuity (BCVA), and various imaging characteristics were noted. 37 eyes of 22 patients with diagnosis of diabetic papillopathy were included [mean age of 46.6 ± 13.5 years, five (22.7%) females and 17 (77.3%) males]. Bilateral involvement was seen in 15 (68.2%) patients. The mean baseline BCVA was 0.51 ± 0.49 logMAR (Snellen equivalent 20/60). Two eyes (5.4%) had features of concurrent mild NPDR, 9 eyes (24.3%) had moderate NPDR, 10 eyes (27.03%) had severe NPDR while 16 (43.2%) other had PDR. All eyes had optic disc edema while 4 had disc pallor at presentation. Telangiectatic vessels/ neovascularisation of disc was present in 17 eyes (45.9%) detected either clinically or on optical coherence tomography (OCT) angiography. 11 (29.7%) eyes had a peripapillary cuff of subretinal fluid accompanying the disc edema. Sixteen eyes (43.2%) had centre involving macular edema seen on OCT. In eyes with a macular edema, the mean central macular thickness was 407.4 ± 71.42 microns at baseline. On assessing the baseline factors that contribute to the final visual acuity, presenting visual acuity was the only variable found to be statistically significant. Although described to have good visual outcome, eyes presenting with poor visual acuity tend to have worse vision on follow up. This may aid in prognosticating and guiding management plan.

Association between resistivity index of central retinal artery and severity of diabetic retinopathy.

Diabetic retinopathy (DR) is a leading cause of ocular morbidity. Its progression depends mainly on retinal vasculature and ocular blood flow. Color Doppler imaging (CDI) is a noninvasive imaging technique that measures blood flow velocity. The resistivity index (RI), calculated by the CDI, reflects the vascular resistance distal to the measuring location. RI is independent of the doppler angle and position of the patient, making it a reliable and reproducible parameter. To the best of our knowledge, there is only one study in literature studying the association between resistivity index (RI) of the central retinal artery (CRA) and severity of DR. To determine the association between RI of CRA and severity of DR. To determine the association between RI of CRA and spectral-domain optical coherence tomography (SD-OCT) biomarkers for DR. Type II diabetics visiting our OPD underwent DR screening and were graded into three categories according to ETDRS classification which include Group A-No diabetic retinopathy (No DR), Group B-Nonproliferative diabetic retinopathy (Moderate-Severe-Very Severe NPDR), and Group C-Proliferative diabetic retinopathy (PDR). SD-OCT was performed. Ultrasonic color doppler imaging was done. RI of the CRA was noted. It was compared between the three groups and its association with severity of DR and OCT biomarkers (central subfield thickness, cube average thickness and ellipsoid zone disruption) was studied. 56 eyes of 28 patients were included in our study with 20 in Group A,14 in Group B, and 22 in Group C. RI of CRA compared within groups showed statistically significant association with severity of DR (P < 0.001). The presenting BCVA (LogMar) showed positive correlation with RI in all groups. OCT biomarker central subfield thickness showed a positive correlation with RI in Groups A (P < 0.001) and B. Ellipsoid zone (EZ) disruption showed a statistically significant association with RI in Group C (P < 0.001). The RI of CRA is a reliable biomarker for the assessment of the severity of DR. Patients with high RI of CRA had higher chances of EZ disruption and presented with poor visual acuity.

The Prevalence of Diabetic Retinopathy and Associated Risk Factors among Diabetic Patients in a Tertiary Care Hospital

Background: One of the most serious complications of diabetes that places an enormous strain on the patient, the healthcare system, and the world economy is diabetic retinopathy (DR). It includes long-term exposure to the metabolic changes linked to diabetes, which cause damage to the retina's microvasculature. Objectives: The aim of the study was to assess the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in a tertiary care hospital. Methods: This cross-section observational study was carried out in the Department of Ophthalmology, North Bengal medical College. Convenience sampling technique was followed. Face to face interview was done to collect data with a semi-structured questionnaire. After collection, the data were checked and cleaned, followed by editing, compiling, coding and categorizing according to the objectives and variable to detect errors and to maintain consistency, relevancy and quality control. Statistical evaluation of the results used to be obtained via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). The duration of the period from July 2018 to July 2022. A total of 120 patients were participate in the study. Results: About 58.33% respondents were male and 41.67% were female. Majority (33.33%) of the respondents were within the age group of 50-59. 33.33% were service holder, 41.67% were businessman, 12.5 were day labor, 6.67% were farmer. 75% were from urban area and 25% from rural area. The prevalence of DR in this study was 41.1%. About 90% had DM of &lt;5 years, 55% had 6-10 years, 40% had 15-20 Years, 30% had 16-20 years and only 7% had &gt;21 years. About 50% had normal grade of diabetic retinopathy in the worse eye, 15% had Mild NPDR, 8.33% had Moderate NPDR, 6.67% had Mild to moderate NPDR with non-CSME, 2.5% Moderate NPDR with CSME, Severe NPDR with non-CSME Severe NPDR with CSME and Advanced PDR respectively. Mean FBS (mg/dl) was 160.86±70.6, Total cholesterol (mg/dl) was 183.2 ± 2.1, Triglycerides (mg/dl) was 161.2 ± 2.6, Systolic BP was 130.56±15.7 and Diastolic BP was 80.86±13.4. Patients with baseline age of &lt;60 years were three times (AOR = 3.2:95% CI: 1.19–8.63) more likely to develop DR. The odds of DR is about 3 times (AOR = 2.91:95% CI: 1.01–8.35) higher for patients with disease duration of ≥6 years as compared to disease duration of &lt;6 years. Systolic blood pressure also had statistically significant association with patients having blood pressure of &lt;140 mmHg being about 3.6 times (AOR = 0.28:95% CI: 0.09–0.82) less likely to have DR as compared to hypertensive patients with systolic blood pressure of ≥140 mmHg. The other cofactors, history of hypertension, and total cholesterol level were not independent significant factors for the development of DR in our study. Conclusion: Systolic hypertension, being on insulin alone or in combination with OHA, and having diabetes for a longer period of time were all independently linked to the occurrence of DR. The significant DR prevalence our study suggests that routine patient care, including treatment facilities, has to be improved. Healthcare practitioners must make a consistent effort to educate diabetic patients about the importance of blood sugar control and hypertension management in lowering the risk of the start and progression of DR. It is advised that diabetic patients get health education regarding the importance of routine eye exams for the early detection and treatment of diabetes-related eye problems.

Assessment of anaemia and hyperglycaemic status in progression of diabetic retinopathy along with macular changes: A case control study

: Diabetes-related visual impairment is preventable through control measures. As diabetic retinopathy and maculopathy lack effective treatment, prevention is key. This study examines glucose, HbA1c, and hemoglobin to assess their impact on disease development and severity.Study includes 100 case (diabetic retinopathy) and 100 control (diabetes without retinopathy)subjects. Further, case group was subdivided into subgroups according to its severity and depending on the presence of maculopathy. Thereafter, values of different renal parameters were compared between these sub groups.The mean FBS and PPBS values significantly correlate with diabetic retinopathy (DR) severity (P&amp;#60;0.001 for FBS, P=0.012 for PPBS). Uncontrolled diabetes compounds DR risk. All very severe NPDR and PDR patients had HbA1c &amp;#62;7.0. No significant relationship between HbA1c and DR severity (P=0.302) was found. Elevated HbA1c in cases (P&amp;#60;0.001) underscores hyperglycemia's role. CSME, F/PP blood sugar, and HbA1c show no significant correlation. DR group has higher anemia likelihood (P=0.001), increasing with severity (P=0.017). Hemoglobin's relation to CSME is statistically insignificant.Elevated FBS, PPBS, and HbA1C levels in diabetic retinopathy (DR) cases link hyperglycemia to DR development. Severity correlates with these parameters. HbA1C rises notably in severe NPDR and PDR. Anemia risk increases, but CSME shows no significant correlation. Monitoring biochemistry is vital due to limited DR treatment options.

Depression in Individuals With Diabetic Retinopathy in the US National Health and Nutrition Examination Survey, 2005-2008

To examine the relationship between diabetic retinopathy (DR) and depression in the United States. Retrospective, cross-sectional study. National Health and Nutrition Examination Survey (NHANES) participants between 2005 and 2008 (ages 40-85 years) were included. Prevalence of major depression among DR stages as determined by retinal imaging was estimated. Multivariable models assessed associations between depression and DR. Depression was more common in those with moderate to severe DR (16%) than in those with no DR (7%), mild nonproliferative diabetic retinopathy (NPDR, 6%), or proliferative DR (5%). In a model with DR stages that adjusted for demographic factors, there was an association between moderate to severe DR and depression (odds ratio [OR], 2.46, 95% CI, 1.03-5.85). Depression was more prevalent in those with moderate to severe NPDR than in those with no DR, mild NPDR, or proliferative DR. This relationship is statistically significant after adjustment for demographic factors.

Association between Diabetic Foot Ulcer and Diabetic Retinopathy

Diabetes mellitus is a metabolic disorder with disturbance in carbohydrate, protein and fat metabolism because of partial or complete deficiency of insulin secretion or action. As it can cause various complications and Diabetic retinopathy being the most common and perhaps the most serious of all ocular complications. Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus which result in significantly elevated morbidity and mortality. Aim of the study was to assess the severity of diabetic retinopathy in relation to various grades of diabetic foot ulcer among 100 patients with clinically diagnosed type 2 Diabetes Mellitus with diabetic foot ulcer patients. 25% of the study participants were found to have Moderate NPDR with 15% of the study participants having severe NPDR. 11.1% of study participants with grade 4 DFU had PDR with HRC and 33.3% of study participants with grade 4 DFU had Severe NPDR. 47.1% and 35.3% of study participants with grade 3 DFU had Severe NPDR and moderate NPDR respectively. The association was found to be statistically significant between the severity of diabetic retinopathy and the grades of diabetic foot ulcer of the study participants. The study concluded that the severity of diabetic retinopathy increases with the increase in the stages of DFU and there is a possibility that the presence of DFU can predict the progression to advanced stages of DR. The results of our study support the need for a system of ophthalmological referral in case of detection of DFU, as well as a prompt referral of DR patients to a DFU specialist. Also, in advanced age DFU patients, and particularly those with longer duration of diabetes, early detection of DR and timely treatment may decrease the risk of severe vision loss or blindness. Keywords: diabetic foot ulcer, diabetic retinopathy, risk factors, severity, India

Frequency of Diabetic Retinopathy in Diabetic Patients in Pakistan

Objective: To determine the frequency of diabetic retinopathy and its types in diabetic patients of Pakistan. Study Design: cross sectional study. Place and duration: study was conducted in department of Ophthalmology, Nishtar Hospital Multan from 1st June 2020 to 2nd June 2021 in one-year duration. Methodology: Study was conducted on 300 diabetic patients and presented at the outpatient’s department of hospital. Refraction was done in all patients with the Snellen chart and fundus was examined with slit lamp or fundoscopy method. Main variables of study were diabetic retinopathy, macular edema, and types of diabetic retinopathy. Diabetic retinopathy was further divided into proliferating retinopathy, non-proliferating retinopathy (mild, moderate and sever) according to severity of DR. Results: Out of three hundred patients 65.0% were observed with diabetics’ retinopathy. Prevalence of macular edema in diabetics patients was 13.0%. The diabetic's patients were categories according to retinopathy severity; 28.3% had mild NPDR, 13.0% had moderate NPDR, 11.0% had severe NPDR and 7.7% had PDR. Conclusion: Diabetic retinopathy either proliferative or non-proliferative is highly prevalent in Pakistani population. Early detection and management are necessary to prevent its role in blindness.

Study of changes in choroidal thickness with severity of diabetic retinopathy and diabetic macular edema in type 2 diabetic patients

: Diabetic retinopathy (DR) is one of the long-term microvascular complications of Diabetes mellitus. Chronic hyperglycemia cause microvascular abnormalities to both retina and choroid. Optical coherence tomography (OCT) is a non-invasive fundus imaging modality, which plays a vital role in revealing the pathogenesis and development of retinal–choroidal diseases.This prospective observational study included 128 eyes of 64 subjects diagnosed with type 2 diabetes and out of 128 eyes, 113 (88%) eyes were found to have DR. Collected data included age, gender, duration of diabetes, glycemic control, comprehensive ocular examination, fundus photography, and CT measurement on OCT.Mean age in the study group was 53.71 ± 9.37 years (45–70 years). Out of 113 eyes, 19 (17%) eyes were diagnosed as mild NPDR, 21 (19%) eyes had moderate NPDR, 36 (31%) eyes had severe NPDR and 37 (33%) eyes had PDR. The average SFCT in MILD NPDR was 310 ± 14.70 μm at 95% CI (1.86), MODERATE NPDR was 316 ± 17.97 μm at 95% CI (2.70), SEVERE NPDR was 326.02 ± 14.05 μm at 95% CI (4.59) and PDR was 298.55 ± 18.75μm at 95% CI. (1.41). The presence of DME significantly affects average SFCT. It was observed that choroidal thickness tends to increase as the severity DR with DME progress.The average SFCT was thicker in patients with increase in severity of DR, and then SFCT decreased in patients with PDR. As the severity of NPDR increased from mild to moderate to severe NPDR, there was increase in sub foveal choroidal thickness. (p&amp;#60;0.05). PDR showed decrease in sub foveal choroidal thickness in comparison to NPDR which is highly statistically significant. p=0.01 (p&amp;#60;0.05). The presence of DME significantly affects average SFCT (p&amp;#60;0.05). It was observed that choroidal thickness tends to increase as the severity DR with DME progress. Thus, Choroidal thickness measurement can help in assessment of DR pathogenesis.

Prevalence of microalbuminuria in patients with type 2 diabetes mellitus having diabetic retinopathy in a tertiary care hospital in eastern India: A cross-sectional study

Diabetic retinopathy is a common microvascular complication of diabetes mellitus and one of the leading causes of acquired blindness. Microalbuminuria reflects a pathophysiological state of vascular dysfunction and organ damage. It is noticed that a rise in urinary albumin excretion is seen in the early phase of diabetic retinopathy. The concordance of microalbuminuria and diabetic retinopathy has been well reported in type 1 diabetes; however, for type 2 diabetes, there is a paucity of data. To estimate the prevalence of microalbuminuria in diabetic retinopathy patients with type 2 diabetes attending the out-patient department (OPD) in a tertiary care center in eastern India and also to find out any association between microalbuminuria and severity of diabetic retinopathy. : The study included 200 patients with type 2 diabetic patients having diabetic retinopathy. The study populations were selected by thorough clinical examination and as per inclusion–exclusion criteria. Estimation of urinary albumin and albumin creatinine ratio was done by using Konelab 20 Autoanalyzer machine by the immunoturbidimetry method. Diabetic retinopathy was classified as per the International Clinical Diabetic Retinopathy Severity Scales into mild, moderate, severe, very severe non-proliferative as well as proliferative diabetic retinopathy. Data were analyzed with ratio, rate, percentage, and statistical significance was considered if p&amp;#60;0.5. : The prevalence of microalbuminuria was found in 36% (72 patients). The highest number of patients (88.24%) with microalbuminuria was found in severe NPDR. 93.06% of patients with microalbuminuria had clinically significant macular edema. A statistically significant correlation (p&amp;#60;0.001) was found between microalbuminuria and the degree of retinopathy in mild, moderate, and severe NPDR. A significant correlation was found between urinary microalbumin and the severity of diabetic retinopathy.