Signs Of Diabetic Retinopathy Research Articles

Network pharmacology and biochemical experiments reveal the antiapoptotic mechanism of huperzine A for treating diabetic retinopathy

Background/aimsDiabetic retinopathy is the most common eye disease that causes blindness in the working population. Neurodegeneration is the early sign of diabetic retinopathy, but no drug has been approved for...

Structural and functional characterization of retinal impairment in T1DM patients without diabetic retinopathy: a 3-year longitudinal study.

To analyze the progression of structural and functional retinal impairment in type 1 diabetes mellitus (T1DM) patients with no clinical signs of diabetic retinopathy (DR) during a 3-year follow-up. This was an observational longitudinal study. Post-pediatric T1DM patients without clinical signs of DR, and sex- and age-matched healthy subjects were recruited at San Raffaele Hospital (Milan, Italy). Each patient underwent a comprehensive ophthalmological evaluation, including optical coherence tomography (OCT), OCT-angiography (OCT-A), retinal static and dynamic vessel analysis (DVA), and microperimetry. 21 eyes of 21 T1DM patients (10 females; 24 ± 2years old), and 21 age and sex-matched healthy subjects were enrolled. At baseline, T1DM eyes revealed a significantly decreased vessel length density using OCT-A (p < 0.001 and p = 0.046 in 3 × 3 and 6 × 6mm images) and a significantly increased vessel density index (p = 0.013 and p = 0.087 in 3 × 3 and 6 × 6mm images) of deep capillary plexus. DVA detected a significantly decreased vessel response to flicker light (p = 0.002). A significantly increased thickness of ganglion cellular layer 6-mm-diameter subfields in inferior and superior quadrants was found in diabetic patients (p < 0.001 in both subfields). At 3-years-follow-up no significant longitudinal changes were disclosed in all analyses. Concomitant subclinical microvascular and neurodegenerative damages could be early signs of DR onset that precede functional alterations and clinical signs of DR development. These alterations demonstrated a stable trend over time.

Automatic exudate and aneurysm segmentation in OCT images using UNET++ and hyperreflective-foci feature based bagged tree ensemble.

Diabetic retinopathy's signs, such as exudates (EXs) and aneurysms (ANs), initially develop from under the retinal surface detectable from optical coherence tomography (OCT) images. Detecting these signs helps ophthalmologists diagnose DR sooner. Detecting and segmenting exudates (EXs) and aneurysms (ANs) in medical images is challenging due to their small size, similarity to other hyperreflective regions, noise presence, and low background contrast. Furthermore, the scarcity of public OCT images featuring these abnormalities has limited the number of studies related to the automatic segmentation of EXs and ANs, and the reported performance of such studies has not been satisfactory. This work proposes an efficient algorithm that can automatically segment these anomalies by improving key steps in the process. The potential area where these hyper-reflective EXs and ANs occur was scoped by our method using a deep-learning U-Net++ program. From this area, the candidates for EX-AN were segmented using the adaptive thresholding method. Nine features based on appearances, locations, and shadow markers were extracted from these candidates. They were trained and tested using bagged tree ensemble classifiers to obtain only EX-AN blobs. The proposed method was tested on a collection of a public dataset comprising 80 images with hand-drawn ground truths. The experimental results showed that our method could segment EX-AN blobs with average recall, precision, and F1-measure as 87.9%, 86.1%, and 87.0%, respectively. Its F1-measure drastically outperformed two comparative methods, binary thresholding and watershed (BT-WS) and adaptive thresholding with shadow tracking (AT-ST), by 78.0% and 82.1%, respectively.

Early Assessment of Diabetic Retinopathy by Detecting Microaneurysm with Deep Neural Network

Objectives: This study aims to detect early signs of diabetic retinopathy, also known as microaneurysm (MA). Early detection of MA can help in diagnosing diabetic retinopathy effectively. Methods: To achieve this objective a method is proposed which is based on a deep learning model that incorporates transfer learning. The dataset used in this study is E-Ophtha which consists of 381 high-quality images. The proposed model consists of three steps which are preprocessing, feature extraction and classification. The method uses CLAHE to enhance the details of the fundus image. The feature extraction step and the classification are done using a deep learning algorithm. The proposed method is compared by using parameters such as Recall, Precision, and accuracy. Findings: The accuracy achieved by the model is about 98.82%-100%, a recall/sensitivity of 100%, and precision is also 100% which is close to the state of the art. This implies that deep learning methods are a good fit for identifying microaneurysms and ultimately detecting diabetic retinopathy. Novelty: Early detection and diagnosis of diabetic retinopathy can be achieved with this approach, and appropriate medication can impede the disease's development. Keywords: Diabetic Retinopathy, PDR, NPDR, Image Processing, Deep Learning

Cataract surgery in patients with diabetes mellitus. Prevention and optimisation of the diabetic macular edema therapy

Diabetes mellitus (DM) is a major public health problem, with approximately one third having signs of diabetic retinopathy (DR). In such patients, cataracts develop at an earlier age and 2–5 times more frequently. The incidence of macular edema (ME) after phacoemulsification of cataracts (FEC) in patients with diabetes has been shown to increase by 1.80 times and, in the presence of DR by 6.23. The critical period for retinal deterioration is 2 months after FEC, which requires an active therapy and monitoring. For patients with pre-existing diabetic macular edema (DME), If the cataract does not affect daily activities of patients with a pre-existing DME and the optical clarity is adequate, it is preferable to postpone surgical treatment in order to maximize retinal stabilization on OCT at two consecutive visits with a month’s interval between. In the case of severe impairment of lens transparency, FEC with an intravitreal injection of anti-VEGF 28 days or steroids 1 month before surgery under strict monitoring of the retinal condition using OCT is recommended. If macular changes are absent and there is a risk of developing DME, the use of nonsteroid anti-inflammatory drugs is necessary. Prophylactic intravitreal therapy is unacceptable in the absence of MO.

Doppler ultrasound-based evaluation of hemodynamic changes in the ophthalmic artery and central retinal artery in patients with type 1 diabetes mellitus without retinopathy and with mild non-proliferative retinopathy.

Determination of blood flow parameters in the ophthalmic artery and central retinal artery using Doppler ultrasound in patients with type 1 diabetes mellitus without fundus signs of diabetic retinopathy and with mild non-proliferative retinopathy. To eliminate the impact of other systemic factors on vascular flow, the study enrolled a total of 80 patients with type 1 diabetes mellitus, aged between 18 and 45 years. The study participants did not have any diabetic complications or other systemic or ocular comorbidities. The control group comprised 81 healthy individuals within a similar age range. Color Doppler ultrasound examinations of the ophthalmic artery and central retinal artery were performed to evaluate selected blood flow parameters including peak systolic velocity, end-diastolic velocity, and resistance index. Patients with type 1 diabetes mellitus exhibited statistically significant decrease in both systolic and end-diastolic velocities in the central retinal artery, accompanied by an elevation in resistance index, compared to the control group. The study revealed differences in blood flow parameters between the patients without fundus changes and those exhibiting mild non-proliferative retinopathy. Specifically, patients with retinopathy showed a significant decrease in both systolic velocity and end-diastolic velocity in the central retinal artery. No differences were observed for the same parameters in the ophthalmic artery. When analyzing the patients' blood flow parameters in relation to the degree of diabetes control, as determined by glycated hemoglobin levels, a statistically significant reduction in systolic velocity was identified in both the ophthalmic and central retinal arteries in the group with poorly controlled diabetes. Examination of the orbital vessels using Doppler ultrasound in patients with type 1 diabetes mellitus holds promise as an effective method for early detection of vascular abnormalities.

Changes in macular sensitivity in long‐term type 1 diabetic patients without diabetic retinopathy after 5 years of follow‐up

Aims/Purpose: To compare macular sensitivity measured with microperimetry in patients with Type 1 diabetes mellitus (DM1) without signs of diabetic retinopathy (DR) after 5 years of follow‐up.Methods: Twenty‐six eyes from 26 long‐term DM1 patients without DR signs were included. All participants underwent a complete ophthalmic examination including best corrected visual acuity (BCVA), intraocular pressure, fundoscopy, axial length and microperimetry examination using macular integrity assessment (MAIA) microperimeter (Topcon Corporation, Tokyo, Japan). The data wERE compared with the macular sensitivity results obtained 5 years ago. Nonparametric tests were used for the comparison (Mann–Whitney U test).Results: The mean age of the DM1 patients was 43.04 ± 11.03 years and their disease evolution time was 29.69 ± 9.25 years with good glycaemic control (HbA1c = 7.47 ± 0.84%). Regarding sex distribution, 11 eyes were from women (42.3%) and 15 were from men (57.7%). The DM1 patients did not show statistically significant changes in macular sensitivity in any of the macular rings between 2018 and 2023 with p &gt; 0.05. Central macular sensitivity had no significant changes with p = 0.378, and a mean of 27.38 ± 2.55 dB in 2018 versus a mean of 27.77 ± 2.46 dB in 2023. Macular integrity, fixation stability P1 and fixation stability P2 remained unchanged, p = 0.292, p = 0.861 and p = 0.529, respectively, showing no decrease in retinal sensitivity.Conclusions: Long term DM1 patients with no DR lesions show no changes in macular sensitivity after 5 years of follow‐up.

Evaluation of Retinal Nerve Fibre Layer in Diabetic Patients as an Early Manifestation of Diabetic Retinopathy

Purpose: To evaluate retinal nerve fibre layer (RNFL) in diabetic patients as an early manifestation of diabetic retinopathy (DR). Method: This comparative study was conducted on 30 diabetic patients who were had no signs of DR, and in the control group comprising 30 healthy non-diabetic patients selected as sample size. Demographic data including their age, duration of diabetes, drugs used for treatment, hypertension and previous ocular surgery were noted. Complete ophthalmological examination was performed, including slit-lamp biomicroscopy, refraction, intraocular pressure measurement, dilated fundus examination, fundus fluorescein angiography for patients with non-proliferative DR and optical coherence tomography imaging using Heidelberg Spectralis. Results: The RNFL thicknesses in each of the quadrants were analysed and then a comparison was done in case and control groups. Also, RNFL thickness among all study participants with HbA1c levels was investigated. The mean RNFL thickness in the superior.inferior nasal and temporal quadrants were 119.2, 120.1, 80.6 and 63.2, respectively. The mean thickness was noted in each group in each of the quadrants and was found to be lesser than the control population of diabetics. Conclusion: The imaging of RNFL may be an important tool in assessing diabetes.related changes early and should be made part of diabetic screening.

Four years follow‐up OCTA changes in long‐term type 1 diabetic patients without diabetic retinopathy

Aims/Purpose: To assess changes in retinal capillary plexuses and choriocapillaris over 4 years' time in long‐term Type 1 diabetic patients (DM1) without diabetic retinopathy (DR).Methods: Twenty‐four eyes of 24 long‐term DM1 patients with no DR lesions were examined by optical coherence tomography angiography (OCTA) over a 4 year follow‐up period. Vascular density (VD) of both superficial and deep retinal capillary plexuses (SCP, DCP) and choriocapillaris (CC) were compared, as well as foveal avascular zone (FAZ) area and diameters.Results: Mean age was 46.84 ± 11.28 years and the average DM1 evolution time was 28.88 ± 8.04 years. Mean HbA1c level was 7.34 ± 0.94% at the last examination. SCP showed a statistically significant increase in VD in all areas except the inferior quadrant. There were no changes in the area or diameters of the FAZ in the SCP. In the DCP, there was a significant increase in VD in the temporal quadrant and a decrease in the inferior quadrant, along with a decrease in the horizontal diameter of the FAZ. The nasal area of the CC showed a significant increase in VD.Conclusions: DM1 patients present changes in the inner retina microvascularization after a follow‐up period of 4 years before displaying any signs of DR, mainly an increase in VD the SCP of the retina, along with a decrease in VD in the inferior quadrant of the DCP.

Imaging the Retinal Vascular Mural Cells In Vivo: Elucidating the Timeline of Their Loss in Diabetic Retinopathy.

Vascular mural cells (VMCs) are integral components of the retinal vasculature with critical homeostatic functions such as maintaining the inner blood-retinal barrier and vascular tone, as well as supporting the endothelial cells. Histopathologic donor eye studies have shown widespread loss of pericytes and smooth muscle cells, the 2 main VMC types, suggesting these cells are critical to the pathogenesis of diabetic retinopathy (DR). There remain, however, critical gaps in our knowledge regarding the timeline of VMC demise in human DR. In this study, we address this gap using adaptive optics scanning laser ophthalmoscopy to quantify retinal VMC density in eyes with no retinal disease (healthy), subjects with diabetes without diabetic retinopathy, and those with clinical DR and diabetic macular edema. We also used optical coherence tomography angiography to quantify capillary density of the superficial and deep capillary plexuses in these eyes. Our results indicate significant VMC loss in retinal arterioles before the appearance of classic clinical signs of DR (diabetes without diabetic retinopathy versus healthy, 5.0±2.0 versus 6.5±2.0 smooth muscle cells per 100 µm; P<0.05), while a significant reduction in capillary VMC density (5.1±2.3 in diabetic macular edema versus 14.9±6.0 pericytes per 100 µm in diabetes without diabetic retinopathy; P=0.01) and capillary density (superficial capillary plexus vessel density, 37.6±3.8 in diabetic macular edema versus 45.5±2.4 in diabetes without diabetic retinopathy; P<0.0001) is associated with more advanced stages of clinical DR, particularly diabetic macular edema. Our results offer a new framework for understanding the pathophysiologic course of VMC compromise in DR, which may facilitate the development and monitoring of therapeutic strategies aimed at VMC preservation and potentially the prevention of clinical DR and its associated morbidity. Imaging retinal VMCs provides an unparalleled opportunity to visualize these cells in vivo and may have wider implications in a range of diseases where these cells are disrupted.

Assessment of Visual Evoked Potential to Detect Visual Pathway Dysfunction in Gestational Diabetes Mellitus: A Longitudinal Case-Control Study With Postpartum Follow-up.

The increasing prevalence of gestational diabetes mellitus (GDM) during pregnancy has opened the opportunity to study its short- and long-term effects on maternal ophthalmic health. Visual evoked potential (VEP) is a non-invasive electrophysiological test that detects functional disturbances along the visual pathway before the physical signs of diabetic retinopathy (DR) can set in.This longitudinal study is aimed at the assessment of changes in VEP in GDM during different stages of pregnancy and 6-12 weeks after parturition by comparing it with normoglycemic controls. Diagnosed cases of GDM were recruited along with normoglycemic controls at 24-28 weeks of gestation.Each participant was required to attend two follow-up appointments at 32-38 weeks of gestation and 6-12 weeks after parturition. A blood sample was taken in a fasting state to record biochemical parameters. VEP was recorded using Neuropack S1 MEB-9400 electrodiagnostic equipment (Nihon Kohden, Tokyo, Japan) in a dark room by providing pattern reversal stimuli to each eye. A total of 29 participants (15 in the control group and 14 in the GDM group) completed the entire study procedure.The observed mean P100 latency of both eyes in the GDM group was recorded longer as compared to that in the control group at baseline and during late pregnancy. Although the mean P100 latency saw a significant decline in postpartum visits as compared to that in late pregnancy, the values were higher than in the control group. P100 latency at baseline correlated significantly to serum advanced glycated end products' (AGE'S) levels in the GDM group. Our study findings reflect that the diagnosis of GDM is associated with significant changes in VEP during and after pregnancy as compared to that of healthy pregnant women.

Eye &amp; Diabetes in Morocco: Where are we from the global screening guidelines?

Abstract In Morocco, the prevalence of diabetes in the adult population is 12.4% (WHO). Diabetic Retinopathy (DR) is the 2nd cause of blindness. Nearly 1 million people worldwide are blind due to diabetes. The aim of our work is to study the epidemiological profile of patients with diabetes in ophthalmology and to determine the observance of the follow-up guidelines. This is a descriptive study carried out at the Vision Clinic of Tetouan-Morocco, including all diabetic patients who presented to the ophthalmology consultation of the same doctor, between June 2022 and December 2022. The study involved 500 patients, including 217 men and 283 women, with an average age of 62 years. The average duration of diabetes was 11.5 years. 1 out of 3 diabetic patients was unaware that diabetes was a blinding disease and 3 out of 4 patients did not follow a specific diet. 1 out of 8 patients has an annual ophthalmological check-up. 55% of the patients have a screening every 2-5 years, when 7% haven't had their eyes checked in the last 10 years. Visual complaints accounted for 58% of the motivations for all consultations, while diabetes only accounted for 30%. Depending on the duration of the condition, diabetes represents 60% of the reasons for consultation among new diabetics (1 year) whereas it represents only 20% among diabetics over 10 years old. Eye examinations revealed a proliferative DR in 24% of the cases and a non proliferative DR in 22%. In 31%, there was no sign of DR and in 23%, the fundus was inaccessible due to cataract. The prevalence of proliferative DR increases with years of diabetes, reaching 40% in diabetics over 20 years old. The results of this work prove that diabetes is still underestimated by the Moroccan population. This is probably related to a lack of information of the target population. Thus, health professionals should strengthen their education in order to establish a better monitoring and screening policy aimed to reduce the occurrence of an avoidable blindness. Key messages • Less than one Diabetic out of 3 consults an ophthalmologist for their diabetes &amp; Only one diabetic out of 8 consults annually in ophthalmology. • The older the diabetes, the less regular is the consultation in ophthalmology &amp; One out of 4 diabetics will already have proliferative diabetic retinopathy at their ophthalmological consultation.

LONGITUDINAL MICROVASCULAR AND NEURONAL RETINAL EVALUATION IN PATIENTS WITH DIABETES MELLITUS TYPES 1 AND 2 AND GOOD GLYCEMIC CONTROL.

To evaluate microvascular and neuronal changes over 3 years in patients with Type 1/2 diabetes mellitus (DM1/DM2), good metabolic control, and no signs of diabetic retinopathy. In this prospective, longitudinal study, 20 DM1, 48 DM2, and 24 controls underwent macular optical coherence tomography and optical coherence tomography angiography at baseline and after 3 years. Following parameters were considered: thickness of the central macula, retinal nerve fiber layer, ganglion cell (GCL+/GCL++) complex; perfusion and vessel density and fractal dimension at the superficial and deep capillary plexuses; choriocapillaris flow deficits; and foveal avascular zone metrics. MATLAB and ImageJ were used for optical coherence tomography angiography scans analyses. The mean HbA1c was 7.4 ± 0.8% in DM1 and 7.2 ± 0.8% in DM2 at baseline, with no change at 3 years. No eye developed diabetic retinopathy. In longitudinal analyses, perfusion density at superficial capillary plexuses ( P = 0.03) and foveal avascular zone area and perimeter ( P < 0.0001) significantly increased in DM2 compared with other groups. No longitudinal changes occurred in optical coherence tomography parameters. In comparisons within groups, DM2 had a significant thinning of GCL++ in the outer ring, decreased perfusion density at deep capillary plexuses and choriocapillaris flow deficits, and increase in foveal avascular zone perimeter and area in deep capillary plexuses; DM1 had an increase in foveal avascular zone perimeter in deep capillary plexuses ( P < 0.001 for all comparisons). Longitudinal data showed significant microvascular retinal changes in DM2. No changes were detected in neuronal parameters and in DM1. Longer and larger studies are needed to confirm these preliminary data.

Early retinal neurovascular findings in post-transplant diabetes mellitus patients without clinical signs of diabetic retinopathy

BackgroundPost-transplant diabetes mellitus (PTDM) is a specific subtype of diabetes with an uncertain impact on mortality and morbidity in post-transplant patients. Diabetic retinopathy is the most common microvascular complication of diabetes mellitus, but the long-term clinical progression in PTDM is unknown. New technologies are being used to assess pre-clinical signs of retinal changes, such as swept-source optical coherence tomography (OCT) and OCT-angiography. The aim of this study was to detect pre-clinical structural and vascular changes in the retina using swept-source-OCT and OCT-angiography in patients with PTDM.MethodsIn this retrospective cohort study, post-kidney transplant patients were divided into PTDM and non-PTDM (control) groups. Both eyes of eligible PTDM patients and controls were included in this study. Inner retinal layer thickness was measured with swept-source-OCT. Retinal capillary density and the foveal avascular zone were measured with OCT-angiography.ResultsIn the PTDM group, reduced thickness was found in the inferior ganglion cell layer plus inner plexiform layer (95% CI -8.76 to -0.68; p = 0.022) and the temporal inferior segment (95% CI -10.23 to -0.76; p = 0.024) of the inner retina, as well as in the retinal nerve fiber layer in the temporal (95% CI -34.78 to -9.28 p = 0.001) and temporal inferior segments (95% CI -33.26 to -5.03 p = 0.008). No significant differences were found in the vascular capillary plexus between groups at all depths, segments, or foveal avascular zone (p = 0.088).ConclusionsAccording to OCT-angiography, PTDM patients had reduced inner neurosensory retinal layers but no significant change in vascular density, which suggests that early neuroretinal degeneration might occur prior to vascular changes secondary to PTDM. Prospective studies could help elucidate the clinical course of retinal neuropathy and microvascular pathology in PTDM and provide a better understanding of PTDM complications.

Factors Associated with Utilization of Teleretinal Imaging in a Hospital-Based Primary Care Setting.

Regular eye examinations to screen for the initial signs of diabetic retinopathy (DR) are crucial for preventing vision loss. Teleretinal imaging (TRI) offered in a primary care setting provides a means to improve adherence to DR screening, particularly for patients who face challenges in visiting eye care providers regularly. The present study evaluates the utilization of TRI to screen for DR in an outpatient, hospital-based primary care clinic. Patients with diabetes mellitus (DM) but without DR were eligible for point-of-care screening facilitated by their primary care provider, utilizing a non-mydriatic, handheld fundus camera. Patient demographics and clinical characteristics were extracted from the electronic medical record. Patients who underwent TRI were more likely to be male, non-White, and have up-to-date monitoring and treatment measures, including hemoglobin A1c (HbA1c), microalbumin, and low-density lipoprotein (LDL) levels, in accordance with Healthcare Effectiveness Data and Information Set (HEDIS) guidelines. Our findings demonstrate that TRI can reduce screening costs compared to a strategy where all patients are referred for in-person eye examinations. A net present value (NPV) analysis indicates that a screening site reaches the break-even point of operation within one year if an average of two patients are screened per workday.

Retinal and choroidal microvascular characterization and density changes in different stages of diabetic retinopathy eyes.

The purpose of this study was to evaluate the changes in fundus vascular density and micromorphological structure of all vascular plexuses during the different stages of diabetic retinopathy (DR), and the correlation between fundus blood flow and the DR severity. This observational cross-sectional study was conducted of 50 eyes with different stages of DR, 25 diabetes mellitus (DM) patients without clinical signs of DR and 41 healthy eyes. The foveal avascular zone (FAZ), vessel density of superficial capillary plexus (SCP), and deep retinal capillary plexus (DCP) were acquired by RTVue XR Avanti OCTA device. The perfusion density (PD), skeleton vessel density (SVD) was manually calculated using ImageJ. The area under receiver operating characteristic (ROC) curve was used to determine the diagnostic value of OCTA parameters in distinguishing DR and healthy eyes. The choroidal VD were significantly higher in the healthy group than in the DM without DR, NPDR, and PDR groups (p < 0.001). The mean retinal parafovea VD, PD, and retinal SVD were higher in healthy and DM without DR eyes compared with NPDR and DR eyes in all vascular layers (p < 0.001). The parafoveal VD of SCP, and DCP decreased, and FAZ area increased with the exacerbation of DR. The OCTA parameters, including FAZ area, parafovea VD, PD, and SVD in all vascular layers showed significant correlation with DR severity (all p < 0.001). ROC curves of OCTA parameters (FAZ area, retinal parafovea VD, retinal PD, and SVD in all vascular layers) for had high sensitivity and specificity in distinguishing DR versus healthy eyes. The choroidal parafovea VD, retinal parafovea VD, retinal PD, and SVD in the two plexuses decreased, and retinal FAZ area increased significantly with worsening DR. VD, PD, and SVD might be potential early biomarkers indicating the progression of DR before appearance of clinically PDR in patients with DM. In this study, OCTA parameters had high sensitivity and specificity in distinguishing DR and healthy eyes.

Artificial Intelligence Systems for Diabetic Retinopathy Screening: Appraisal on the 3rd US FDA Approved Algorithms- AEYE-DS

Artificial Intelligence (AI) has revolutionized the field of healthcare in recent years, and one of its most promising applications is on the interpretation of medical images [1]. In ophthalmology, the first success comes to the screening and diagnosis of Diabetic Retinopathy (DR) [2]. DR is a common complication of Diabetes Mellitus (DM) that affects the eyes, and early detection and treatment is crucial in preventing vision loss, especially over the working populations [3]. The use of AI in DR screening involves analyzing digital fundus images to detect any signs of DR, including microaneurysms, dot and blot haemorrhages, cotton-wool spots, venous beading, intraretinal microvascular anomalies [4]. Currently, there are 3 US FDA approved systems on DR screening, IDx-DR (Digital Diagnostics), EyeArt (Eyenuk, Inc) and AEYE-DS (AEYE Health, Inc) [5-7]. AI has several advantages over traditional screening methods, including usage by non-ophthalmologically trained medical personnel, accessible and stable performance over whatever time and place, increased speed of clinical workflow, these might potentially help to improve outcomes for patients with DM. In the era of rapidly advancing technology, the use of AI in ophthalmology is an exciting development that might transform our future practice [8]. In this appraisal, we focus on the 3rd US FDA approved AI algorithms for DR.

Association of serum lipids and random plasma glucose levels with severity of diabetic retinopathy

Diabetic retinopathy is the most common vision-threatening chronic microvascular, microangiopathy complication of diabetes militias.We have designed this cross sectional observational study to understand the role of serum lipids and random plasma glucose level with severity of diabetic retinopathy (DR). This study was accomplished with 210 patients that came to us in the diabetic clinic. There were two groups: Group A - All DM patients with no apparent sign of diabetic retinopathy (Grade I) and Group B - All DM Patients with any signs of diabetic retinopathy (Grade II - V). Diabetic retinopathy (DR) was graded according to The International Clinical Diabetic Retinopathy Disease Severity Scale on dilated fundus examination and fundus phtotograpgy. Serum lipids (Total, LDL, and HDL cholesterol and triglycerides) were then assessed according to NCEP ATP III guidlines. The correlation of the severity DR was then assessed with serum lipids and random plasm glucose.We found that total cholesterol and triglycerides played a detrimental role in the severity of diabetic retinopathy and the likelihood of developing a more severe form of diabetic retinopathy was dependent on their levels (P&amp;#60;0.05). The Association of HDL and LDL with different grades of diabetic retinopathy was also found significant (P&amp;#60;0.05). However, the association of VLDL (P&amp;#62;0.05) was found insignificant. Similarly, the values of total cholesterol, triglycerides and HDL showed a significant rise with severity of diabetic macular edema (DME)In this present study, the significant association of total cholesterol, triglycerides and HDL with DR thus concludes that along with strict glycemic monitoring and control, the of control of hyperlipidemia is also noteworthy to prevent the progression of DR and DME.

Content of mediators of innate immunity in the tears of patients with vascular and neurodegenerative manifestations of diabetic retinopathy

According to the results of recent studies, diabetic retinopathy can be considered not only as a vascular disease, but also as a neurodegenerative process. Study of the composition of the tear fluid is used to assess the state of local immunity in the development of eye diseases. However, studies examining the effect of tear composition in diabetic retinopathy are few. The aim of the study is to determine the levels of IL-1β, IL-10, TGF-β3, MMP-7, TIMP-2, protein S100b, BDNF and NGF in the tear fluid ofpatients with vascular and neurodegenerative manifestations of diabetic retinopathy. The study included 80 patients diagnosed with type 2 diabetes which were divided into 2 groups: the 1st group included 40 patients who had no clinical signs of diabetic retinopathy on the fundus; the 2nd group included 40 patients with initial signs of non-proliferative diabetic retinopathy. All those included in the study were examined on an optical coherent tomograph RTVue-100 (USA); the volume of focal losses of retinal ganglion cells (FLV) was determined. An increase in FLV above the normative base of the device was regarded as an OCT-sign of retinal neurodegeneration. According to the results of OCT, the participants of the first and second groups were additionally divided into 4 subgroups: 1A — patients without vascular changes in the fundus and without OCT signs of retinal neurodegeneration (n = 12); 1B — patients without vascular changes in the fundus and with the presence of OCT signs of retinal neurodegeneration (n = 28); 2A — patients with initial non-proliferative DR and without OCT signs of retinal neurodegeneration (n = 10); and 2B — patients with initial non-proliferative DR and with OCT signs of retinal neurodegeneration (n = 30). The levels of IL-1β, IL-10, TGF-β3, MMP-7, TIMP-2, protein S100 b, BDNF, and NGF in tear fluid were determined by enzyme-linked immunosorbent assay. Levels of IL-1β and IL-10 in tear fluid in all subgroups were comparable to controls throughout the study. TGF-β3 content in the tear fluid of patients in the group with initial signs of non-proliferative DR (group 2) was significantly (p = 0.001) lower compared with control and group 2. However, there was no significant difference (p &gt; 0.05) between subgroups A and B within groups. The concentration of MMP-7 in the tear fluid in all subgroups was significantly lower than in the control (p &lt; 0.05). However, in the subgroups with OCT signs of retinal neurodegeneration (1B and 2B), the deficiency of this metalloproteinase was more pronounced (p = 0.0001). The levels of the neuropeptides under study NGF, BDNF and S100 B in tear fluid did not differ from controls in all subgroups.

Perivenular Capillary Rarefaction in Diabetic Retinopathy: Interdevice Characterization and Association to Clinical Staging.

Geometric perfusion deficit (GPD) is a newly described OCT angiography (OCTA) parameter identifying the total area of presumed retinal ischemia. The aim of our study is to characterize differences in GPD and other common quantitative OCTA parameters between macular full field, perivenular zones, and periarteriolar zones for each clinical stage of nonproliferative diabetic retinopathy (DR) and to assess the influence of ultrahigh-speed acquisition and averaging on the described differences. Prospective observational study. Forty-nine patients, including 11 (22.4%) with no sign of DR, 12 (24.5%) with mild DR, 13 (26.5%) with moderate DR, and 13 (26.5%) with severe DR. Patients with diabetic macular edema, proliferative DR, media opacity, head tremor, and overlapping retinal diseases or systemic diseases influencing OCTA were excluded. OCT angiography was performed 3 times for each patient: 1 using Solix Fullrange single volume (V1) mode, 1 using Solix Fullrange 4 volumes mode with automatically averaged scan (V4), and 1 using AngioVue. Full macular, periarteriolar, and perivenular perfusion density (PD), vessel length density (VLD), vessel density index, and GPD for both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). In patients showing no sign of DR, PD and VLD were significantly lower in the perivenular area in both the DCP and SCP using V1 and V4, whereas GPD was significantly higher in the perivenular zone in the DCP and SCP with all 3 devices. In patients with mild DR, all 3 measurements (PD, VLD, and GPD) were significantly different in the perivenular zone with all 3 devices. In patients with moderate DR, PD and VLD were lower in the DCP and SCP when measured with V1 and V4. Moreover, GPD was higher in the perivenular zone in the DCP with all 3 devices, whereas only V4 detected a difference in the SCP. In severe DR, only V4 detected a lower PD and VLD and a higher GPD in the DCP of the perivenular zone. V4 also detected a higher GPD in the SCP. Geometric perfusion deficit highlights prevalent perivenular location of macular capillary ischemia in all stages of DR. In severe DR patients, only averaging technology allows detection of the same finding. The author(s) have no proprietary or commercial interest in any materials discussed in this article.