Stereo Fundus Photography Research Articles

Factors associated with visual field or structure progression occurring first in a prospective study on patients with untreated open-angle glaucoma with normal intraocular pressure

Background/ObjectivesTo identify factors associated with disc/retina deterioration in stereo fundus photographs preceding that of the visual field (VF), as determined with a Humphrey Field Analyzer (HFA) (Structure First deterioration) and factors associated with the latter preceding the former (Field First deterioration) in open-angle glaucoma (OAG) with lower normal intraocular pressure (IOP).Subjects/MethodsProspective cohort study. Ninety eyes of 90 patients with OAG and a baseline IOP < 15 mmHg participated in a 5-year prospective study without treatment. IOP measurements and HFA 24-2 Swedish Interactive Test Algorithm Standard tests were performed every 3 months, and fundus photographs were obtained every 6 months. VF deterioration was determined by Guided Progression Analysis and deterioration of disc/retina was determined on stereophotographs by an independent committee. A multivariable Cox proportional hazard model was used to identify factors associated with Structure First deterioration, and with Field First deterioration.ResultsThe average baseline age and mean deviation were 53.9 ± 9.8 years and −2.8 ± 2.8 dB, respectively. During the 5-year follow-up, the probability of Field First deterioration was 49% ± 6.6% (standard error) and that of Structure First deterioration was 33% ± 6.4% (P = 0.062, log-rank test). Disc hemorrhage (DH) prior to the event (P = 0.006) was associated with Structure First deterioration, and older age was associated with Field First deterioration (P = 0.040).ConclusionsIn OAG eyes with lower normal IOP, DH was significantly associated with Structure First deterioration, and age was significantly associated with Field First deterioration.

327-OR: Smaller HDL Particles and ABCA1 Cholesterol Efflux Capacity Predict Incident Proliferative Retinopathy Only among Men with Type 1 Diabetes

Clinical studies have provided evidence for a potential role of dyslipidemia in the development of retinopathy in type 1 diabetes. Existing evidence, however, is generally based on conventional lipid analysis and/or cross-sectional study designs. We therefore assessed the prospective association of HDL particle concentration (HDL-P) and cholesterol efflux capacity (CEC) with incident proliferative diabetic retinopathy (PDR) in a cohort of childhood-onset type 1 diabetes. HDL-P (calibrated differential ion mobility analysis) and total and ABCA1-specific CEC (validated cell-based assays) were quantified in 186 men and 185 women with type 1 diabetes free of PDR (stereo fundus photography) at baseline (mean age 25.6 years; diabetes duration, 17.1 years). Women had higher large HDL-P than men; the concentrations of extra-small, small and medium HDL-P as well as both total and ABCA1 CEC were similar by sex. During a median follow-up of 28 years, 108 men and 100 women developed PDR. In multivariable Cox models stratified by sex, HDL-C did not predict PDR incidence in either sex. However, in addition to increased HbA1c, non-HDL-C, white blood cell count and albumin excretion rate, increased extra-small (HR=0.25, 95% CI=0.09-0.67) and small (HR=0.72, 95% CI=0.55-0.94) HDL-P concentrations and ABCA1 CEC (HR=0.80, 95% CI=0.64-0.998) negatively predicted PDR in men but not women, among whom HbA1c, hypertension and white blood cell count were the only consistent significant predictors of PDR. In conclusion, while extra-small and small HDL-P concentrations and ABCA1 CEC did not differ by sex in type 1 diabetes, they only predicted incident PDR in men, a finding similar to our previously reported results for coronary artery disease. Further research is warranted to better understand the role of HDL in the pathophysiology of PDR and why this appears to differ by sex in type 1 diabetes. Disclosure T.Costacou: None. R.G.Miller: None. T.J.Orchard: None. Funding National Institutes of Health (R01HL130153, R01DK034818)

Evaluation of Resistive Index of Orbital Vessels Using Color Doppler Imaging in Patients with Type 2 Diabetes Mellitus.

Background:Resistive index (RI), derived from color Doppler imaging (CDI), is a marker of vascular resistance used widely in varied clinical settings. The aim of this study was to analyze the association between RIs of the orbital vessels in a pure cohort of type 2 diabetic patients with or without retinopathy using CDI.Methods:Fifty patients having type 2 diabetes and 50 age-matched controls were evaluated in this prospective study. Diabetic retinopathy (DR) was diagnosed based on seven-field stereo fundus photography and diabetic patients were divided into two. Patients with no DR (n = 26) were taken as Group 1, while patients with DR (n = 24) were taken as Group 2. CDI was performed and the RIs of the ophthalmic artery (OA), posterior ciliary artery (PCA), central retinal artery (CRA), and central retinal vein (CRV) were measured.Results:Significant differences were observed in the mean RI values of all orbital arteries between controls and patients with DR (P < 0.05). Comparison of RI values between controls and Group 1 showed no significant differences. Mean RI values of the PCA and CRA were found to be significantly higher in the patients in Group 2 than in Group 1 (P = 0.03 and P < 0.001, respectively). The duration of diabetes correlated with the mean RI of all the orbital vessels. RI of the CRA was a reliable predictive indicator for DR (P = 0.001).Conclusion:RIs of the orbital arteries are significantly higher in patients with DR. RI of the orbital vessels can be a potentially useful biomarker in the early diagnosis and follow-up of patients with DR.

567-P: The Neutrophil-to-Lymphocyte Ratio as a Biomarker of Diabetic Retinopathy: A Cross-Sectional Study

Aims: Diabetic retinopathy (DR) is one of the most prevalent complications, which causes visual impairment and vision loss in diabetic patients. It has been demonstrated that inflammation plays an important role in DR. Accumulating evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) is a novel potential marker for determining the inflammatory state. We aimed to evaluate the correlation between the NLR and DR. Methods: We performed a cross-sectional study involving 1658 patients with type 2 diabetic mellitus (T2DM) at the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2018. All these subjects underwent stereo fundus photography taken by a 45° Non-Mydriatic Fundus Camera (CR6-45NM, Canon, Tokyo, Japan) through undilated pupils, and physical examinations including body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP). Laboratory tests were also performed to determine the levels of fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), serum creatinine (Scr), blood urea nitrogen (BUN), and glycosylated hemoglobin A1c (HbA1c). The NLR was calculated based on the absolute numbers of neutrophils and lymphocytes. Results: 214 of the patients had DR. The age, DM duration, NLR, SBP were significantly higher in patients with DR compared with patients without DR (p &amp;lt; 0.01). After the adjustments by multivariable analyses, the NLR was still significantly associated with DR (P=0.048, OR=1.088, 95% CI=1.001-1.182). Conclusion: Our finding reveals that higher NLR values are a reliable biomarker for the occurrence of DR. Disclosure M. Li: None. X. Tang: None. Y. Tan: None. Y. Nie: None. H. Li: None. Y. Chen: None. Funding Research and Development Plans in Key Areas of Guangdong Province (2019B020227003); National Natural Science Foundation of China (81770826); National Key Research and Development Program of China (2017YFA0105803)

Evaluation of retrobulbar circulation in type 2 diabetic patients using color Doppler imaging.

Purpose:To investigate the retrobulbar circulatory parameters in type 2 diabetes mellitus patients with color Doppler imaging (CDI) and compare the results with nondiabetic controls.Methods:This prospective study included 50 type 2 diabetic patients and 50 age-matched controls. Seven field stereo fundus photography was used to diagnose and classify diabetic retinopathy (DR). Diabetic patients were further divided into two: Group 1, consisted of patients with no DR, mild and moderate non-proliferative DR (n = 36); Group 2, severe nonproliferative and proliferative DR (n = 14). CDI was performed using Philips iU22 xMATRIX ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), resistivity index (RI) and pulsatile index (PI) of ophthalmic (OA), posterior ciliary artery (PCA), and central retinal artery (CRA) along with central retinal vein (CRV) were recorded.Results:RI in the ophthalmic artery was significantly higher in both DR groups than the control group (P = 0.000). Diabetic Group 1 had decreased blood flow velocity (PSV and EDV) in PCA compared to controls (P = 0.046 and P = 0.010, respectively). Group 2 DR had significantly reduced EDV and increased RI in CRA compared to Group 1 (P = 0.015). Binary logistic regression analysis revealed glycosylated hemoglobin and RI of OA to be independent risk factors of DR.Conclusion:Significant changes in resistivity index and flow velocities were observed in the retrobulbar vessels, especially in ophthalmic artery in diabetics compared to controls. CDI with results of increased resistance or decreased flow could be useful to predict individuals at higher risk for developing severe DR.

The Light and the Dark of Early and Intermediate AMD: Cone- and Rod-Mediated Changes Are Linked to Fundus Photograph and FAF Abnormalities.

The purpose of this paper is to describe the extent to which scotopic and photopic measures of visual function predict color fundus photograph (CFP) and fundus autofluorescence (FAF) changes in early and intermediate nonexudative AMD. Sixty-nine observers were recruited: 56 AMD patients (mean age, 73 ± 12.98 years) and 13 controls (mean age, 67.77 ± 9.72 years). A nonmydriatic retinal camera was used to obtain stereo fundus photographs and FAF images were recorded with a cSLO Heidelberg Spectralis HRA+OCT. Visual acuity (VA) was measured using an Early Treatment of Diabetic Retinopathy Study chart. Contrast sensitivity (CS) was assessed with a Pelli-Robson chart. Dark adaptation (DA) curves were recorded at 3° eccentricity using a PC-based technique. Analysis of these curves yielded five parameters: cone threshold (CT), cone time constant (CC), cone-rod break (α), slope of the second rod component (S2), and rod-rod break (β). Both cone and rod sensitivity recovery were grossly abnormal in the patients. The rod recovery slope (S2) most accurately predicted the fundus photograph-based grade and the FAF classification (ρ = 0.61 and ρ = 0.60, respectively; both P < 0.0001). CS showed a strong association with FAF (ρ = 0.50, P < 0.0001) and with fundus photograph-based grade (ρ = 0.38, P < 0.002). There was no correlation between VA and either imaging method. Dynamic, rod-based measures most accurately reflect the severity of early AMD. Although less specific to AMD than DA changes, static photopic abnormalities such as CS also correspond with morphologic changes. Assessment of function in early AMD should include dynamic rod- and cone-mediated measurements of sensitivity recovery.

599-P: Diabetic Retinopathy (DR) Screening Performance of General Ophthalmologists, Retina Specialists, and Artificial Intelligence (AI): Analysis from a Pivotal Multicenter Prospective Clinical Trial

A prospective study (NCT03112005) evaluated DR screening using the EyeArt AI eye screening system and dilated ophthalmoscopy by board-certified ophthalmologists against the ETDRS clinical reference standard (CRS) of adjudicated expert grading of 4-wide field stereoscopic fundus photographs. A total of 497 subjects with diabetes from 10 U.S. clinical centers underwent undilated 2-field fundus photography for analysis by the EyeArt system, dilated ophthalmoscopy, and dilated 4-wide field stereo fundus photography for the CRS. Performance (Table) of dilated ophthalmoscopy against CRS for identifying referable DR [moderate non-proliferative or higher on the International Clinical Diabetic Retinopathy severity scale or clinically significant macular edema] indicates significant variability across retina specialists and general ophthalmologists. In a previous study, this AI system has been shown to achieve sensitivity 89.0% [95% CI: 87.7-90.2%] and specificity 91.6% [95% CI: 91.0-92.2%] against 7-field ETDRS reference standard. We await the results of the EyeArt system in this multicenter study to verify its ability to provide a more consistent performance for detection of referable DR to facilitate DR screening in primary care and endocrinology clinics. Disclosure E. Ipp: Research Support; Self; Eyenuk Inc., Novartis Pharmaceuticals Corporation. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. S.R. Sadda: Consultant; Self; Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Optos. Other Relationship; Self; Nidek. Other Relationship; Spouse/Partner; Topcon. Funding Eyenuk Inc.

37-LB: Diabetic Retinopathy (DR) Screening Performance of an Artificial Intelligence (AI) System: Analysis from a Pivotal Multicenter Prospective Clinical Trial

A prospective study (NCT03112005) evaluated DR screening using the EyeArt AI eye screening system against the ETDRS clinical reference standard (CRS). A total of 893 subjects with diabetes were enrolled at 15 U.S. clinical centers and completed 2-field fundus photography for analysis by the EyeArt system and dilated 4-wide field stereo fundus photography for adjudicated expert grading to establish CRS. The EyeArt system provided eye-level results for referable DR (rDR) [moderate non-proliferative DR (NPDR) or higher on the International Clinical DR (ICDR) severity scale or clinically significant diabetic macular edema (CSDME)] and for vision-threatening DR (vtDR) [severe NPDR or higher on the ICDR scale or CSDME]. Out of 1718 eyes with gradable CRS for rDR, 1392 eyes were negative and 326 were positive. Out of 1702 eyes with gradable CRS for vtDR, 1588 were negative and 114 were positive. The EyeArt system was evaluated against CRS for identifying rDR and vtDR under an undilated protocol and a dilate-if-needed protocol (where dilated images were used for subjects with ungradable EyeArt results on undilated images). Results (Table) indicate that the EyeArt AI system compares favorably with the clinical reference standard and meets the predetermined study endpoints for the detection of referable and vision-threatening DR in people with diabetes. Disclosure B.W. Bode: Consultant; Self; ADOCIA, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Research Support; Self; Becton, Dickinson and Company, Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Eyenuk Inc., Insulet Corporation, National Institutes of Health, Novo Nordisk Inc., Sanofi Research &amp; Development, Senseonics, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi US, Senseonics. Stock/Shareholder; Self; AgaMatrix, Glytec, LLC. E. Ipp: Research Support; Self; Eyenuk Inc., Novartis Pharmaceuticals Corporation. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. S.R. Sadda: Consultant; Self; Carl Zeiss Meditec, Centervue, Heidelberg Engineering, Optos. Other Relationship; Self; Nidek. Other Relationship; Spouse/Partner; Topcon. Funding National Institutes of Health (EY027241, EY026864)

Diabetic retinopathy in type 1 diabetes patients in Western Norway.

To describe the prevalence of diabetic retinopathy (DR), associated risk factors and health-related quality of life (HRQoL) in a population-based cohort of patients with type 1 diabetes mellitus (DM1). All patients underwent a general and ophthalmic examination including seven-field stereo fundus photography for grading of DR and diabetic macular oedema (DMO). Kaplan-Meier survival analyses were performed to evaluate disease progression in relation to diabetes duration, age and year of diabetes onset. HRQoL and its association with DR were assessed by the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. A total of 237 DM1 patients were included. Mean age at inclusion was 34years (range, 4-75years), and mean diabetes duration was 19years (range, 5months-63years). A total of 145 patients (61%) had DR. Sixty-two patients (26%) had mild, 39 (16%) moderate and 13 (5%) severe nonproliferative DR, while 31 (13%) had proliferative DR. The prevalence of DMO was 8%. The most important risk factors predicting severity of DR were diabetes duration (p<0.0001) and HbA1c level (p<0.0001). Neuropathy (p=0.006), nephropathy (p=0.004) and male gender (p=0.02) were also significant predictors of DR. Compared to normative SF-36 data, there was a linear trend of decreasing HRQoL with increasing severity of DR that was statistically significant for the four physical dimension scores. The prevalence of DR in DM1 was largely within the range of previous reports. Diabetes duration, HbA1c level, neuropathy, nephropathy and male gender were all significant predictors of DR severity. The patients with more severe DR had lower HRQoL.

Genetic testing for central areolar choroidal dystrophy

Abstract We studied the scientific literature and disease guidelines in order to summarize the clinical utility of the genetic test for central areolar choroidal dystrophy (CACD). CACD is mostly inherited in an autosomal dominant manner. Transmission is rarely autosomal recessive. Overall prevalence is currently 1-9 per 100 000. CACD is caused by mutations in the PRPH2 and GUCY2D genes. Clinical diagnosis is based on clinical findings, ophthalmological examination, fluorescein angiography, electroretinography (showing cone dystrophy) and stereo fundus photography. The genetic test is useful for confirming diagnosis, and for differential diagnosis, couple risk assessment and access to clinical trials.

Long-term Effects of Intravitreal 0.19 mg Fluocinolone Acetonide Implant on Progression and Regression of Diabetic Retinopathy

To investigate the effects of fluocinolone acetonide (FAc) on the progression to proliferative diabetic retinopathy (PDR) and the impact of FAc on changes in Early Treatment Diabetic Retinopathy Study (ETDRS) diabetic retinopathy (DR) severity scale (DRSS) grade during the Fluocinolone Acetonide in Diabetic Macular Edema (FAME) A and B Phase III clinical trials. Post hoc analysis of data from the 36-month prospective, randomized, FAME A and B trials. Patients with diabetic macular edema (DME) who received sham control or FAc 0.2 or 0.5 μg/day. A masked reading center (University of Wisconsin-Madison) determined DRSS grade and retinal perfusion status using standard 7-field stereo fundus photography and fluorescein angiography, respectively. Retinopathy changes over time were determined by DRSS step differences from baseline to month 36. Pairwise comparisons between the 3 treatment groups were performed using a log-rank test without adjustment for covariates, with the primary comparison between sham control and 0.2 μg/day FAc. Study eye progression to PDR based on a composite clinical outcome of (1)progression from nonproliferative diabetic retinopathy (NPDR) to PDR based on graded fundus photographs, (2)panretinal photocoagulation (PRP), or (3) pars plana vitrectomy (PPV) for PDR; and study eye changes on the DRSS. In the integrated FAME data set, compared with sham control-treated subjects, time to first PDR event was significantly delayed in subjects treated with FAc (P < 0.001), and this effect was confirmed in subgroups with more severe DR and chronic DME at baseline. In addition, subjects with retinal nonperfusion at baseline showed greater reduction in progression to PDR with FAc treatment. Both FAc dosages demonstrated statistically significant improvements in mean DR severity compared with sham treatment at months 6, 12, and 18. Numerically more subjects who received FAc experienced 2-or-more- or 3-or-more-step improvements in DR severity compared with subjects who received sham; conversely, fewer subjects treated with FAc experienced 2-or-more- or 3-or-more-step worsening in DR severity. The 3-or-more-step improvement with 0.5 μg/day FAc was statistically significantly different from sham control. In subjects with DME, sustained intraocular delivery of FAc slows development of PDR and slows progression of diabetic retinopathy.

Prevalence and risk factors of retinopathy in patients with or without metabolic syndrome: a population-based study in Shenyang

ObjectiveTo investigate the relationship between metabolic syndrome (MS) and the prevalence of retinopathy.DesignA cross-sectional study was carried out from August 2013 to September 2014 in Fengyutan Sub-District.Primary and secondary outcome...

Incidence, Progression, and Associated Risk Factors of Posterior Vitreous Detachment in Type 2 Diabetes Mellitus: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS II, Report No. 7)

ABSTRACTPurpose: To report the incidence and progression of posterior vitreous detachment (PVD) and factors influencing the same in a cohort of patients with type 2 diabetes in a South Indian population. Methods: A subset of 615 subjects from Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study II were included in this study. All of the subjects underwent detailed ophthalmic evaluation including stereo fundus photography. The status of PVD was assessed using B-scan ultrasonography. A p value of <0.05 was considered statistically significant. Results: The incidence of either incomplete PVD (IPVD) or complete PVD (CPVD) from no PVD at baseline visit was 80.8%. Of them, 32.63% converted to CPVD from IPVD at baseline. High prevalence of emmetropia was observed in subjects with stable No PVD. Risk factors associated with the conversion of CPVD from no PVD and IPVD at baseline were age (OR: 1.04, p = 0.002), myopia (OR: 2.14, p = 0.009), and increase in axial length (OR: 1.35, p = 0.004). Subjects undergoing cataract surgery were at 2.32 times higher risk of converting to CPVD (p = 0.038). Conclusion: Independent risk factors for the progression of PVD were increase in age, myopia, increased axial length, and cataract surgery.

Stereo imaging in ophthalmology

Stereo imaging in ophthalmology is an important diagnostic modality and a task not often undertaken in many ophthalmic photography departments. Origins of retinal stereo imaging date back to over 100 years ago. Stereo imaging is recommended, for example, for all photographs of the optic nerve head and for ocular angiography intended to determine clinically significant macular oedema. It is also useful in determining sub types of wet-form age-related macular degeneration. Stereo fundus photography and angiography facilitate the diagnostic process by clearly defining retinal structure and elevation. This allows the clinician to assess the patient's retina, presenting a 3D image that does not move and is not light sensitive. Stereo imaging of the fundus is useful for follow-up management of the patient, and is used extensively in clinical trials. This article will look at the history of stereo photography, its application and rationale to ophthalmology, and the different methods of attaining stereo images of the retina.

Comparement of stereo fundus photography with fundus fluorescein angiography for the incidence of cilioretinal arteries

Background To compare the stereo fundus photography and fundus fluorescein angiography (FFA) for the incidence of cilioretinal arteries.

The Association of Skin Intrinsic Fluorescence With Type 1 Diabetes Complications in the DCCT/EDIC Study

OBJECTIVETo determine whether skin intrinsic fluorescence (SIF) is associated with long-term complications of type 1 diabetes (T1D) and, if so, whether it is independent of chronic glycemic exposure and previous intensive therapy.RESEARCH DESIGN AND METHODSWe studied 1,185 (92%) of 1,289 active Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) participants from 2010 to 2011. SIF was determined using a fluorescence spectrometer and related cross-sectionally to recently determined measures of retinopathy (stereo fundus photography), cardiac autonomic neuropathy (CAN; R-R interval), confirmed clinical neuropathy, nephropathy (albumin excretion rate [AER]), and coronary artery calcification (CAC).RESULTSOverall, moderately strong associations were seen with all complications, before adjustment for mean HbA1c over time, which rendered these associations nonsignificant with the exception of sustained AER >30 mg/24 h and CAC, which were largely unaffected by adjustment. However, when examined within the former DCCT treatment group, associations were generally weaker in the intensive group and nonsignificant after adjustment, while in the conventional group, associations remained significant for CAN, sustained AER >30 mg/24 h, and CAC even after mean HbA1c adjustment.CONCLUSIONSSIF is associated with T1D complications in DCCT\\EDIC. Much of this association appears to be related to historical glycemic exposure, particularly in the previously intensively treated participants, in whom adjustment for HbA1c eliminates statistical significance.

Quantitative Evaluation of Papilledema from Stereoscopic Color Fundus Photographs

To derive a computerized measurement of optic disc volume from digital stereoscopic fundus photographs for the purpose of diagnosing and managing papilledema. Twenty-nine pairs of stereoscopic fundus photographs and optic nerve head (ONH) centered spectral domain optical coherence tomography (SD-OCT) scans were obtained at the same visit in 15 patients with papilledema. Some patients were imaged at multiple visits in order to assess their changes. Three-dimensional shape of the ONH was estimated from stereo fundus photographs using an automated multi-scale stereo correspondence algorithm. We assessed the correlation of the stereo volume measurements with the SD-OCT volume measurements quantitatively, in terms of volume of retinal surface elevation above a reference plane and also to expert grading of papilledema from digital fundus photographs using the Frisén grading scale. The volumetric measurements of retinal surface elevation estimated from stereo fundus photographs and OCT scans were positively correlated (correlation coefficient r(2) = 0.60; P < 0.001) and were positively correlated with Frisén grade (Spearman correlation coefficient r = 0.59; P < 0.001). Retinal surface elevation among papilledema patients obtained from stereo fundus photographs compares favorably with that from OCT scans and with expert grading of papilledema severity. Stereoscopic color imaging of the ONH combined with a method of automated shape reconstruction is a low-cost alternative to SD-OCT scans that has potential for a more cost-effective diagnosis and management of papilledema in a telemedical setting. An automated three-dimensional image analysis method was validated that quantifies the retinal surface topography with an imaging modality that has lacked prior objective assessment.

Optic Nerve Head Morphology and Visual Field Function in Patients with AIDS and without Infectious Retinitis

Purpose: To evaluate morphology of the optic nerve head and visual field in AIDS patients without retinitis.Methods: One randomly selected eye from 246 patients with AIDS without retinitis was evaluated from prospective multicenter Longitudinal Studies of Ocular Complications of AIDS. Stereo fundus photographs of OHN and serial VF data over 5-years were analyzed. Main outcomes included vertical cup-to-disc ratio (CDR), mean deviation, and pattern standard deviation scores on VF testing.Results: The median CDR was 0.39 at enrollment and 0.40 at 5-year follow-up. An unadjusted linear regression model revealed a mean change in CDR of 0.004 after 5-years (P = 0.04). After adjustment for practice effect, there were no statistically significant changes in VF performance observed during the 5 years of follow-up.Conclusions: We detected clinically minimal, but statistically significant changes in ONH morphology and no change in VF performance among eyes of patients with AIDS and without retinitis.

Prevalence of posterior vitreous detachment in the population with type II diabetes mellitus and its effect on diabetic retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study SN-DREAMS report no. 23

To report the prevalence of posterior vitreous detachment (PVD), and predisposing factors to PVD and their effect on diabetic retinopathy. Population-based study. The study included subjects with type II diabetes mellitus enrolled from a cross-sectional study. Participants underwent a biochemical examination, and a comprehensive ocular examination which included stereo fundus photography. Diabetic retinopathy was graded by use of Klein's classification and diabetic maculopathy was graded by use of the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. The status of the posterior vitreous was assessed by use of B-scan ultrasonography. The prevalence of PVD was 63.3 %. The risk factors for PVD included age, gender, sight-threatening diabetic retinopathy, and axial length. It was observed that incomplete PVD could lead to sight-threatening diabetic retinopathy. We report the prevalence and risk factors of PVD in subjects with diabetes mellitus. Incomplete PVD is a major risk factor for sight-threatening diabetic retinopathy.

Prevalence of Visual Impairment and Associated Risk Factors in Subjects with Type II Diabetes Mellitus: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS, Report 16).

Purpose:To report the prevalence of visual impairment (VI) and the associated risk factors in type II diabetic subjects.Materials and Methods:The study included type II diabetes mellitus subjects who were enrolled from a cross-sectional study. Participants underwent biochemical testing and comprehensive ocular examination including stereo fundus photography. The VI was defined based on the World Health Organization criteria.Results:The prevalence of VI was 4% in the cohort. The risk factors associated with the presence of VI included a female gender, age greater than 60 years, low socio-economic status, hypertension, microalbuminuria, macroalbuminuria, neuropathy, use of insulin and alcohol. Various ocular risk factors are nuclear sclerosis, subjects who have undergone cataract surgery, myopia and sight-threatening diabetic retinopathy (STDR). After adjusting for the factors using stepwise logistic regression analysis, hypertension, use of alcohol, post-cataract surgery and myopia were not risk factors. Stepwise logistic regression analysis indicated that VI was higher among subjects older than 60 years (odds ratio (OR): 4.95 [2.67-9.15]) and those who belonged to a low socio-economic status (OR: 2.91 [1.24-6.85]). The systemic risk factors for VI included microalbuminuria (OR: 2.91 [1.59-5.33]), macroalbuminuria (OR: 4.65 [1.57-13.77]) and presence of neuropathy (OR: 1.97 [1.09-3.59]) among subjects. Subjects with nuclear sclerosis (OR: 36.82 [11.12-112.36]) and presence of STDR (OR: 4.17 [1.54-11.29]) were at a higher risk of VI. Cataract was the most common cause of VI in the cohort.Conclusion:Visual impairment, among type II diabetic subjects (4%), is a major public health problem that needs to be addressed. Cataract is the most common reversible cause of vision impairment in this population.