Vision-threatening Retinopathy Research Articles

Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services

IntroductionThe aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility...

Clinical Validation of a Program for Diagnosing Vision-Threatening Diabetic Retinopathy Based on Automatic Segmentation Algorithms

Background. Diabetic retinopathy is a very common, debilitating disease that requires early diagnosis and treatment. The development of new screening methods is a priority area of medicine in recent years. Purpose: Approbation of the software (SW) based on algorithms for automatic segmentation of signs of DR “Retina AI” in clinical practice, the study of the capabilities of the software “Retina AI” in the diagnosis of vision-threatening DR.Methods. Analysis of clinical data obtained from patients undergoing diagnostics and treatment at the Federal Research and Clinical Center for Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia and the Moscow Regional Scientific Research Clinical Institute. 123 photographs of the fundus were analyzed using the RETINA.AI platform. Fundus photography was carried out using a fundus camera VISUCAM 500 (Zeiss).Results. In the process of analyzing fundus photographs with Retina AI algorithms, a high efficiency of automatic detection of vision-threatening retinopathy was revealed. The accuracy of the method in diagnosing vision-threatening DR was 95 %, sensitivity — 96.59 %, specificity — 91.4 %, ROC AUC — 0.94.Conclusion. The DR diagnostic program based on adaptive segmentation algorithms is a tool for solving the DR screening problem.

109-OR: Prior Cerebrovascular Disease Was Positively Associated with Severe Diabetic Retinopathy and Diabetic Macular Edema in Type 2 Diabetes

Background and Purpose: Although it is well established that diabetic retinopathy (DR) and diabetic macular edema (DME) are risk factors for incident cerebrovascular disease (CVD), whether the CVD history could be a predictor of severe DR or DME remains unknown among people with type 2 diabetes. Also, the effects of aging or systolic blood pressure on incident severe DR or DME in individuals with a history of CVD remains unknown. Methods: Severe DR and DME were defined as vision-threatening treatment-required diabetic eye diseases (TRDED). Enrolled were 31,638 Japanese patients with type 2 diabetes. We longitudinally explored the existence of such an association not only overall but also according to various factors. Results: The main outcome of TRDED was observed in 854 (2.7%) patients during a mean follow-up of 5.3 years (5.1/1,000 person-years). Prior CVD was present in 694 of 31,638 (2.2%) patients at baseline. In a multivariate adjusted Cox regression model, prior CVD was positively associated with incident TRDED in analysis of the study population (hazard ratio, 1.63 [95% confidence interval, 1.11-2.37] overall; 1.47 [0.54, 3.99] for age ≤49 y; 1.69 [1.12, 2.55] for age ≥50 y; 1.46 [0.89, 2.39] for SBP ≤139 mmHg; 1.97 [1.09, 3.58] for SBP ≥140 mmHg). All results, including several stratified analyses, correlated with visual inspection of the corresponding Kaplan-Meier analysis with log-rank tests indicating gaps between curves for those with and without prior CVD. Conclusions: These results indicate that CVD is a predictor of vision-threatening severe retinopathy, and suggested that they shared a common background pathophysiology. It also contributed to preventing severe visual impairment and further deterioration of the quality of life after stroke. Disclosure M.Yamamoto: None. M.Iwanaga: None. T.Yamada: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. H.Hasebe: None. H.Shiozaki: None. R.Kodera: None. T.Sato: None. Y.Yaguchi: None. T.Osawa: None. Y.Matsubayashi: None. Funding Japan Society for the Promotion of Science (JP21K11569, JP22K16212)

In a Large Healthcare System in the Bronx, Teleretinal Triaging Was Found to Increase Screening and Healthcare Access for an Underserved Population with a High Incidence of T2DM and Retinopathy

The early treatment of diabetic retinopathy (DR) prevents vision-threatening proliferative retinopathy (PDR) and macular edema (DME). Our study evaluates telemedicine (teleretinal) screening for DR in an inner-city healthcare network with a high ethnic diversity and disease burden. Fundus photographs were obtained and graded in a centralized reading center between 2014 and 2016. Patients with positive screenings were referred to a retina specialist. An analysis of sensitivity and specificity and a subgroup analysis of prevalence, disease severity, and follow-up adherence were conducted. In 2251 patients, the '1-year' and 'Overall' follow-ups were 35.1% and 54.8%, respectively. Severe grading, male gender, and age were associated with better follow-up compliance. The DR, PDR, and DME prevalence was 24.9%, 4.1%, and 5.9%, respectively, and was significantly associated with HbA1c. The sensitivity and specificity for DR, PDR, and DME were 70% and 87%, 87% and 75%, and 37% and 95%, respectively. No prevalence differences were noted between ethnicities. Annual diabetic eye exam adherence increased from 55% to 85% during the study period. Teleretinal triaging is sensitive and specific for DR and improved diabetic eye exam compliance for underserved populations when integrated into large healthcare networks. The adherence to follow-up recommendations was better among older patients and among those with more severe retinopathy.

Antenatal risk factors for retinopathy of premature

This literature review presents the antenatal risk factors for the development of retinopathy of prematurity (ROP). Despite advances in antenatal and neonatal therapeutic interventions, screening, and follow-up, ROP remains a potentially vision-threatening retinopathy that requires careful monitoring and timely intervention to prevent the progression of adverse visual impairment or blindness. ROP is a multifactorial disease. The main risk factors are low gestational age and low birth weight. Recent experimental and clinical data support the hypothesis that multiple antenatal factors are involved in the etiology and progression of ROP. These factors include the age of the mother, maternal diseases, pregnancy-associated maternal pathologies, use of drugs to correct these conditions, and inflammatory process. Their roles are ambiguous and often contradictory. The physiology of the mother and placenta can significantly influence the risk of ROP development in preterm infants. The placenta connects the mothers body and the fetus, and it functions in the exchange of nutrients and oxygen between the mother and the fetus. Therefore, any pathological changes in the mothers body entail changes in the placenta, which this directly affects the fetus. A sudden loss of placental support is detrimental to the development of infants in the immediate postnatal period. Thus, these factors should be taken into account when assessing the risk of ROP development to predict and prevent poor vision in children.

Prevalence of diabetic retinopathy in patients with newly diagnosed type 2 diabetes: A systematic review and meta-analysis.

Type 2 diabetes mellitus (T2DM) can remain undiagnosed for many years, during which micro- and macro-vascular complications may develop. This study aimed to assess the worldwide prevalence of diabetic retinopathy (DR) in patients with newly diagnosed T2DM. We systematically searched electronic databases for relevant studies published from inception to 01 January 2022. Selected studies reported the prevalence of DR among patients with newly diagnosed T2DM, specifying the case definition used. Random-effects meta-analysis was used to derive the pooled prevalence. Subgroup and meta-regression analyses were used to investigate variations in the prevalence estimates in terms of available variables. Data from 77 studies including 99,847 patients with newly diagnosed T2DM were included from 26 countries. The pooled prevalence of DR among patients with newly diagnosed T2DM was 13.1% (95% CI, 11.1%-15.1%; I2 =97.0%). DR was higher in clinic-based samples compared with community-based samples (15.0%, 95% CI=12.4%-17.8% vs. 11.5%, 95% CI=8.9%-14.5%; p=0.05; I2 =97.0%) and was higher in countries in the WHO African 19.2% (95% CI, 14.6%-24.3%; I2 =76.0%), South-East Asia 15.4% (95% CI, 10.0%-21.6%; I2 =79.1%), and European 15.0% (95% CI, 11.2%-19.2%; I2 =82.0%) regions. A higher proportion of female patients was significantly associated with a lower prevalence of DR in patients with newly diagnosed T2DM. We observed that the prevalence of DR in patients with newly diagnosed T2DM has remained unchanged over time. Globally, DR is a prevalent complication among patients with newly diagnosed T2DM indicating the importance of establishing effective strategies to promote regular screening for the early diagnosis of T2DM alongside routine ophthalmic assessment at the time of T2DM diagnosis to reduce the burden of vision-threatening retinopathy.

Certain Dietary Nutrients Reduce the Risk of Eye Affliction/Retinopathy in Individuals with Diabetes: National Health and Nutrition Examination Survey, 2003-2018.

As the global trend of diabetes intensifies, the burden of vision-threatening retinopathy, particularly diabetic retinopathy (DR), is increasing. There is an urgent need to seek strategies for early prevention and control of DR. This study attempted to comprehensively evaluate the relationship between dietary nutrient intake and the risk of DR to provide assistance for doctors in guiding the diet of diabetic patients. Data from eligible participants with diabetes from the US National Health and Nutrition Examination Survey (NHANES) from 2003–2018 were analyzed. Univariate logistic regression was used to assess the association between 58 dietary nutrient intakes and self-reported eye disease risk. Multivariate logistic regression model was used to further evaluate the relationship between the two groups after adjusting relevant confounding factors. A total of 4595 diabetic patients were included. People with self-reported eye affliction/retinopathy had lower dietary fiber, butanoic, octanoic, vitamin A, alpha-carotene, folate, magnesium, copper and caffeine intake compared to those without self-reported eye affliction/retinopathy. The pooled ORs (95% CIs) were 0.78 (0.62–0.98), 0.79 (0.63–0.99), 0.72 (0.58–0.91), 0.74 (0.59–0.93), 0.70 (0.55–0.88), 075 (0.60–0.95), 0.79 (0.64–0.99), 0.67 (0.54–0.84) and 0.80 (0.64–0.99). Dietary cholesterol and hexadecenoic intake were higher, with the pooled ORs (95% CIs) of 1.26 (1.01–1.58) and 1.27 (1.02–1.59), respectively. Our research found that among dietary nutrients, dietary fiber, butanoic, octanoic, vitamin A, alpha-carotene, folate, magnesium, copper and caffeine intake reduced the occurrence of DR. Cholesterol and hexadecenoic intake promoted the occurrence of DR. This suggests that certain dietary nutrients should be paid more attention in the prevention of DR.

The Impact of Optical Coherence Tomography in the Early Identification of Children with Sickle Cell Retinopathy.

Introduction Sickle cell disease is characterized by the production of abnormal hemoglobin, which affects hemoglobin molecule stability during hypoxia and leads to the formation of sickle cells, resulting in increased hematic viscosity, hemolysis, and microvascular blockage. Vasoocclusion is assumed to be the primary cause of vision-threatening retinopathy in sickle cell disease. The aim of this study was to improve the early detection of sickle cell retinopathy (SCR) in children with sickle cell disease (SCD) and investigate the link between systemic and ocular symptoms. Methods This cross-sectional study comprised children with SCD. The patient files provided a detailed medical history. The laboratory tests included a blood count, reticulocyte count, and Hb electrophoresis. The slit lamp, fundus, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) were all part of the ophthalmological examination. Results The study comprised 15 children with sickle cell disease who met the inclusion and exclusion criteria, with a mean age of 11.15 ± 1.29 years. Nine of the children were males (60%) and six were females (40%). 8 (53.3%) of the children had Hb SS, three (20%) had Hb SC, three (20%) had Hb SB+, and one (6.7%) had Hb SB0. Four children (26.7%) had poor visual acuity. A fundus examination revealed significant abnormal findings in 12 of the 7 children's eyes (40 percent). Macular thinning was detected by OCT in 10 eyes of 7 children (33.3%). Flow voids at the deep retinal capillary plexus were detected by OCTA in 10 eyes of 7 children (33.3%). Longer disease duration, higher reticulocytic percent, more painful crises, and noncompliance with hydroxyurea medication were all linked to the existence of eye abnormalities on fundus examination and OCT. Conclusion OCTA can show early retinal damage in sickle cell patients with macular changes. Sickle cell retinopathy is usually associated with more severe disease.

472-P: Sex Differences in the Effect of High Serum Uric Acid on the Incidence of Vision-Threatening Retinopathy in Those with Type 2 Diabetes

Elevated serum uric acid reportedly increases the risk of development and progression of diabetic retinopathy with conflicting results. However, whether it also increases the incidence of severe vision-threatening diabetic eye diseases has been scarcely investigated. Also unknown is whether there are sex differences in the incidence of advanced retinopathies. To clarify this, we utilized ICD-and medical treatment codes from a nationwide claims database that finally included 13,721 type 2 diabetes patients (mean age 50 y, HbA1c 7.0%, mean follow-up period 5.8 y, 10,962 men) . During the study period, 388 patients developed vision-threatening treatment-required diabetic eye diseases (4.9/1000 person-years) . Multivariate Cox analysis demonstrated that a serum uric acid ≥7.1 mg/dl was significantly positively associated in men with future occurrence of treatment-required diabetic eye diseases, but not in women. Hazard ratios for those with serum uric acid ≥7.1 mg/dl for incident treatment-required diabetic eye diseases were 1.36 (95% confidence interval, 1.01-1.85) in men and 2. (0.71-6.08) in women, compared with the reference group (<7.1 mg/dl) after adjusting for covariates. This finding suggested that the effect of high serum uric acid on the development of vision-threatening retinopathy in individuals with type 2 diabetes differed between men and women. Although estrogen-induced effects, decreased antioxidant activity, and increased oxidative stress may partially explain the differences in results between men and women, further investigation is needed. Disclosure M. Yamamoto: None. K. Fujihara: None. H. Ishiguro: None. M. Ishizawa: None. M.H. Yamada: None. T. Osawa: None. M. Kitazawa: None. M. Kaneko: None. M. Iwanaga: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Takeda Pharmaceutical Company Limited. Funding The Japan Society for the Promotion of Science and the Ministry of Health, Labor and Welfare, Japan. (18K17897)

Association of heart rate variability with progression of retinopathy among adults with type 2 diabetes.

AimWe evaluated the associations of heart rate variability (HRV) with incident vision‐threatening retinopathy and retinopathy progression among adults with type 2 diabetes.MethodsParticipants recruited to the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study with HRV measures at baseline were analysed. HRV measures included standard deviation of all normal‐to‐normal intervals (SDNN) and root mean square of successive differences between normal‐to‐normal intervals (rMSSD). Low SDNN was defined as SDNN <8.2 ms; low rMSSD as rMSSD <8.0 ms. We used multivariable adjusted Cox proportional hazards and modified Poisson regression models to generate risk estimates for incident vision‐threatening retinopathy and retinopathy progression, respectively.ResultsA total of 5810 participants without incident vision‐threatening retinopathy at baseline (mean age 62 years, 40.5% women, 63.5% White) were included. Over a median of 4.7 years, 280 incident vision‐threatening retinopathy cases requiring treatment occurred. Low HRV (vs. normal HRV) was associated with higher risk of incident vision‐threatening retinopathy (adjusted hazard ratio 1.32 [95%CI 1.03–1.71] and 1.14 [95%CI 1.01–1.28] for low SDNN and rMSSD, respectively). In the subset of 2184 participants with complete eye examinations at baseline and 4 years, 191 experienced retinopathy progression, and low HRV (vs. normal HRV) was associated with a higher risk of retinopathy progression (adjusted relative risks 1.36 [95%CI 1.01–1.83] and 1.36 [95%CI 1.01–1.84] for low SDNN and rMSSD, respectively).ConclusionsCardiac autonomic neuropathy, as assessed by low HRV, was independently associated with increased risks of incident vision‐threatening retinopathy and overall retinopathy progression in a large cohort of adults with type 2 diabetes.

Progression to Vision-Threatening Retinopathy Complications Following Panretinal Laser for Proliferative Diabetic Retinopathy.

To report the time in which patients with panretinal photocoagulation (PDR) progress to vision-threatening retinopathy (VTR) complications after receiving PRP, and risk factors in routine clinical practice. Records of patients with complete PRP for PDR were retrospectively reviewed for up to 3.5 years after PRP. Two hundred twenty eyes were selected. Time from PRP to VTR was 1.25 ± 0.82 years. Age, Black race, neovascularization of the disc on examination, diabetic foot disease (DFD), and high-risk PDR characteristics on fluorescein angiography were identified as significant risk factors. Half of patients with DFD on examination developed a VTR within 1.5 years after PRP (P < .001). In clinical practice, providers may consider DFD and Black race as predictors of time to VTR event within 4 years after PRP in patients with PDR. [Ophthalmic Surg Lasers Imaging Retina. 2022;53(4):186-193.].

Frequent Eye Examinations Urged for Children with Type 2 Diabetes.

According to this study: Children who had type 2 diabetes developed vision-threatening retinopathy after a shorter duration of diabetes and at a higher rate than children who had type 1 diabetes.Children who have type 2 diabetes may need eye examinations as frequently or more frequently than those who have type 1 diabetes.

Validation of Computer-Aided Diagnosis of Diabetic Retinopathy from Retinal Photographs of Diabetic Patients from Telecamps

Objective: To validate an algorithm previously developed by the Healthcare Technology Innovation Centre, IIT Madras, India for screening of diabetic retinopathy (DR), in fundus images of diabetic patients from telecamps to examine the screening performance for DR. Design: Photographs of patients with diabetes were examined using the automated algorithm for the detection of DR Setting: Mobile Teleophthalmology camps were conducted in two districts in Tamil Nadu, India from Jan 2015 to May 2017. Participants: 939 eyes of 472 diabetic patients were examined at Mobile Teleophthalmology camps in Thiruvallur and Kanchipuram districts, Tamil Nadu, India,. Fundus images were obtained (40-45-degree posterior pole in each eye) for all patients using a nonmydriatic fundus camera by the fundus photographer. Main Outcome Measures: Fundus images were evaluated for presence or absence of DR using a computer-assisted algorithm, by an ophthalmologist at a tertiary eye care centre (reference standard) and by a fundus photographer. Results: The algorithm demonstrated 85% sensitivity and 80% specificity in detecting DR compared to ophthalmologist. The area under the receiver operating characteristic curve was 0.69 (95%CI=0.65 to 0.73). The algorithm identified 100% of vision-threatening retinopathy just like the ophthalmologist. When compared to the photographer, the algorithm demonstrated 81% sensitivity and 78% specificity. The sensitivity of the photographer to detect DR was found to be 86% and specificity was 99% in detecting DR compared to ophthalmologist. Conclusions: The algorithm can detect the presence or absence of DR in diabetic patients. All findings of vision-threatening retinopathy could be detected with reasonable accuracy and will help to reduce the workload for human graders in remote areas.

The risk for developing vision-threatening retinopathy after cataract surgery in diabetic patients depends on the postoperative follow-up time.

To identify parameters that can predict the postoperative risk for progression of retinopathy to a vision-threatening stage after cataract surgery. This may optimize the timing of surgery and the postoperative follow-up strategy in diabetic patients. Multi-state survival analysis with death as competing risk was used to investigate how year of onset and age of onset of diabetes, gender, body mass index, HbA1c and blood pressure had affected the risk for developing diabetic macular oedema (DME) and proliferative diabetic retinopathy (PDR) among 2540 right eyes from 2797 diabetic patients operated for cataract on one or both eyes during 25 years until July 1. 2019. Cataract surgery had been performed in 98.8% of patients reaching 90 years of age. The risk for developing both DME and PDR was increased by cataract surgery. The risk was highest during the first postoperative years and increased by pre-operative variability in HbA1c. The risk after more than 20 years postoperatively increased by increased cumulative HbA1c pre-operatively. The other studied risk factors contributed differently to the development of the two complications. Decision models for the timing of cataract surgery in diabetic patients should consider that the risk for developing vision-threatening retinopathy depends on follow-up time. Differences in the risk profiles for developing DME and PDR after cataract surgery support that the two complications should be regarded as separate late complications.

434-P: Large Quantity of Alcohol Intake per Occasion was Positively Associated with Vision-Threatening Eye Diseases in Japanese Men with Type 2 Diabetes

Heavy total alcohol consumption was reported to increase the risk of development and progression of diabetic retinopathy. However, differing from total alcohol consumption, whether the quantity of alcohol intake per occasion had harmful or beneficial effects related to severe eye diseases caused by diabetes remains unknown. To clarify this, we utilized ICD-10 and medical treatment codes from a nationwide claims database that finally included 21,392 men with type 2 diabetes (mean age 53 y, HbA1c 7.0%, mean follow-up period 4.3 y). During the study period, 425 patients developed vision-threatening treatment-required diabetic eye diseases (TRDED) (4.6/1000 person-years). Multivariate Cox analysis demonstrated that a large quantity of alcohol per occasion defined as ≥3 drinks per occasion was positively associated with future occurrence of TRDED. One drink was defined as a standard Japanese drink with a volume equivalent to 23 g ethanol. Hazard ratio in patients drinking large amounts of alcohol per occasion for incident TRDED was 4.49 (95% confidence interval, 1.98-10.19) compared with the reference group (≤1 drink per occasion) after adjusting for covariates including total alcohol consumption. This finding demonstrated that a large quantity of alcohol per occasion had a significant association with future vision-threatening retinopathy in men with type 2 diabetes. The mechanism of this finding with regard to severe retinopathy awaits further research. Disclosure M. Yamamoto: None. T. Yamada: None. S. Kodama: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., Novo Nordisk, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co. K. Fujihara: None. Y. Yaguchi: None. T. Osawa: None. M. Kaneko: None. M. Kitazawa: None. T. Sato: None. M. H. Yamada: None. Y. Matsubayashi: None.

Artificial intelligence for improving sickle cell retinopathy diagnosis and management.

Sickle cell retinopathy is often initially asymptomatic even in proliferative stages, but can progress to cause vision loss due to vitreous haemorrhages or tractional retinal detachments. Challenges with access and adherence to screening dilated fundus examinations, particularly in medically underserved areas where the burden of sickle cell disease is highest, highlight the need for novel approaches to screening for patients with vision-threatening sickle cell retinopathy. This article reviews the existing literature on and suggests future research directions for coupling artificial intelligence with multimodal retinal imaging to expand access to automated, accurate, imaging-based screening for sickle cell retinopathy. Given the variability in retinal specialist practice patterns with regards to monitoring and treatment of sickle cell retinopathy, we also discuss recent progress toward development of machine learning models that can quantitatively track disease progression over time. These artificial intelligence-based applications have great potential for informing evidence-based and resource-efficient clinical diagnosis and management of sickle cell retinopathy.

Four-Year Screening Interval and Vision-Threatening Retinopathy in Type 2 Diabetes Patients With Good Glycemic Control

ObjectiveTo assess whether vision-threatening retinopathy developed after 4 years in patients with type 2 diabetes with good glycemic control during follow-up. Patients and MethodsUsing data from the Action to Control Cardiovascular Risk in Diabetes and Action to Control Cardiovascular Risk in Diabetes Follow-on studies (conducted from January 1, 2001, to October 14, 2014), we investigated the incidence of vision-threatening retinopathy after 4 years in patients with type 2 diabetes with good or poor glycemic control. Patients with proliferative diabetic retinopathy at baseline were excluded. Vision-threatening retinopathy was defined as severe nonproliferative diabetic retinopathy, proliferative diabetic retinopathy, laser photocoagulation, or vitrectomy. Good and poor glycemic control was defined as mean glycated hemoglobin level less than 7% and 7% or greater during follow-up, respectively. ResultsThis study included 2285 patients. Among patients with no retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was 0% (0 of 386) and 0.8% (6 of 721) in those with good and poor glycemic control, respectively (P=.54). Similarly, severe retinopathy was not observed at 8 years in patients who did not have retinopathy at 4 years. Among patients with mild to moderate nonproliferative diabetic retinopathy at baseline, the 4-year incidence of vision-threatening retinopathy was significantly higher in those with poor glycemic control than in those with good glycemic control (9.7% [77 of 790] vs 4.4% [13 of 297]; P=.004). Additionally, the remission rate of diabetic retinopathy was low in patients with a long duration of diabetes. Four-year incidences of vision-threatening retinopathy were higher in patients with retinopathy at baseline who had poorer glycemic control and longer durations of diabetes. ConclusionIt may be safe to extend screening intervals for diabetic retinopathy to 4 years or longer in patients with type 2 diabetes with no retinopathy.

Prevalence of diabetic retinopathy in self-reported diabetics among various ethnic groups and associated risk factors in North-East India: A hospital-based study.

Purpose:To describe the prevalence and severity of diabetic retinopathy (DR) among different ethnic groups of North-East India and to study the associated risk factors.Methods:In this hospital based cross sectional study 7,133 individuals among the age group of 20-79 years, attending the OPD, were screened for presence of Diabetes Mellitus (DM) (HbA1c >7% or previously diagnosed). Among them, 780 (10.94%) had diabetes; they were evaluated for presence of any retinopathy (based on fundus photograph and fluorescein angiography), its grade (based on International DR severity scale), and risk factors. DR patients were further grouped into different ethnicities (Assamese, Bengali, minor tribes, and other immigrants).Results:Of the 780 patients with diabetes, 58 patients had type 1 DM and 722 patients had type 2 DM. The overall prevalence of DR was 30.0% with vision-threatening retinopathy and maculopathy being 10.00% and 4.49%, respectively. The prevalence of retinopathy range was the highest in the immigrants’ group (50.00% among type 1 DM and 44.93% among type 2 DM) and lowest in the tribal's groups (16.67% among type 1 DM and 22.35% among type 2 DM). The risk factors showing significant association with DR were longer diabetes duration, older age, family history of diabetes, higher HbA1c level, associated hypertension, hypertriglyceridemia, and pregnancy state (P value <0.05).Conclusion:Every third patient with diabetes had some form of DR with Vision Threatening DR (VTDR) affecting every tenth patient. There was also a wide variation in the prevalence of DR among ethnic groups and this difference could not be attributed to variation in the known measurable risk factors among different ethnic groups, thus signifying the role of ethnicity in occurrence and severity of DR.

Deep Learning Detection of Sea Fan Neovascularization From Ultra-Widefield Color Fundus Photographs of Patients With Sickle Cell Hemoglobinopathy

Adherence to screening for vision-threatening proliferative sickle cell retinopathy is limited among patients with sickle cell hemoglobinopathy despite guidelines recommending dilated fundus examinations beginning in childhood. An automated algorithm for detecting sea fan neovascularization from ultra-widefield color fundus photographs could expand access to rapid retinal evaluations to identify patients at risk of vision loss from proliferative sickle cell retinopathy. To develop a deep learning system for detecting sea fan neovascularization from ultra-widefield color fundus photographs from patients with sickle cell hemoglobinopathy. In a cross-sectional study conducted at a single-institution, tertiary academic referral center, deidentified, retrospectively collected, ultra-widefield color fundus photographs from 190 adults with sickle cell hemoglobinopathy were independently graded by 2 masked retinal specialists for presence or absence of sea fan neovascularization. A third masked retinal specialist regraded images with discordant or indeterminate grades. Consensus retinal specialist reference standard grades were used to train a convolutional neural network to classify images for presence or absence of sea fan neovascularization. Participants included nondiabetic adults with sickle cell hemoglobinopathy receiving care from a Wilmer Eye Institute retinal specialist; the patients had received no previous laser or surgical treatment for sickle cell retinopathy and underwent imaging with ultra-widefield color fundus photographs between January 1, 2012, and January 30, 2019. Deidentified ultra-widefield color fundus photographs were retrospectively collected. Sensitivity, specificity, and area under the receiver operating characteristic curve of the convolutional neural network for sea fan detection. A total of 1182 images from 190 patients were included. Of the 190 patients, 101 were women (53.2%), and the mean (SD) age at baseline was 36.2 (12.3) years; 119 patients (62.6%) had hemoglobin SS disease and 46 (24.2%) had hemoglobin SC disease. One hundred seventy-nine patients (94.2%) were of Black or African descent. Images with sea fan neovascularization were obtained in 57 patients (30.0%). The convolutional neural network had an area under the curve of 0.988 (95% CI, 0.969-0.999), with sensitivity of 97.4% (95% CI, 86.5%-99.9%) and specificity of 97.0% (95% CI, 93.5%-98.9%) for detecting sea fan neovascularization from ultra-widefield color fundus photographs. This study reports an automated system with high sensitivity and specificity for detecting sea fan neovascularization from ultra-widefield color fundus photographs from patients with sickle cell hemoglobinopathy, with potential applications for improving screening for vision-threatening proliferative sickle cell retinopathy.

New Insights into Diabetic and Vision-Threatening Retinopathy: Importance of Plasma Long Pentraxine 3 and Taurine Levels

ABSTRACT Purpose To investigate diabetic retinopathy (DR), plasma long pentraxin-3 (PTX-3) and taurine levels, and systemic factors in patients with type 2 diabetes mellitus (DM). Materials and Methods Patients with type 2 DM were categorized based on the presence of DR and maculopathy. Retinal findings (retinopathy, maculopathy, flame-shaped hemorrhage, intraretinal microvascular abnormalities, neovascularization of the optic disc, neovascularization elsewhere, and soft exudate); laboratory findings (fasting blood glucose, glycosylated hemoglobin [HbA1c], Taurine, PTX-3); systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed. Results In this study, 39 patients with a mean age of 59.5 ± 8.1 years were included. The mean taurine level was significantly lower (p = .025) and HbA1c values were significantly higher (p = .0001) in patients with and without DR, respectively. In patients with varying severity of DR, a significant difference in the plasma taurine level was found (p = .0001). The mean PTX-3 level decreased with the severity of retinopathy; however, there was no significant difference in levels among the grading groups (p = .732). Taurine and PTX-3 levels were significantly lower in patients with maculopathy (p = .001 and p = .022, respectively) and significantly higher in patients with grade 0 maculopathy than in those with grade 1, 2, or 3 maculopathy (p = .023, p = .01, and p = .01, respectively). Patients with flame-shaped hemorrhage had significantly lower PTX-3 levels (p = .009) and higher SBP and DBP levels (p = .003, p = .023) than those without the hemorrhage. Conclusions No significant relation between PTX-3 level and severity of DR was found. HbA1c, taurine, and PTX-3 levels in patients with vision-threatening DR symptoms were significantly different from those without these symptoms. Management of systemic blood pressure and glycemic control is mandatory in the follow-up of DR, and increasing the plasma taurine levels can prevent vision loss.