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Gao Y, Lu RX, Tang Y, Yang XY, Meng H, Zhao CL, Chen YL, Yan F, Cao Q. Systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in patients with type 2 diabetes at different stages of diabetic retinopathy. Int J Ophthalmol 2024; 17:877-882. [PMID: 38766329 PMCID: PMC11074207 DOI: 10.18240/ijo.2024.05.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024] Open
Abstract
AIM To investigate systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) levels in patients with type 2 diabetes at different stages of diabetic retinopathy (DR). METHODS This retrospective study included 141 patients with type 2 diabetes mellitus (DM): 45 without diabetic retinopathy (NDR), 47 with non-proliferative diabetic retinopathy (NPDR), and 49 with proliferative diabetic retinopathy (PDR). Complete blood counts were obtained, and NLR, PLR, and SII were calculated. The study analysed the ability of inflammatory markers to predict DR using receiver operating characteristic (ROC) curves. The relationships between DR stages and SII, PLR, and NLP were assessed using multivariate logistic regression. RESULTS The average NLR, PLR, and SII were higher in the PDR group than in the NPDR group (P=0.011, 0.043, 0.009, respectively); higher in the NPDR group than in the NDR group (P<0.001 for all); and higher in the PDR group than in the NDR group (P<0.001 for all). In the ROC curve analysis, the NLR, PLR, and SII were significant predictors of DR (P<0.001 for all). The highest area under the curve (AUC) was for the PLR (0.929 for PLR, 0.925 for SII, and 0.821 for NLR). Multivariate regression analysis indicated that NLR, PLR, and SII were statistically significantly positive and independent predictors for the DR stages in patients with DM [odds ratio (OR)=1.122, 95% confidence interval (CI): 0.200-2.043, P<0.05; OR=0.038, 95%CI: 0.018-0.058, P<0.05; OR=0.007, 95%CI: 0.001-0.01, P<0.05, respectively). CONCLUSION The NLR, PLR, and SII may be used as predictors of DR.
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Affiliation(s)
- Ying Gao
- Department of Ophthalmology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211112, Jiangsu Province, China
| | - Rong-Xin Lu
- Department of Thoracic Surgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Yun Tang
- Medical School, Nanjing University, Nanjing 210093, Jiangsu Province, China
| | - Xin-Yi Yang
- Department of Ophthalmology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Hu Meng
- Department of Ophthalmology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Chang-Lin Zhao
- Department of Ophthalmology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211112, Jiangsu Province, China
| | - Yi-Lu Chen
- Department of Ophthalmology, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211112, Jiangsu Province, China
| | - Feng Yan
- Department of Ophthalmology, Taikang Xianlin Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210046, Jiangsu Province, China
| | - Qian Cao
- Department of Ophthalmology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
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Zajner C, Moayad L, Popovic MM, Kertes PJ, Kohly RP, Wong D, Muni RH. Relationship Between Disease and Treatment Factors in Diabetes With Vision Difficulty: A Cross-Sectional, Population-Based Analysis. Ophthalmic Surg Lasers Imaging Retina 2024; 55:142-153. [PMID: 38270564 DOI: 10.3928/23258160-20240110-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Relationships between disease and treatment factors of diabetes and vision difficulty remain largely unknown. This study investigated the relationship between disease and treatment factors in diabetes and participants' self-reported vision difficulty. PATIENTS AND METHODS This was a cross-sectional, population-based analysis. Data from the National Health Interview Survey was used and analyzed through univariable and multivariable logistic regression. RESULTS From the 29,464 included participants, logistic regression showed increased odds of self-reported vision difficulty among participants with diabetes (odds ratio [OR] = 2.14, P < 0.001), prediabetes (OR = 1.95, P < 0.001), or gestational diabetes (OR = 1.54, P < 0.001) compared to participants without diabetes. Those who reported having diabetes for more than a year had higher odds of vision difficulty (OR = 1.97, P = 0.02), as did those who were taking insulin (OR = 1.62, P < 0.001), those who had taken less insulin to save money within the past year (OR = 1.87, P = 0.01), and those who reported experiencing diabetes-related stress (OR = 2.14, P < 0.001). CONCLUSIONS Duration of diabetes, diabetes-related stress, and taking less insulin than recommended to save money were associated with vision difficulty. [Ophthalmic Surg Lasers Imaging Retina 2024;55:142-153.].
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Pot E, Guenezan L, Pelen F, Facon G. [Evaluation of an experiment in ophthalmology telemedicine]. J Fr Ophtalmol 2024; 47:103986. [PMID: 38123443 DOI: 10.1016/j.jfo.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To meet the need for access to eye care in an area with a lack of physicians, a telemedicine workstation in ophthalmology was created. The main objective was to measure the improved access to eye care via telemedicine consultation. METHODS No criteria of age, sex or geographical location were defined. Depending on the cause for the consultation and the results of the examinations conducted by an ophthalmic technician physically present in the center, the patient might be given a telemedicine consultation with an ophthalmologist. Eleven indicators were defined to achieve the study objectives. Data were compared with a reference eye care center. RESULTS The quality, safety of care, and medical benefits of telemedicine consultation were not inferior to those of the reference center. The consultations screened 25 cases of age-related macular degeneration, 240 glaucoma, 229 cataracts and 27 diabetic retinopathy. 88.5% of patients were included in a cooperative ophthalmologist/technician protocol, compared with 27.3% in the reference center (P<0.0001). DISCUSSION The telemedicine workstation must be linked to a main center located at most a one-hour drive away. The equipment must be adapted to the use of telemedicine and to allow the technician to perform the necessary assessments and examinations. The number of emergency department visits after telemedicine consultation at the telemedicine workstation was higher than the reference center, which may lead to a subsequent study. CONCLUSION Telemedicine consultation improves access to eye care in a medically under-served area.
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Affiliation(s)
- E Pot
- Section santé publique, Epcare, 49, rue Molière, 92120 Montrouge, France
| | - L Guenezan
- Section santé publique, Epcare, 49, rue Molière, 92120 Montrouge, France.
| | - F Pelen
- Groupe Point Vision, 15, rue Pasquier, 75008 Paris, France
| | - G Facon
- Groupe Point Vision, 15, rue Pasquier, 75008 Paris, France
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Ahmed Y, Reddy M, Mederos J, McDermott KC, Varma DK, Ludwig CA, Ahmed IK, Khaderi KR. Democratizing Health Care in the Metaverse: How Video Games can Monitor Eye Conditions Using the Vision Performance Index: A Pilot Study. OPHTHALMOLOGY SCIENCE 2024; 4:100349. [PMID: 37869021 PMCID: PMC10587622 DOI: 10.1016/j.xops.2023.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 10/24/2023]
Abstract
Objective In a world where digital media is deeply engrained into our everyday lives, there lies an opportunity to leverage interactions with technology for health and wellness. The Vision Performance Index (VPI) leverages natural human-technology interaction to evaluate visual function using visual, cognitive, and motor psychometric data over 5 domains: field of view, accuracy, multitracking, endurance, and detection. The purpose of this study was to describe a novel method of evaluating holistic visual function through video game-derived VPI score data in patients with specific ocular pathology. Design Prospective comparative analysis. Participants Patients with dry eye, glaucoma, cataract, diabetic retinopathy (DR), age-related macular degeneration, and healthy individuals. Methods The Vizzario Inc software development kit was integrated into 2 video game applications, Balloon Pop and Picture Perfect, which allowed for generation of VPI scores. Study participants were instructed to play rounds of each video game, from which a VPI score was compiled. Main Outcome Measures The primary outcome was VPI overall score in each comparison group. Vision Performance Index component, subcomponent scores, and psychophysical inputs were also compared. Results Vision Performance Index scores were generated from 93 patients with macular degeneration (n = 10), cataract (n = 10), DR (n = 15), dry eye (n = 15), glaucoma (n = 16), and no ocular disease (n = 27). The VPI overall score was not significantly different across comparison groups. The VPI subcomponent "reaction accuracy" score was significantly greater in DR patients (106 ± 13.2) versus controls (96.9 ± 11.5), P = 0.0220. The VPI subcomponent "color detection" score was significantly lower in patients with DR (96.8 ± 2.5; p=0.0217) and glaucoma (98.5 ± 6.3; P = 0.0093) compared with controls (101 ± 11). Psychophysical measures were statistically significantly different from controls: proportion correct (lower in DR, age-related macular degeneration), contrast errors (higher in cataract, DR), and saturation errors (higher in dry eye). Conclusions Vision Performance Index scores can be generated from interactions of an ocular disease population with video games. The VPI may offer utility in monitoring select ocular diseases through evaluation of subcomponent and psychophysical input scores; however, future larger-scale studies must evaluate the validity of this tool. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Yusuf Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Mohan Reddy
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Vizzario, Inc, Venice, California
| | - Jacob Mederos
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Vizzario, Inc, Venice, California
| | - Kyle C. McDermott
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Vizzario, Inc, Venice, California
| | - Devesh K. Varma
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Prism Eye Institute, Oakville, Ontario, Canada
| | - Cassie A. Ludwig
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Iqbal K. Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Prism Eye Institute, Oakville, Ontario, Canada
- Moran Eye Centre, University of Utah School of Medicine, Salt Lake City, Utah
| | - Khizer R. Khaderi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California
- Vizzario, Inc, Venice, California
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Murphy LF, Bryce TN, Coker J, Scott M, Roach MJ, Worobey L, Botticello AL. Medical, dental, and optical care utilization among community-living people with spinal cord injury in the United States. J Spinal Cord Med 2024; 47:64-73. [PMID: 35993789 PMCID: PMC10795619 DOI: 10.1080/10790268.2022.2110817] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT/OBJECTIVE Information about patterns of healthcare utilization for people living with spinal cord injury (SCI) is currently limited, and this is needed to understand independent community living after SCI. This study investigates self-reported healthcare utilization among community-living people with SCI and assesses disparities across demographic, socioeconomic, and injury-related subgroups. DESIGN Secondary analysis of cross-sectional survey data administered via telephone interview. SETTING 6 SCI Model Systems centers in the United States (California, Colorado, New Jersey, New York, Ohio, and Pennsylvania). PARTICIPANTS Adults with chronic, traumatic SCI who were community-living for at least one year after the completion of an inpatient rehabilitation program (N = 617). INTERVENTIONS Not applicable. OUTCOME MEASURES Utilization of a usual source of 4 types of health care in the past 12 months: primary, SCI, dental, and optical. RESULTS 84% of participants reported utilizing primary care in the past year. More than half reported utilizing SCI (54%) and dental (57%) care, and 36% reported utilizing optical care. There were no significant differences across key subgroups in the utilization of primary care. Participants who had been injured for 5 years or less and participants with greater educational attainment were more likely to report utilizing SCI care. Participants with higher household income levels were more likely to report using dental care. Female participants and older age groups were more likely to report using optical care. CONCLUSION Rates of healthcare utilization among people with SCI are below recommended rates and vary across demographic, socioeconomic, and injury-related subgroups. This information can inform future research to target barriers to using healthcare services among community-living people with SCI.
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Affiliation(s)
- Lauren F. Murphy
- Center for Spinal Cord Injury Research and Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Michael Scott
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Mary Joan Roach
- Case Western Reserve University, Cleveland, Ohio, USA
- MetroHealth System, Cleveland, OH, USA
| | - Lynn Worobey
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda L. Botticello
- Center for Spinal Cord Injury Research and Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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Xue R, Wan G. Association Between Vision-Related Functional Burden and Sleep Disorders in Adults Aged 20 and Over in the United States. Transl Vis Sci Technol 2023; 12:3. [PMID: 37917088 PMCID: PMC10627301 DOI: 10.1167/tvst.12.11.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023] Open
Abstract
Purpose The impact of functional vision, rather than visual acuity, on sleep disorders is not well understood. This study estimated the relationship between vision-related functional burden and sleep disorders among a nationally representative sample in the United States. Methods Data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 were analyzed, which included a total of 10,914 US adults 20 years and older. Sleep disorders and vision-related functional burden were measured by the NHANES questionnaire sleep disorders section and vision section, respectively. Logistic regression was used to explore the association between vision-related functional burden and sleep disorders. Results A total of 9384 NHANES participants had complete functional vision and sleep disorders data. The mean age at baseline was 47.8 years, and the weighted prevalence of sleep disorders among adults with vision-related functional burden was 20.3%. After controlling for age, gender, race, smoking status, drinking frequency, general health condition, hypertension, diabetes, coronary heart disease, and depression, vision-related functional burden remained significantly associated with sleep disorders (adjusted odds ratio, 1.502; 95% confidence interval, 1.210-1.864; P < 0.001), whereas the association between presenting visual acuity and sleep disorders was not statistically significant. Conclusions Vision-related functional burden rather than impairment of visual acuity was related to the increased prevalence of sleep disorders in adults 20 years and older in the United States. Translational Relevance Our study provides insight into the relationship between functional vision and sleep disorders. It should be noted that individuals who report vision-related functional burden might be at risk of sleep disorders.
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Affiliation(s)
- Rong Xue
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, Henan, P.R. China
| | - Guangming Wan
- Department of Ophthalmology, First Affiliated Hospital of Zhengzhou University, Henan Province Eye Hospital, Zhengzhou, Henan, P.R. China
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Zhong Z, Lin Y, Zhong L, Yu X, Xie A. Sex Difference in the Association between Depression and Adherence to Recommended Dilated Eye Examinations among Patients with Diabetes: Findings from National Health and Nutrition Examination Survey. Ophthalmic Res 2023; 66:1308-1317. [PMID: 37820597 PMCID: PMC10634276 DOI: 10.1159/000534480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION The relationship between depression and adherence to regular dilated fundus examination (DFE) in patients with diabetes remains unclear. This study aimed to assess the association between depression and adherence to annual or biennial DFE among individuals with diabetes. METHODS In this cross-sectional study, we used the National Health and Nutrition Examination Survey database from 2005 to 2016 which contains information on demographics, clinical characteristics, health-related factors, and the time since last DFE. Participants were classified as having depression based on a score of >9 on the Patient Health Questionnaire-9. The main outcomes were the association between depression and the adherence of patients with diabetes to annual or biennial DFE. The second objective was to explore the potential influence of gender in this association. The independent association of depression with DFE compliance was explored by a series of multivariate logistic regression analyses (overall sample and then stratified by sex). RESULTS In total, 3,656 eligible participants were identified. The adherence rates to annual or biennial DFE were all higher for participants without depression than those with depression (64.8% vs. 56.1% and 80.3% vs. 69.7%, respectively). In the multivariate analyses, depression was neither independently associated with the adherence to annual DFE nor biennial DFE in the overall sample. An interaction was observed between depression and gender for the adherence to annual or biennial DFE (p = 0.017 and p = 0.026, respectively). When analyses were stratified by sex, female patients with diabetes and depression had a significantly increased odds ratio (OR) of being nonadherent to annual and biennial DFE (OR = 1.52, 95% confidence interval [CI]: 1.02-2.25, p = 0.039; OR = 1.55, 95% CI: 1.02-2.35, p = 0.039, respectively). However, this relationship was not evident in men with diabetes. CONCLUSIONS The independent association between depression and DFE compliance varied by sex, that is, only female patients with diabetes and depression were at a higher risk of nonadherence to annual or biennial DFE compared to those without depression.
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Affiliation(s)
- Zhe Zhong
- Department of Ophthalmology, Pingkuang General Hospital, Pingxiang, PR China
| | - Yaying Lin
- Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, PR China
- Wuxi Medical College, Jiangnan University, Wuxi, PR China
| | - Li Zhong
- Department of Operating Room, Pingkuang General Hospital, Pingxiang, PR China
| | - Xi Yu
- Cataract Special Department, Aier Eye Hospital of Yichun, Yichun, PR China
| | - Aihong Xie
- Department of Ophthalmology, Pingkuang General Hospital, Pingxiang, PR China
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Rathinavelu J, Sarvepalli SM, Bailey B, D'Alessio D, Hadziahmetovic M. The Impact of Pregnancy on Diabetic Retinopathy: A Single-Site Study of Clinical Risk Factors. Ophthalmic Res 2023; 66:1169-1180. [PMID: 37573783 PMCID: PMC10614555 DOI: 10.1159/000533416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION This study aimed to provide information on modifiable and non-modifiable risk factors for the progression and development of diabetic retinopathy (DR) and diabetic macular edema (DME). This retrospective chart review case-control study was designed to provide perspective on clinical variables. METHODS Single-center study analysis was completed with chart review, identifying 50 patients (100 eyes) ultimately included in the final analysis. Included patients were women with type 1 or 2 diabetes that entered prenatal care and had a delivery from January 2010 to December 2022. The primary outcome measure was clinical variables between progression and no progression groups. Data were analyzed via χ2 analysis and independent samples t test when appropriate. Significantly different variables were further analyzed by binary logistic regression. RESULTS The DR progression group had significantly higher prepregnancy HbA1c levels (9.9) when compared to the no progression group (8.5, p value 0.028). DR progression group also had higher rates (51.9%) of full-term births. The DME progression group had significantly higher rates of type 2 diabetics (100%) compared to the no progression group (30.9%, p value 0.029). Hypertension treatment before (81.8%; p value 0.008) pregnancy was also more common in the DME progression group. Intravitreal injections were more common in patients with visual acuity deterioration (26.7%, p value 0.046). The average number of fetal complications was significantly higher in the visual acuity non-worsening group (1.1) compared to the progression group (0.5, p value 0.04). These variables were not statistically significant after entry into multivariate analysis. DISCUSSION Severity and treatment of retinopathy before pregnancy, type of diabetes, and blood pressure control are all significant factors affecting the progression and development of severe ocular complications in pregnancy.
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Affiliation(s)
- Jay Rathinavelu
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Swara M Sarvepalli
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA,
| | - Beth Bailey
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
| | - David D'Alessio
- Department of Endocrinology, Duke University, Durham, North Carolina, USA
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Neo JRE, Visperas CA, Tan MPH, Tay SS. Novel use of robot-assisted gait rehabilitation in a patient with stroke and blindness. BMJ Case Rep 2023; 16:e255457. [PMID: 37479488 PMCID: PMC10364153 DOI: 10.1136/bcr-2023-255457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
Robot-assisted gait training (RAGT) is an effective adjunctive treatment for patients with stroke that helps to regain functional mobility and is applied in many rehabilitation units for poststroke neurorecovery. We discuss our successful attempt to apply RAGT in a patient with blindness that impeded his ability to maintain balance during gait training. He initially required two assistants to walk, but after undergoing conventional therapy with adjunctive RAGT, he improved to standby assistance for ambulation. There were also improvements in balance, activity tolerance and quality of life. Low-or-no vision states can affect the pace of recovery poststroke, but RAGT and conventional physiotherapy can possibly be combined in such patients to improve balance and motor outcomes. The Andago robot's safety features of weight support, harnessed suspension and walking mode selection supported our decision and enabled us to apply it safely for this patient.
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Affiliation(s)
| | | | | | - San San Tay
- Rehabilitation Medicine, Changi General Hospital, Singapore
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Dhoot DS, Moini H, Reed K, Du W, Vitti R, Berliner AJ, Singh RP. Functional outcomes of sustained improvement on Diabetic Retinopathy Severity Scale with intravitreal aflibercept in the VISTA and VIVID trials. Eye (Lond) 2023; 37:2020-2025. [PMID: 35440699 PMCID: PMC10333274 DOI: 10.1038/s41433-022-02058-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 03/17/2022] [Accepted: 04/01/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To assess time to, cumulative incidence of, and functional benefit of achieving sustained ≥2-step Diabetic Retinopathy Severity Scale (DRSS) improvement in diabetic macular oedema (DMO). METHODS Post hoc analysis of VISTA/VIVID including eyes with DMO treated with intravitreal aflibercept injections (IAI), 2 mg q4 weeks (2q4, n = 250) or q8 weeks after 5 monthly doses (2q8, n = 249), or laser control (n = 249). Changes from baseline in best-corrected visual acuity (BCVA) and central subfield thickness (CST) were evaluated in sustained (≥2 consecutive visits) DRSS subgroups (≥1-step worsening, no change, ≥2-step improvement). RESULTS Time to sustained ≥2-step DRSS improvement was shorter for both the IAI 2q4 and IAI 2q8 groups versus laser (both log-rank p < 0.001). Cumulative incidences of sustained ≥2-step DRSS improvement with IAI 2q4 and IAI 2q8 versus laser were 40.0% and 42.8% versus 15.5% (both p < 0.001) through week 100. Mean differences (95% CI) in BCVA gains from baseline at weeks 52 and 100 between eyes with sustained ≥2-step DRSS improvement versus sustained ≥1-step DRSS worsening were -3.0 (-8.9, 2.9) and 6.2 (0.2, 12.2) letters with laser, and 4.2 (0.8, 7.6) and 4.9 (1.3, 8.4) letters with IAI combined, respectively. Difference (95% CI) in CST reduction was significantly greater only with IAI combined at week 100 (-83.0 [-140.8, -25.3]). Correlations between BCVA and CST changes were weak. CONCLUSIONS DMO eyes treated with IAI achieved sustained ≥2-step DRSS improvement significantly earlier and more frequently versus laser. This improvement was associated with greater BCVA gains, independent of CST reductions. TRIAL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ) identifiers: NCT01363440 and NCT01331681 .
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Affiliation(s)
- Dilsher S Dhoot
- California Retina Consultants/Retina Consultants of America, Santa Barbara, CA, USA
| | - Hadi Moini
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Weiming Du
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | - Robert Vitti
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA.
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Jia H, Luo H, Wu Z, Meng X, Zhang L, Hu W, Yu K, Chen R, Sun X. Residential greenness exposure and decreased prevalence of diabetic retinopathy: A nationwide analysis in China. ENVIRONMENTAL RESEARCH 2023; 221:115302. [PMID: 36642124 DOI: 10.1016/j.envres.2023.115302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Diabetic retinopathy (DR) is a leading cause of vision impairment and blindness among diabetics. We aimed to explore whether long-term exposure to residential greenness was beneficial to DR. RESEARCH DESIGN AND METHODS We used data from a large-scale, cross-sectional screening survey conducted in 129 cities of 27 provincial regions of China from 2018 to 2021 among patients with diabetes. We measured residential greenness exposure as the 3-year average of annual maximum Normalized Difference Vegetation Index (NDVI) at a spatial resolution of 250 m. DR was assessed by ophthalmologists based on fundus photographs. The primary outcome was DR, and secondary outcome included DR severity status (i.e., nonproliferative and proliferative), hallmarks of retinal lesions and macular oedema. RESULTS A total of 484,380 adult participants with diabetes were included in the current analysis, and 15.7% of them were diagnosed with DR. NDVI was inversely and linearly associated with DR prevalence, and an increment of 0.1 NDVI was associated with a 10% (9%-10%) decrease in DR prevalence. Significant and inverse associations were further found for nonproliferative and proliferative DR, hallmarks of lesions and macular oedema. The association between greenness and DR was stronger among participants who were older, obese, lived in the south, had longer duration of diabetes or did not take antidiabetic medications. CONCLUSIONS This large-scale nationwide study provides the first-hand epidemiological evidence on the associations of residential greenness with DR. Our findings highlight the importance of residential greenness in alleviating DR risk especially in an era of aging and urbanization.
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Affiliation(s)
- Huixun Jia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China; Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Huihuan Luo
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Zhenyu Wu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Xia Meng
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Lina Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Weiting Hu
- Shanghai Phoebus Medical Co. Ltd., Shanghai, China
| | - Kexin Yu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China.
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China; National Clinical Research Center for Eye Diseases, Shanghai, China.
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12
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Alwakid G, Gouda W, Humayun M. Deep Learning-Based Prediction of Diabetic Retinopathy Using CLAHE and ESRGAN for Enhancement. Healthcare (Basel) 2023; 11:healthcare11060863. [PMID: 36981520 PMCID: PMC10048517 DOI: 10.3390/healthcare11060863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Vision loss can be avoided if diabetic retinopathy (DR) is diagnosed and treated promptly. The main five DR stages are none, moderate, mild, proliferate, and severe. In this study, a deep learning (DL) model is presented that diagnoses all five stages of DR with more accuracy than previous methods. The suggested method presents two scenarios: case 1 with image enhancement using a contrast limited adaptive histogram equalization (CLAHE) filtering algorithm in conjunction with an enhanced super-resolution generative adversarial network (ESRGAN), and case 2 without image enhancement. Augmentation techniques were then performed to generate a balanced dataset utilizing the same parameters for both cases. Using Inception-V3 applied to the Asia Pacific Tele-Ophthalmology Society (APTOS) datasets, the developed model achieved an accuracy of 98.7% for case 1 and 80.87% for case 2, which is greater than existing methods for detecting the five stages of DR. It was demonstrated that using CLAHE and ESRGAN improves a model’s performance and learning ability.
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Affiliation(s)
- Ghadah Alwakid
- Department of Computer Science, College of Computer and Information Sciences, Jouf University, Sakakah 72341, Al Jouf, Saudi Arabia;
| | - Walaa Gouda
- Department of Electrical Engineering, Faculty of Engineering at Shoubra, Benha University, Cairo 11672, Egypt;
| | - Mamoona Humayun
- Department of Information Systems, College of Computer and Information Sciences, Jouf University, Sakakah 72341, Al Jouf, Saudi Arabia
- Correspondence:
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13
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Cioana M, Deng J, Nadarajah A, Hou M, Qiu Y, Chen SSJ, Rivas A, Toor PP, Banfield L, Thabane L, Chaudhary V, Samaan MC. Global Prevalence of Diabetic Retinopathy in Pediatric Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA Netw Open 2023; 6:e231887. [PMID: 36930156 PMCID: PMC10024209 DOI: 10.1001/jamanetworkopen.2023.1887] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
IMPORTANCE Type 2 diabetes (T2D) is increasing globally. Diabetic retinopathy (DR) is a leading cause of blindness in adults with T2D; however, the global burden of DR in pediatric T2D is unknown. This knowledge can inform retinopathy screening and treatments to preserve vision in this population. OBJECTIVE To estimate the global prevalence of DR in pediatric T2D. DATA SOURCES MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, the Web of Science, and the gray literature (ie, literature containing information that is not available through traditional publishing and distribution channels) were searched for relevant records from the date of database inception to April 4, 2021, with updated searches conducted on May 17, 2022. Searches were limited to human studies. No language restrictions were applied. Search terms included diabetic retinopathy; diabetes mellitus, type 2; prevalence studies; and child, adolescent, teenage, youth, and pediatric. STUDY SELECTION Three teams, each with 2 reviewers, independently screened for observational studies with 10 or more participants that reported the prevalence of DR. Among 1989 screened articles, 27 studies met the inclusion criteria for the pooled analysis. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines for systematic reviews and meta-analyses. Two independent reviewers performed the risk of bias and level of evidence analyses. The results were pooled using a random-effects model, and heterogeneity was reported using χ2 and I2 statistics. MAIN OUTCOMES AND MEASURES The main outcome was the estimated pooled global prevalence of DR in pediatric T2D. Other outcomes included DR severity and current DR assessment methods. The association of diabetes duration, sex, race, age, and obesity with DR prevalence was also assessed. RESULTS Among the 27 studies included in the pooled analysis (5924 unique patients; age range at T2D diagnosis, 6.5-21.0 years), the global prevalence of DR in pediatric T2D was 6.99% (95% CI, 3.75%-11.00%; I2 = 95%; 615 patients). Fundoscopy was less sensitive than 7-field stereoscopic fundus photography in detecting retinopathy (0.47% [95% CI, 0%-3.30%; I2 = 0%] vs 13.55% [95% CI, 5.43%-24.29%; I2 = 92%]). The prevalence of DR increased over time and was 1.11% (95% CI, 0.04%-3.06%; I2 = 5%) at less than 2.5 years after T2D diagnosis, 9.04% (95% CI, 2.24%-19.55%; I2 = 88%) at 2.5 to 5.0 years after T2D diagnosis, and 28.14% (95% CI, 12.84%-46.45%; I2 = 96%) at more than 5 years after T2D diagnosis. The prevalence of DR increased with age, and no differences were noted based on sex, race, or obesity. Heterogeneity was high among studies. CONCLUSIONS AND RELEVANCE In this study, DR prevalence in pediatric T2D increased significantly at more than 5 years after diagnosis. These findings suggest that retinal microvasculature is an early target of T2D in children and adolescents, and annual screening with fundus photography beginning at diagnosis offers the best assessment method for early detection of DR in pediatric patients.
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Affiliation(s)
- Milena Cioana
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jiawen Deng
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ajantha Nadarajah
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Maggie Hou
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Yuan Qiu
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sondra Song Jie Chen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Angelica Rivas
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Parm Pal Toor
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St Joseph’s Health Care, Hamilton, Ontario, Canada
- Biostatistics Unit, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Varun Chaudhary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Michael G. De Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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14
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The Patient Experience with Diabetic Retinopathy: Qualitative Analysis of Patients with Proliferative Diabetic Retinopathy. Ophthalmol Ther 2023; 12:431-446. [PMID: 36460939 PMCID: PMC9834467 DOI: 10.1007/s40123-022-00614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/06/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Few qualitative studies have explored the patient experience of daily life with proliferative diabetic retinopathy (PDR) and associated treatments. Herein, a conceptual model was developed to comprehensively examine symptoms, functional impacts, and treatment experiences in PDR. METHODS A qualitative, mixed-methods study comprising a literature search and semi-structured interviews with clinicians and patients was conducted. Published literature and online patient resources were searched to identify concepts relevant to patients, including symptoms, functional impacts, and treatment experiences of PDR. Semi-structured interviews with experienced clinicians were conducted to identify symptoms and impacts reported by patients with PDR and to receive feedback regarding concepts identified from the literature search. A preliminary conceptual model was then developed based on findings from the literature search and clinician interviews. Patients with PDR participated in two rounds of semi-structured interviews to identify additional concepts relevant to the patient experience in PDR and associated treatments, which informed revisions to the conceptual model. Saturation of patient interviews was assessed. RESULTS Findings from the literature search and clinician interviews yielded 109 concepts that were included in a preliminary conceptual model with three overarching domains: symptoms, impacts, and managing the disease. Clinicians confirmed concepts identified from the literature search. During interviews, patients reported a broad spectrum of symptoms (e.g., red vision); functional impacts relating to activities of daily living (e.g., reading), emotional functioning (e.g., loss of independence), and social functioning (e.g., problems recognizing faces); and treatment experiences (e.g., improves eye problems, no change) associated with PDR. Additional concepts elicited in patient interviews informed revisions to the conceptual model. Saturation was achieved in the patient sample. CONCLUSIONS A wide variety of symptoms, functional impacts, and treatment experiences that significantly affect health-related quality of life were identified in patients with PDR. These insights are critical for understanding PDR symptomology and assessing treatment response.
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15
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Jiang H, Liu Z, Townsend JH, Wang J. Effects of Methylenetetrahydrofolate Reductase ( MTHFR) Polymorphisms on Retinal Tissue Perfusion in Mild Diabetic Retinopathy Patients Receiving the Medical Food, Ocufolin ®. Clin Ophthalmol 2023; 17:1121-1127. [PMID: 37077224 PMCID: PMC10106310 DOI: 10.2147/opth.s401743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
Purpose We evaluate the effects of methylenetetrahydrofolate reductase (MTHFR) polymorphisms on retinal tissue perfusion in patients with mild diabetic retinopathy (DR + PM) taking the medical food, Ocufolin®, for 6 months. Methods Prospective, case-controlled study. Eight early diabetic retinopathy patients with common reduced function MTHFR polymorphisms (DR+PM) and 15 normal controls (NC) were recruited. MTHFR polymorphisms were subtyped as normal, C677T, or A1298C. Best corrected visual acuity (BCVA) was evaluated. Retinal blood flow velocity (BFV) was measured using Retinal Function Imager. Retinal tissue perfusion (RTP, blood flow rate per inner retinal volume) was calculated within a 2.5 mm diameter circle centered on the fovea. The medical food is intended to address ocular ischemia with high doses of vitamin B-complexes and antioxidants, including L-methylfolate, methylcobalamin, zinc, copper, lutein, vitamins C, D, E, and n-acetylcysteine. The subjects were provided with a medical food for a period of 6 months. Results BCVA and vascular indices of DR + PM patients at baseline were initially below those of NC and improved after medical food. Compared to baseline, DR + PM patients after the medical food had significantly improved BCVA during the follow-up period (P < 0.05). In comparison, overall RTP and arteriolar BFV were significantly increased at 6 months (P < 0.05). The changes varied with MTHFR subtypes. In patients with the C677T and the C677T/A1298C compound mutations, RTP was increased at 6 months as compared to that at baseline and 4 months (P < 0.05). In patients with only the A1298C mutation, all microcirculation metrics were increased from baseline at 4 and 6 months, but with less improvement at 6 months than at 4 months (P < 0.05). Conclusion Medical food was effective in improving both visual acuity and retinal tissue perfusion in DR + PM patients. The degree of improvement of retinal microcirculation varied among MTHFR subtypes.
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Affiliation(s)
- Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zhiping Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Jianhua Wang, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL, 33136, USA, Tel +1 305 482-5010, Fax +1 305 482-5012, Email
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16
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Nourinia R, Dastmardi M, Dastmardi M, Azimi R, Hassanpour K. The diagnostic characteristics of direct ophthalmoscopy for diabetic retinopathy screening by family physicians. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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17
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Shi J, Zhang C, Zhao Q, Zhang X, Guo L, Jia T. Experience of patients with diabetic retinopathy: A qualitative study. J Adv Nurs 2022; 79:1789-1798. [PMID: 36218198 DOI: 10.1111/jan.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/19/2022] [Accepted: 09/21/2022] [Indexed: 12/01/2022]
Abstract
AIMS To understand the status quo and needs of self-management of patients with diabetic retinopathy (DR) and to provide a reference for formulating management programs that meet the needs of these patients. DESIGN A qualitative interview study. METHODS Semi-structured, in-depth interviews were conducted between November and December 2021. A purposive sample of 15 patients with DR who were hospitalized in the Retinal Department of Eye Hospital was recruited. Colaizzi's analysis was used to organize and analyse the interview data. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS The experience of patients with DR can be summarized into four themes: (1) lack of DR knowledge, (2) low quality of life, (3) poor self-management behaviour and (4) seek for support from many aspects. CONCLUSION Patients with DR lack disease knowledge and have poor self-management abilities and adherence. Medical staff should provide personalized care according to the patient's self-management status and needs, promote the establishment of self-management behaviours and prevent and delay disease progression. IMPACT This study helps assist medical staff in the early management of patients with DR and provides a reference for the construction of prevention programs for patients.
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Affiliation(s)
- Jinghua Shi
- Department of Nursing, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Can Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Qingqing Zhao
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ximei Zhang
- Department of Vitreoretinopathy, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Lixia Guo
- Department of Nursing, Shanxi Eye Hospital, Taiyuan, Shanxi, China
| | - Tingting Jia
- Department of Nursing, Shanxi Eye Hospital, Taiyuan, Shanxi, China
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18
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Nadeem MW, Goh HG, Hussain M, Liew SY, Andonovic I, Khan MA. Deep Learning for Diabetic Retinopathy Analysis: A Review, Research Challenges, and Future Directions. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22186780. [PMID: 36146130 PMCID: PMC9505428 DOI: 10.3390/s22186780] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 05/12/2023]
Abstract
Deep learning (DL) enables the creation of computational models comprising multiple processing layers that learn data representations at multiple levels of abstraction. In the recent past, the use of deep learning has been proliferating, yielding promising results in applications across a growing number of fields, most notably in image processing, medical image analysis, data analysis, and bioinformatics. DL algorithms have also had a significant positive impact through yielding improvements in screening, recognition, segmentation, prediction, and classification applications across different domains of healthcare, such as those concerning the abdomen, cardiac, pathology, and retina. Given the extensive body of recent scientific contributions in this discipline, a comprehensive review of deep learning developments in the domain of diabetic retinopathy (DR) analysis, viz., screening, segmentation, prediction, classification, and validation, is presented here. A critical analysis of the relevant reported techniques is carried out, and the associated advantages and limitations highlighted, culminating in the identification of research gaps and future challenges that help to inform the research community to develop more efficient, robust, and accurate DL models for the various challenges in the monitoring and diagnosis of DR.
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Affiliation(s)
- Muhammad Waqas Nadeem
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
| | - Hock Guan Goh
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
- Correspondence: (H.G.G.); (I.A.)
| | - Muzammil Hussain
- Department of Computer Science, School of Systems and Technology, University of Management and Technology, Lahore 54000, Pakistan
| | - Soung-Yue Liew
- Faculty of Information and Communication Technology (FICT), Universiti Tunku Abdul Rahman (UTAR), Kampar 31900, Malaysia
| | - Ivan Andonovic
- Department of Electronic and Electrical Engineering, Royal College Building, University of Strathclyde, 204 George St., Glasgow G1 1XW, UK
- Correspondence: (H.G.G.); (I.A.)
| | - Muhammad Adnan Khan
- Pattern Recognition and Machine Learning Lab, Department of Software, Gachon University, Seongnam 13557, Korea
- Faculty of Computing, Riphah School of Computing and Innovation, Riphah International University, Lahore Campus, Lahore 54000, Pakistan
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19
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Zhou Y, Xuan Y, Liu Y, Zheng J, Jiang X, Zhang Y, Zhao J, Liu Y, An M. Transcription factor FOXP1 mediates vascular endothelial dysfunction in diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:3857-3867. [PMID: 35695913 DOI: 10.1007/s00417-022-05698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/15/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is still the fastest growing cause of blindness in working aged adults, and its typical characteristics are endothelial cell dysfunction and pericytes loss. Transcription factor fork head box P1 (FOXP1) is a member of FOX family involved in diabetes progression and is expressed in endothelial cells. The purpose of this study was to investigate the role and mechanism of FOXP1 in DR. METHODS The vitreous of DR patients and non-DR patients were collected, and the expression of FOXP1 was detected by real-time polymerase chain reaction (RT-qPCR) and enzyme-linked immunosorbent assay (ELISA). Human umbilical vein endothelial cells (HUVECs) cultured in high glucose simulated DR environment, and the expressions of FOXP1, vascular endothelial growth factor (VEGF), and pigment epithelium derived factor (PEDF) were detected by RT-qPCR and western blot (WB) after transfection of small interfering RNA (siRNA) to knock out FOXP1. At the same time, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay (MTT), 5-ethynyl-2'-deoxyuridine assay (EDU), flow cytometry, Transwell assay, and tube-forming experiment were performed to determine cell proliferation, migration, and tube-forming ability. RESULTS We found that FOXP1 was highly expressed in the vitreous of DR patients and HUVECs under high glucose condition. After FOXP1 was decreased, the activation of VEGF expression and inhibition of PEDF expression in HUVECs induced by high glucose were reversed; meanwhile, cell proliferation, migration, and tube formation decreased, and apoptosis was promoted. CONCLUSION Generally, FOXP1 is highly expressed in the vitreous of DR patients, and its silence prevented VEGF/PEDF signaling pathway stimulated by high glucose and also reduced the proliferation, migration, and tube formation of endothelial cell, thus improving vascular endothelial dysfunction caused by DR. The results indicate that FOXP1 may be a therapeutic target of DR.
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Affiliation(s)
- Yekai Zhou
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yaling Xuan
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yi Liu
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jiaxuan Zheng
- The Second Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyun Jiang
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yun Zhang
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Jian Zhao
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yanli Liu
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China. .,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Meixia An
- Department of Ophthalmology, The Third Affiliated Hospital of Southern Medical University, No.183, Zhongshan Avenue West, Tianhe District, Guangzhou City, Guangdong Province, China. .,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, Guangdong, 510630, People's Republic of China.
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20
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Kalur A, Iyer AI, Muste JC, Talcott KE, Singh RP. Impact of retinal fluid in patients with diabetic macular edema treated with anti-vascular endothelial growth factors in routine clinical practice. Can J Ophthalmol 2022:S0008-4182(22)00090-4. [PMID: 35395214 DOI: 10.1016/j.jcjo.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aims to determine the effect of intraretinal (IRF) and subretinal (SRF) fluid on visual outcomes for diabetic macular edema (DME) patients treated with anti-vascular endothelial growth factor (anti-VEGF) in routine clinical practice. DESIGN Optical coherence tomography scans were analyzed with a deep-learning artificial intelligence software to quantify IRF, SRF, and total retinal fluid (TRF) at baseline and at 3, 6, and 12 months. Predictive variables for best-corrected visual acuity (BCVA) were evaluated with linear mixed-effects regression models. PARTICIPANTS A total of 220 DME eyes of 220 patients from the Cole Eye Institute at Cleveland Clinic. METHODS Retrospective, nonrandomized cohort study. RESULTS BCVA improved from baseline to 12 months (63.36 ± 14.72 to 68.49 ± 13.14 Early Treatment Diabetic Retinopathy Study letters, p < 0.001, respectively). Central subfield thickness improved from baseline to 12 months (411.74 ± 129.7 to 335.94 ± 116.91 mm, p < 0.001, respectively). Injection frequency per patient was 8.25 ± 2.5 injections over 12 months. The linear mixed-effects regression model in the foveal region for TRF, IRF, and SRF volume at the fourth quartile showed BCVA losses of -8.29 letters (range, -10.96 to -5.62 letters, p < 0.001), -7.52 letters (range, -10.3 to -4.74 letters, p < .001), and -6.93 letters (range, -10.54 to -3.41 letters, p < .001), respectively. CONCLUSIONS The highest quartile of TRF, IRF, and SRF volumes led to worse visual outcomes after 12 months of anti-VEGF treatment in patients with DME. Further studies designed to investigate the effect of anti-VEGF treatment on retinal fluid morphology could provide greater insight into individualized DME treatment.
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Affiliation(s)
- Aneesha Kalur
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amogh I Iyer
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin C Muste
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine E Talcott
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rishi P Singh
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio.
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21
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Lu ES, Cui Y, Le R, Zhu Y, Wang JC, Laíns I, Katz R, Lu Y, Zeng R, Garg I, Wu DM, Eliott D, Vavvas DG, Husain D, Miller JW, Kim LA, Miller JB. Detection of neovascularisation in the vitreoretinal interface slab using widefield swept-source optical coherence tomography angiography in diabetic retinopathy. Br J Ophthalmol 2022; 106:534-539. [PMID: 33355148 PMCID: PMC9092312 DOI: 10.1136/bjophthalmol-2020-317983] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/18/2020] [Accepted: 11/21/2020] [Indexed: 11/11/2022]
Abstract
AIMS To compare the efficacy of diabetic retinal neovascularisation (NV) detection using the widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vitreoretinal interface (VRI) Angio slab and SS-OCT VRI Structure slab. METHODS A prospective, observational study was performed at Massachusetts Eye and Ear from January 2019 to June 2020. Patients with proliferative diabetic retinopathy (PDR), patients with non-proliferative diabetic retinopathy and patients with diabetes but without diabetic retinopathy were included. All patients were imaged with WF SS-OCTA using the 12×12 mm Angio scan protocol centred on the fovea and optic disc. The en-face SS-OCTA VRI Angio slab and SS-OCT VRI Structure slab were evaluated for the presence or absence of NV. SS-OCTA B-scan was used to classify NV according to cross-sectional morphology (forward, tabletop or flat). All statistical analyses were performed using SPSS V.26.0. RESULTS One hundred and forty-two eyes of 89 participants were included in the study. VRI Angio detected NV at higher rates compared with VRI Structure (p<0.05). Combining VRI Angio and Structure improved detection rates compared with VRI Angio alone (p<0.05). Due to segmentation errors of the internal limiting membrane, NV with flat morphological classification had lower rates of detection on VRI Angio compared with NV with forward and tabletop morphology (p<0.05). CONCLUSIONS WF SS-OCTA 12×12 mm VRI Angio and SS-OCT VRI Structure imaging centred on the fovea and optic disc detected NV with high sensitivity and low false positives. The VRI slab may be useful to diagnose and monitor PDR in clinical practice.
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Affiliation(s)
- Edward S Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Ying Cui
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Rongrong Le
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Wenzhou Medical University Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jay C Wang
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Inês Laíns
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Raviv Katz
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yifan Lu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Rebecca Zeng
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Itika Garg
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - David M Wu
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Eliott
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Deeba Husain
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Joan W Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Leo A Kim
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Harvard Retinal Imaging Lab, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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22
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Alizadeh Y, Jalali MM, Sehati A. Association of different severity of diabetic retinopathy and hearing loss in type 2 diabetes mellitus. Am J Otolaryngol 2022; 43:103383. [PMID: 35124403 DOI: 10.1016/j.amjoto.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/31/2021] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Microvascular involvement in patients with diabetes mellitus is one of the causes of retinopathy, nephropathy, and neuropathy. The same pathologic processes may occur in the inner ear structures. This case-control study aimed to evaluate the hearing thresholds in type 2 diabetic patients with different severity of diabetic retinopathy (DR) and to compare these findings with controls. MATERIALS AND METHODS We evaluated the hearing threshold in four groups of eligible subjects aged 20-70 years. These groups were controls, diabetic patients with no-DR, with mild-moderate non-proliferative DR (NPDR), and with severe NPDR/proliferative DR (PDR). Each group consisted of 105 subjects. Speech-frequency and high-frequency hearing levels (SFHL and HFHL, respectively) were measured and log-transformed. Analysis of covariance was used. The prevalence rate of moderate or more hearing loss in the groups was estimated. RESULTS In total, 194 men and 226 women participated. The ratio of means of SFHL and HFHL between PDR and controls was 0.18 and 0.20, respectively. Hearing loss was prevalent in severe NPDR/PDR (adjusted prevalence ratio 3.36 for SFHL and 1.51 for HFHL) compared to controls. Also, the prevalence of high-frequency hearing loss was more in mild-moderate NPDR (adjusted prevalence ratio 1.33). CONCLUSIONS The magnitude of the increase in hearing impairment prevalence between the severe NPDR/PDR patients and controls was about 24% for both SFHL and HFHL. We recommend hearing assessment in the screening of the DR patients.
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Affiliation(s)
- Yousef Alizadeh
- Department of Ophthalmology, Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir Mohammad Jalali
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Asieh Sehati
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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23
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Gedde SJ, Feuer WJ, Crane AM, Shi W. Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists. Am J Ophthalmol 2022; 234:285-326. [PMID: 34157277 DOI: 10.1016/j.ajo.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/12/2021] [Accepted: 06/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction. METHODS A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area. RESULTS Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life. CONCLUSIONS The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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24
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Arabi A, Tadayoni R, Ahmadieh H, Shahraki T, Nikkhah H. Update on Management of Non-proliferative Diabetic Retinopathy without Diabetic Macular Edema; Is There a Paradigm Shift? J Ophthalmic Vis Res 2022; 17:108-117. [PMID: 35194501 PMCID: PMC8850856 DOI: 10.18502/jovr.v17i1.10175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
Diabetic retinopathy (DR) is the major cause of visual impairment and blindness in the working-age population. Conventional management for nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME) is derived from the findings of the Early Treatment Diabetic Retinopathy Study (ETDRS). Although the ETDRS protocol basically includes observation, selected cases of severe NPDR may undergo scatter laser photocoagulation. Post-hoc analysis of recent trials has shown that patients with NPDR receiving intravitreal anti-vascular endothelial growth factor (anti-VEGF) for DME would experience improvement in the DR severity scale (DRSS). In addition, recent randomized trials (PANORAMA and Protocol W) have revealed that early intervention with intravitreal aflibercept in eyes with moderately severe to severe NPDR is associated with significant improvement in DRSS and reduced vision-threatening complications of DR. Based on recent studies, it seems that the therapeutic approach to NPDR may undergo a substantial change and a paradigm shift toward considering early intervention with the administration of intravitreal anti-VEGF injections. However, the long-term results and the duration of adherence to anti-VEGF therapy for eyes with NPDR are not yet defined. It is also not apparent whether improvement in DRSS is a true disease modification. Studies showed that DRSS improvement is not associated with retinal reperfusion. In addition, DRCR.net Protocol W showed no visual acuity benefit with the early intravitreal aflibercept injection in moderate to severe NPDR as compared with performing observation plus intravitreal aflibercept applied only after progression to proliferative DR or vision-impairing DME. The cost-benefit ratio is also a challenge. Herein, we look at different aspects of early anti-VEGF application and discuss its pros and cons in the process of treating NPDR.
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Affiliation(s)
- Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Tadayoni
- Université de Paris, Ophthalmology Department, AP-HP, Lariboisière, Saint Louis and Fondation Adolphe de Rothschild Hospitals, Paris, France
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Homayoun Nikkhah
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Zhang Y, An X, Duan L, Jin D, Duan Y, Zhou R, Zhang Y, Kang X, Lian F. Effect of Chinese Patent Medicines on Ocular Fundus Signs and Vision in Calcium Dobesilate-Treated Persons With Non-Proliferative Diabetic Retinopathy: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:799337. [PMID: 35370950 PMCID: PMC8967137 DOI: 10.3389/fendo.2022.799337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR), one of the commonest microvascular complications in diabetic patients, is featured by a series of fundus lesions. Conventional Western medicine therapies for DR are always with modest treatment outcome. This paper is to assess the ocular fundus signs, vision and safety of Chinese patent medicines (CPMs) as an add-on treatment for DR. METHOD 7 electronic databases were searched to determine eligible trials. Randomized controlled trials (RCTs) of non-proliferative diabetic retinopathy (NPDR) in which the intervention group received CPMs combined with calcium dobesilate (CD), and the control group received only CD were included for analysis. Two reviewers extracted the data independently. Results expressing as mean differences (MD) and relative risks (RR) were analyzed with a fixed-effects or random-effects models. RESULTS 19 RCTs involved 1568 participants with 1622 eyes met our inclusion criteria. The results suggested that compared with CD alone, CPMs plus CD for NPDR was superior at reducing the microaneurysm volume (MD -3.37; 95% confidence interval [CI], -3.59 to -3.14), microaneurysm counts (MD -2.29; 95%CI -2.97 to -1.61), hemorrhage area (MD -0.79; 95%CI -0.83 to -0.75), and macular thickness (MD -59.72; 95%CI -63.24 to -56.20). Participants in CPMs plus CD group also achieved a better vision. No obvious adverse events occurred. CONCLUSION CPMs as an add-on therapy for NPDR have additional benefits and be generally safe. This meta-analysis demonstrated that CPMs combined with CD could improve retinal microaneurysm, hemorrhage, macular thickness, visual acuity, fasting blood glucose (FBG), and glycosylated hemoglobin (HbAlc) compared with CD alone. Further studies are needed to provide more conclusive evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42021257999.
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Affiliation(s)
- Yuehong Zhang
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuedong An
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liyun Duan
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - De Jin
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingying Duan
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Rongrong Zhou
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuqing Zhang
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaomin Kang
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fengmei Lian
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengmei Lian,
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Thirunavukkarasu A, Almulhim AK, Albalawi FA, Alruwaili ZM, Almajed OA, Alruwaili SH, Almugharriq MM, Alruwaili AS, Alkuwaykibi MK. Knowledge, Attitudes, and Practices towards Diabetic Retinopathy among Primary Care Physicians of Saudi Arabia: A Multicenter Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9121697. [PMID: 34946423 PMCID: PMC8701346 DOI: 10.3390/healthcare9121697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Primary care physicians play a vital role in preventing the progression of diabetic retinopathy (DR) from the initial stages to the late stages. This questionnaire-based analytical cross-sectional study was carried out to assess the knowledge, attitude, practices, and their correlation among 274 randomly selected primary care physicians in Saudi Arabia. Among the studied population, high knowledge, attitudes, and practice scores were observed in 21.5%, 15%, and 29.2% of the physicians, respectively. The mean knowledge score was significantly higher among the age group of less than 30 years (p = 0.031) and the female gender (p = 0.012). The attitude scores were significantly higher among the Saudi physicians (p = 0.027) and those with PHC work experience of less than five years (p < 0.001). Regarding the practices, a significant association was found among the age group of less than 30 years (p = 0.019) and Saudi physicians (p = 0.003). There was a significant positive correlation between knowledge (correlation coefficient (r) = 0.739, p < 0.001) and attitude (r = 0.479, p = 0.007) with the practice scores. It is recommended that targeted continuous medical education, workshops, and seminars are conducted on the prevention and care of DR among primary care physicians. Furthermore, an exploratory multicenter study that involves primary care physicians belonging to all ministries and private sectors is warranted.
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Affiliation(s)
- Ashokkumar Thirunavukkarasu
- Department of Community and Family Medicine, College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia
- Correspondence: ; Tel.: +966-599739619
| | | | - Faisal Ahmed Albalawi
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
| | - Ziyad Muharib Alruwaili
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
| | - Ola Ali Almajed
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
| | - Sultan Hamoud Alruwaili
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
| | - Malek Mohammed Almugharriq
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
| | - Abdulaziz Saud Alruwaili
- College of Medicine, Jouf University, Sakaka 72388, Saudi Arabia; (F.A.A.); (Z.M.A.); (O.A.A.); (S.H.A.); (M.M.A.); (A.S.A.)
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Wang F, Li L, Xiao H. Analysis of the efficacy and safety of Danshen Dripping pills on the eyes of diabetic retinopathy patients with Qi stagnation and blood stasis. Am J Transl Res 2021; 13:13059-13066. [PMID: 34956524 PMCID: PMC8661188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To analyze the efficacy and safety of compound Danshen dripping pills (CDDPs) in the treatment of patients with diabetic retinopathy (DR) with the syndrome of Qi stagnation and blood stasis. METHODS The clinical data of 81 patients with DR admitted to our hospital were analyzed retrospectively, and the patients were divided into an observation group (n=40) and a control group (n=41) in accordance with a random number table. The observation group was treated with CDDPs, while the control group was treated with Captopril. The response rates, change of severity degrees of retinopathy, improvement of vision, incidence of macular edema and symptom scores were compared between the two groups. RESULTS (1) The ratio of decreasing degree of severity of retinopathy in the observation group was greater than that in the control group, while the ratio of increasing degree of severity of retinopathy in the observation group was lower than that in the control group (P < 0.05). There was no significant difference in the constant ratio of degree of severity of retinopathy between the two groups (P > 0.05). (2) After treatment, the scores for dim vision, somber facial complexion, dry eyes, encrusted skin and numbness of the limbs in the observation group were lower than those in the control group (P < 0.05). (3) The overall response rates (ORRs) were 87.50% and 63.41% in the observation group and the control group, respectively (P < 0.05). (4) After treatment, the vision in the left and right eye in the observation group was higher than those in the control group (P < 0.05). (5) The incidence rates of macular edema were 12.50% and 31.71% in the observation group and the control group, respectively (P < 0.05). CONCLUSION CDDPs can effectively elevate the response rate, reduce the degree of severity of retinopathy, mitigate the incidence of macular edema, and improve the vision of DR patients with the syndrome of Qi stagnation and blood stasis, exhibiting a satisfactory safety profile. Therefore, it has a good application value.
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Affiliation(s)
- Fei Wang
- Department of Ophthalmology, Shengli Oilfield Central Hospital Dongying 257034, Shandong, China
| | - Lianlian Li
- Department of Ophthalmology, Shengli Oilfield Central Hospital Dongying 257034, Shandong, China
| | - Huizhen Xiao
- Department of Ophthalmology, Shengli Oilfield Central Hospital Dongying 257034, Shandong, China
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28
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Smit-McBride Z, Morse LS. MicroRNA and diabetic retinopathy-biomarkers and novel therapeutics. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1280. [PMID: 34532417 PMCID: PMC8421969 DOI: 10.21037/atm-20-5189] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/14/2021] [Indexed: 01/10/2023]
Abstract
Diabetic retinopathy (DR) accounts for ~80% of legal blindness in persons aged 20-74 years and is associated with enormous social and health burdens. Current therapies are invasive, non-curative, and in-effective in 15-25% of DR patients. This review outlines the potential utility of microRNAs (miRNAs) as biomarkers and potential therapy for diabetic retinopathy. miRNAs are small noncoding forms of RNA that may play a role in the pathogenesis of DR by altering the level of expression of genes via single nucleotide polymorphism and regulatory loops. A majority of miRNAs are intracellular and specific intracellular microRNAs have been associated with cellular changes associated with DR. Some microRNAs are extracellular and called circulatory microRNAs. Circulatory miRNAs have been found to be differentially expressed in serum and bodily fluid in patients with diabetes mellitus (DM) with and without retinopathy. Some miRNAs have been associated with the severity of DR, and future studies may reveal whether circulatory miRNAs could serve as novel reliable biomarkers to detect or predict retinopathy progression. Therapeutic strategies can be developed utilizing the natural miRNA/long noncoding RNA (lncRNA) regulatory loops. miRNAs and lncRNAs are two major families of the non-protein-coding transcripts. They are regulatory molecules for fundamental cellular processes via a variety of mechanisms, and their expression and function are tightly regulated. The recent evidence indicates a cross-talk between miRNAs and lncRNAs. Therefore, dysregulation of miRNAs and lncRNAs is critical to human disease pathogenesis, such as diabetic retinopathy. miRNAs are long-distance communicators and reprogramming agents, and they embody an entirely novel paradigm in cellular and tissue signaling and interaction. By targeting specific miRNAs, whole pathways implicated in the pathogenesis of DR may potentially be altered. Understanding the endogenous roles of miRNAs in the pathogenesis of diabetic retinopathy could lead to novel diagnostic and therapeutic approaches to managing this frequently blinding retinal condition.
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Affiliation(s)
- Zeljka Smit-McBride
- Department of Ophthalmology & Vision Science, Vitreoretinal Research Laboratory, School of Medicine, University of California Davis, Davis, California, USA
| | - Lawrence S Morse
- Department of Ophthalmology & Vision Science, Vitreoretinal Research Laboratory, School of Medicine, University of California Davis, Davis, California, USA
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29
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Xiao Y, Choi KS, Warther D, Huffman K, Landeros S, Freeman WR, Sailor MJ, Cheng L. A sustained dual drug delivery system for proliferative vitreoretinopathy. Drug Deliv 2021; 27:1461-1473. [PMID: 33100053 PMCID: PMC7594716 DOI: 10.1080/10717544.2020.1833382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Proliferative vitreoretinopathy (PVR) is a significant threat for vision recovery from retinal detachment or ocular trauma. Currently, no approved pharmacological intervention to prevent PVR. Daunorubicin (DNR) and dexamethasone (DEX) were sequentially loaded into oxidized porous silicon (pSiO2) particles by covalent conjugation. The DNR + DEX-loaded particles, and control particles loaded with DNR only and DEX only were incubated with RPE-populated collagen for daily gel surface quantitation. Toxicity was monitored by ophthalmic examinations and histological evaluation 21 days after injection. At 3rd week following intravitreal injection, a localized retinal detachment (RD) was created by subretinal injection of Healon in all pretreated eyes in addition to 3 non-interventional control eyes. 10 µg of bromodeoxyuridine (BrdU) was injected into the vitreous 4 h before sacrifice on day 3 after RD induction. Retinal sections were stained for glial fibrillary green protein (GFAP) and BrdU to identify activated glial cells and retinal cell proliferation. The studies demonstrated that all three pSiO2 particle types were well tolerated in vivo. DNR alone and DNR + DEX combination formulations demonstrated equally strong suppression on gel contraction (least square mean area of the gel: control = 1.71 vs. 30DNR = 1.85 or 30/40Dual = 1.83, p < .05). Eyes pretreated with pSiO2−DNR + DEX exhibited the least GFAP activation (least square mean intensity mm−2: Dual = 4.03, DNR = 7.76, Dex = 16.23, control = 29.11, p < .05) and BrdU expression (Mean number of BrdU positive cells per mm of retina: Dual = 2.77, DNR = 4.58, Dex = 4.01, control = 6.16, p < .05). The synergistic effect of a sustained release pSiO2−DNR/DEX showed promise for the prevention of PVR development while reducing the necessary therapeutic concentration of each drug.
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Affiliation(s)
- Ying Xiao
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Kyung Seek Choi
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - David Warther
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, USA
| | - Kristyn Huffman
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Stephanie Landeros
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - William R Freeman
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
| | - Michael J Sailor
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, USA
| | - Lingyun Cheng
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
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Singh A, Jothi Balaji J, Rasheed MA, Jayakumar V, Raman R, Lakshminarayanan V. Evaluation of Explainable Deep Learning Methods for Ophthalmic Diagnosis. Clin Ophthalmol 2021; 15:2573-2581. [PMID: 34177258 PMCID: PMC8219310 DOI: 10.2147/opth.s312236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/14/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The lack of explanations for the decisions made by deep learning algorithms has hampered their acceptance by the clinical community despite highly accurate results on multiple problems. Attribution methods explaining deep learning models have been tested on medical imaging problems. The performance of various attribution methods has been compared for models trained on standard machine learning datasets but not on medical images. In this study, we performed a comparative analysis to determine the method with the best explanations for retinal OCT diagnosis. METHODS A well-known deep learning model, Inception-v3 was trained to diagnose 3 retinal diseases - choroidal neovascularization (CNV), diabetic macular edema (DME), and drusen. The explanations from 13 different attribution methods were rated by a panel of 14 clinicians for clinical significance. Feedback was obtained from the clinicians regarding the current and future scope of such methods. RESULTS An attribution method based on Taylor series expansion, called Deep Taylor, was rated the highest by clinicians with a median rating of 3.85/5. It was followed by Guided backpropagation (GBP), and SHapley Additive exPlanations (SHAP). CONCLUSION Explanations from the top methods were able to highlight the structures for each disease - fluid accumulation for CNV, the boundaries of edema for DME, and bumpy areas of retinal pigment epithelium (RPE) for drusen. The most suitable method for a specific medical diagnosis task may be different from the one considered best for conventional tasks. Overall, there was a high degree of acceptance from the clinicians surveyed in the study.
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Affiliation(s)
- Amitojdeep Singh
- Theoretical and Experimental Epistemology Laboratory (TEEL), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Mohammed Abdul Rasheed
- Theoretical and Experimental Epistemology Laboratory (TEEL), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Varadharajan Jayakumar
- Theoretical and Experimental Epistemology Laboratory (TEEL), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Vasudevan Lakshminarayanan
- Theoretical and Experimental Epistemology Laboratory (TEEL), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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31
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Forrest IS, Chaudhary K, Paranjpe I, Vy HMT, Marquez-Luna C, Rocheleau G, Saha A, Chan L, Van Vleck T, Loos RJF, Cho J, Pasquale LR, Nadkarni GN, Do R. Genome-wide polygenic risk score for retinopathy of type 2 diabetes. Hum Mol Genet 2021; 30:952-960. [PMID: 33704450 PMCID: PMC8165647 DOI: 10.1093/hmg/ddab067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/27/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Diabetic retinopathy (DR) is a common consequence in type 2 diabetes (T2D) and a leading cause of blindness in working-age adults. Yet, its genetic predisposition is largely unknown. Here, we examined the polygenic architecture underlying DR by deriving and assessing a genome-wide polygenic risk score (PRS) for DR. We evaluated the PRS in 6079 individuals with T2D of European, Hispanic, African and other ancestries from a large-scale multi-ethnic biobank. Main outcomes were PRS association with DR diagnosis, symptoms and complications, and time to diagnosis, and transferability to non-European ancestries. We observed that PRS was significantly associated with DR. A standard deviation increase in PRS was accompanied by an adjusted odds ratio (OR) of 1.12 [95% confidence interval (CI) 1.04-1.20; P = 0.001] for DR diagnosis. When stratified by ancestry, PRS was associated with the highest OR in European ancestry (OR = 1.22, 95% CI 1.02-1.41; P = 0.049), followed by African (OR = 1.15, 95% CI 1.03-1.28; P = 0.028) and Hispanic ancestries (OR = 1.10, 95% CI 1.00-1.10; P = 0.050). Individuals in the top PRS decile had a 1.8-fold elevated risk for DR versus the bottom decile (P = 0.002). Among individuals without DR diagnosis, the top PRS decile had more DR symptoms than the bottom decile (P = 0.008). The PRS was associated with retinal hemorrhage (OR = 1.44, 95% CI 1.03-2.02; P = 0.03) and earlier DR presentation (10% probability of DR by 4 years in the top PRS decile versus 8 years in the bottom decile). These results establish the significant polygenic underpinnings of DR and indicate the need for more diverse ancestries in biobanks to develop multi-ancestral PRS.
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Affiliation(s)
- Iain S Forrest
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Medical Scientist Training Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kumardeep Chaudhary
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ishan Paranjpe
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ha My T Vy
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carla Marquez-Luna
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ghislain Rocheleau
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aparna Saha
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lili Chan
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tielman Van Vleck
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judy Cho
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Eye and Vision Research Institute, New York Eye and Ear Infirmary at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The BioMe Phenomics Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ben ÂJ, de Souza CF, Locatelli F, Rosses APO, Szortika A, de Araujo AL, de Carvalho G, Lavinsky D, Neyeloff JL, Neumann CR. Health-related quality of life associated with diabetic retinopathy in patients at a public primary care service in southern Brazil. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 64:575-583. [PMID: 34033298 PMCID: PMC10118975 DOI: 10.20945/2359-3997000000223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations. Methods This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders. Results The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740-0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698-0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679-0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521-0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105-0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04). Conclusion The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.
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Affiliation(s)
- Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands,
| | | | - Franciele Locatelli
- Faculdade de Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Adriana Szortika
- Serviço de Oftalmologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | - Aline Lutz de Araujo
- TelessaúdeRS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Gabriela de Carvalho
- Faculdade de Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Daniel Lavinsky
- Faculdade de Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | | | - Cristina Rolim Neumann
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
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Khandekar R, Senthil T, Nainappan M, Edward DP. Magnitude and Determinants of Diabetic Retinopathy Among Indian Diabetic Patients Undergoing Telescreening in India. Telemed J E Health 2021; 28:176-188. [PMID: 33999730 DOI: 10.1089/tmj.2021.0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To determine the magnitude, determinants, and public health issues related to diabetic retinopathy (DR) in India using 2019 data from a for-profit telescreening program. Methods: Digital retinal images were captured using a nonmydriatic fundus camera and transferred via the telescreening program to a reading center. Ophthalmologists trained in DR image reading created the DR status reports. Age/sex-adjusted rates of DR, sight-threatening DR (STDR), and diabetic macular edema (DME) were calculated and correlated with known risk factors. Results: Images of 51,760 Indian diabetic patients (103,520 eyes) were reviewed. The prevalence of DR, STDR, and DME was 19.1% (95% confidence interval [CI]: 18.9-19.5), 5.1% (95% CI: 4.9-5.3), and 3.9% (95% CI: 3.7-4.1), respectively. Based on these data, we projected 14.7 million cases of DR, 3.9 million with STDR, and 3.0 million DME cases in India. Statistically significant risk factors for DR were male gender (odds ratio [OR] = 1.19, p < 0.001), older age (χ2 = 270, df = 3, p < 0.001), history of cataract surgery (OR = 2.0, p < 0.001), longer duration of diabetes (χ2 = 1084, p < 0.001), and type 1 diabetes (OR = 3.9, p = 0.01). There was a statistically significant variation of DR by geographic zones (χ2 = 310, p < 0.001). Laser treatment coverage for STDR was 22%. Duration of diabetes (p < 0.001), cataract surgery in the past (p = 0.02), and females (p = 0.001) were predictors of STDR. Conclusion: This model of telescreening for DR provides an additional pathway for screening and preventing diabetes-related visual morbidity in India. The data from this study can be used for epidemiologic and ophthalmic health policies related to diabetes.
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Affiliation(s)
- Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Deepak P Edward
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, Chicago, Illinois, USA
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Han YS, Pathipati M, Pan C, Leung LS, Blumenkranz MS, Myung D, Toy BC. Comparison of Telemedicine Screening of Diabetic Retinopathy by Mydriatic Smartphone-Based vs Nonmydriatic Tabletop Camera-Based Fundus Imaging. JOURNAL OF VITREORETINAL DISEASES 2021; 5:199-207. [PMID: 34632255 PMCID: PMC8496880 DOI: 10.1177/2474126420958304] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare dilated smartphone-based imaging with a nonmydriatic, tabletop fundus camera as a teleophthalmology screening tool for diabetic retinopathy (DR). METHODS This was a single-institutional, cross-sectional, comparative-instrument study. Fifty-six patients at a safety-net hospital underwent teleophthalmology screening for DR using standard, nonmydriatic fundus photography with a tabletop camera (Nidek NM-1000) and dilated fundus photography using a smartphone camera with lens adapter (Paxos Scope, Verana Health). Masked graders performed standardized photo grading. Quantitative comparisons were performed employing descriptive, κ, Bland-Altman, and receiver operating characteristic analyses. RESULTS Posterior segment photography was of sufficient quality to grade in 89% of mydriatic smartphone-imaged eyes and in 86% of nonmydriatic tabletop camera-imaged eyes (P = .03). Using the tabletop camera as the reference to detect moderate nonproliferative DR or worse (referral-warranted DR), mydriatic smartphone-acquired photographs were found to be 82% sensitive and 96% specific. Dilated smartphone imaging detected referral-warranted DR in 3 eyes whose tabletop camera imaging did not demonstrate referral-warranted DR. Secondary masked review of medical records for the discordances in referral-warranted status from the two imaging modalities was performed, and it revealed revised sensitivity and specificity values of 95% and 98%, respectively. Overall, there was good agreement between tabletop camera and smartphone-acquired photo grades (κ = 0.91 ± 0.1, P < .001; area under the receiver operating characteristic curve = 0.99, 95% CI, 0.98-1.00). CONCLUSIONS Mydriatic smartphone-based imaging resulted in fewer ungradable photos compared to nonmydriatic table-top camera imaging and detected more patients with referral-warranted DR. Our study supports the use of mydriatic smartphone teleophthalmology as an alternative method to screen for DR.
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Affiliation(s)
- Yong Seok Han
- Department of Ophthalmology, University of Southern California Roski
Eye Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
| | - Mythili Pathipati
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
| | - Carolyn Pan
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
| | - Loh-Shan Leung
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
| | - Mark Scott Blumenkranz
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
| | - David Myung
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
| | - Brian Chiwing Toy
- Department of Ophthalmology, University of Southern California Roski
Eye Institute, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of
Medicine, Palo Alto, CA, USA
- Department of Ophthalmology, Santa Clara Valley Medical Center, San
Jose, CA, USA
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Pranata R, Vania R, Victor AA. Statin reduces the incidence of diabetic retinopathy and its need for intervention: A systematic review and meta-analysis. Eur J Ophthalmol 2021; 31:1216-1224. [DOI: 10.1177/1120672120922444] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Purpose: We aimed to perform a systematic literature search on the latest evidence of the role of statin in reducing diabetic retinopathy and its need for intervention. Methods: A comprehensive search on cohort studies/clinical trials that assess statins and diabetic retinopathy up until August 2019 was performed. The outcome measured was the incidence of diabetic retinopathy and its need for intervention. Results: There were 558.177 patients from six studies. Statin was associated with a lower incidence of diabetic retinopathy (hazard ratio: 0.68 (0.55, 0.84), p < 0.001; I2: 95%). For the subtypes of diabetic retinopathy, statin lowers the incidence of proliferative diabetic retinopathy (hazard ratio: 0.69 (0.51, 0.93), p = 0.01; I2: 90%), non-proliferative diabetic retinopathy (hazard ratio: 0.80 (0.66, 0.96), p = 0.02; I2: 93%), and diabetic macular edema (hazard ratio: 0.56 (0.39, 0.80), p = 0.002; I2: 82%). Statin was associated with a reduced need for retinal laser treatment with a hazard ratio of 0.70 (0.64, 0.76) (p < 0.001; I2: 0%), intravitreal injection with a hazard ratio of 0.82 (0.79, 0.85) (p < 0.001; I2: 0%), and vitrectomy with a hazard ratio of 0.64 (0.48, 0.85) (p < 0.001; I2: 75%). Overall, statin was associated with a reduced need for intervention for diabetic retinopathy with a hazard ratio of 0.72 (0.64, 0.80) (p < 0.001; I2: 73%). The regression-based Egger’s test showed statistically significant small-study effects for non-proliferative diabetic retinopathy (p = 0.011) outcomes. Conclusion: Statin was associated with a decreased risk of diabetic retinopathy and its subtypes. Statin also reduced the need for intervention with retinal laser treatment, intravitreal injection, and vitrectomy.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Andi Arus Victor
- Vitreo-Retinal Division, Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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The functional burden of diabetic retinopathy in the United States. Graefes Arch Clin Exp Ophthalmol 2021; 259:2977-2986. [PMID: 33914161 DOI: 10.1007/s00417-021-05210-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/02/2021] [Accepted: 04/19/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To study the association between diabetic retinopathy (DR) and physical functional difficulty using contemporary psychometric validation techniques, and to explore the predictors of physical difficulty among those with diabetes, non-proliferative DR (NPDR), or proliferative DR (PDR). METHODS Cross-sectional study using the National Health and Nutrition Examination Survey (NHANES) database from 2005-2008. Participants were classified as either (i) no diabetes no DR, (ii) diabetes without DR, (iii) mild/moderate NPDR, or (iv) severe NPDR/PDR. The presence of DR was detected by retinal imaging and severity was graded using the Early Treatment Diabetic Retinopathy Study Protocol. The physical difficulty was assessed using a 13-question self-reported questionnaire, validated using factor analysis and item response theory (graded response model) psychometric techniques. Secondary analyses of diabetes and DR populations most at risk of reporting greater physical functional difficulty were undertaken. RESULTS A total of 5321 participants over the age of 40 were included in our study. Of the 13 original physical difficulty questions, one latent trait was identified and 9 questions demonstrated good discrimination and were subsequently retained. In univariable analyses, participants with diabetes and any form of DR all reported significantly higher physical functional difficulty vs those with neither diabetes nor DR (p < 0.01 for all). In multivariable analyses, while those with diabetes or any form of DR remained more likely to report higher physical difficulty vs those with neither diabetes nor DR, only those with severe NPDR/PDR reported substantially higher scores (2.1 sum points higher, p = 0.002). Among participants with diabetes or any form of DR, those with 3 or more medical comorbidities and those with depression reported substantially higher sum physical difficulty scores (p < 0.05 for all). CONCLUSIONS Those with diabetes or DR experience greater functional physical difficulty than those without, particularly profound among those with severe forms of DR. For those with DR, the presence of concurrent depression or medical comorbidities conferred a significantly higher risk of physical difficulty. Providers and healthcare systems should be aware of particularly vulnerable DR populations at increased risk of experiencing daily functioning deficits.
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Statement of the German Ophthalmological Society, the German Retina Society, and the Professional Association of Ophthalmologists in Germany on treatment of diabetic macular edema : Dated August 2019. Ophthalmologe 2021; 118:40-67. [PMID: 33033871 DOI: 10.1007/s00347-020-01244-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Boyer DS, Rippmann JF, Ehrlich MS, Bakker RA, Chong V, Nguyen QD. Amine oxidase copper-containing 3 (AOC3) inhibition: a potential novel target for the management of diabetic retinopathy. Int J Retina Vitreous 2021; 7:30. [PMID: 33845913 PMCID: PMC8042903 DOI: 10.1186/s40942-021-00288-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Diabetic retinopathy (DR), a microvascular complication of diabetes, is the leading cause of visual impairment in people aged 20–65 years and can go undetected until vision is irreversibly lost. There is a need for treatments for non-proliferative diabetic retinopathy (NPDR) which, in comparison with current intravitreal (IVT) injections, offer an improved risk–benefit ratio and are suitable for the treatment of early stages of disease, during which there is no major visual impairment. Efficacious systemic therapy for NPDR, including oral treatment, would be an important and convenient therapeutic approach for patients and physicians and would reduce treatment burden. In this article, we review the rationale for the investigation of amine oxidase copper-containing 3 (AOC3), also known as semicarbazide-sensitive amine oxidase and vascular adhesion protein 1 (VAP1), as a novel target for the early treatment of moderate to severe NPDR. AOC3 is a membrane-bound adhesion protein that facilitates the binding of leukocytes to the retinal endothelium. Adherent leukocytes reduce blood flow and in turn rupture blood vessels, leading to ischemia and edema. AOC3 inhibition reduces leukocyte recruitment and is predicted to decrease the production of reactive oxygen species, thereby correcting the underlying hypoxia, ischemia, and edema seen in DR, as well as improving vascular function. Conclusion There is substantial unmet need for convenient, non-invasive treatments targeting moderately severe and severe NPDR to reduce progression and preserve vision. The existing pharmacotherapies (IVT corticosteroids and IVT anti-vascular endothelial growth factor-A) target inflammation and angiogenesis, respectively. Unlike these treatments, AOC3 inhibition is predicted to address the underlying hypoxia and ischemia seen in DR. AOC3 inhibitors represent a promising therapeutic strategy for treating patients with DR and could offer greater choice and reduce treatment burden, with the potential to improve patient compliance.
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Affiliation(s)
- David S Boyer
- Retina-Vitreous Associates Medical Group, Los Angeles, CA, USA
| | - Joerg F Rippmann
- CardioMetabolic Diseases Research, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | | | - Remko A Bakker
- CardioMetabolic Diseases Research, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | - Victor Chong
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
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Chang SJ, Lee KE, Yang E, Kim HJ. [Diabetes Self-Management Experience of Patients with Diabetes: Focused on the Visually Impaired]. J Korean Acad Nurs 2021; 51:92-104. [PMID: 33706334 DOI: 10.4040/jkan.20231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/17/2020] [Accepted: 12/08/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes. METHODS Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. RESULTS Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly. CONCLUSION It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.
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Affiliation(s)
- Sun Ju Chang
- College of Nursing · The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Kyoung Eun Lee
- College of Nursing, Seoul National University, Seoul, Korea.
| | - Eunjin Yang
- College of Nursing, Seoul National University, Seoul, Korea
| | - Hee Jung Kim
- College of Nursing, Seoul National University, Seoul, Korea
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Shan Y, Xu Y, Lin X, Lou L, Wang Y, Ye J. Burden of vision loss due to diabetic retinopathy in China from 1990 to 2017: findings from the global burden of disease study. Acta Ophthalmol 2021; 99:e267-e273. [PMID: 32869498 DOI: 10.1111/aos.14573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/02/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To conduct a detailed analysis on the burden of vision loss due to diabetic retinopathy (DR) by year, age and gender in China from 1990 to 2017. METHODS This is a between-country, retrospective, comparative burden-of-disease study. Prevalence and Years Lived with Disability (YLDs) data caused by DR in China and relative territories were extracted from the Global Burden of Disease (GBD) study 2017 to observe the changing trends of vision loss. RESULTS Prevalence and YLDs of DR in China increased significantly from 1990 to 2017. The age-standardized prevalence and YLDs rate witnessed a slowly declining trend recently. Higher prevalence and YLDs were observed in female subjects in the past three decades. Middle-aged and elderly people suffered from a higher burden of DR-induced vision loss. The total age-standardized prevalence rate of China in 1990 (17.68) and 2017 (21.88) was lower than that of other seven neighbouring countries. In 2017, moderate vision loss (MVL) (17.19) accounted for the largest proportion in China. The all-age YLDs of DR showed the second-highest increase (150.26%) while the age-standardized YLDs rate showed the third-highest increase (14.91%) among fifteen common causes of vision impairment (VI) from 1990 to 2017. China ranked 3rd among G20 countries in terms of all-age YLDs while ranked 18th in age-standardized YLDs rate in 2017. CONCLUSIONS In the past three decades, the prevalence and YLDs due to DR in China have improved in both genders. This study highlights the importance of prevention for DR, especially for women and the elderly.
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Affiliation(s)
- Yi Shan
- Department of Ophthalmology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Yufeng Xu
- Department of Ophthalmology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Xiling Lin
- Department of Endocrinology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Lixia Lou
- Department of Ophthalmology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Yijie Wang
- Department of Ophthalmology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
| | - Juan Ye
- Department of Ophthalmology School of Medicine The Second Affiliated Hospital of Zhejiang University Hangzhou China
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Wykoff CC, Khurana RN, Nguyen QD, Kelly SP, Lum F, Hall R, Abbass IM, Abolian AM, Stoilov I, To TM, Garmo V. Risk of Blindness Among Patients With Diabetes and Newly Diagnosed Diabetic Retinopathy. Diabetes Care 2021; 44:748-756. [PMID: 33472864 PMCID: PMC7896265 DOI: 10.2337/dc20-0413] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the association between initial diabetic retinopathy (DR) severity/risk of blindness in patients with newly diagnosed DR/good vision in the U.S. RESEARCH DESIGN AND METHODS This retrospective cohort study evaluated adult patients with good vision (20/40 or better) and newly diagnosed DR between 1 January 2013 and 31 December 2017 (index date) in the American Academy of Ophthalmology's Intelligent Research in Sight (IRIS) Registry. The primary exposure of interest was DR severity at index: mild nonproliferative DR (NPDR), moderate NPDR, severe NPDR, and proliferative DR (PDR). The main outcome measure was development of sustained blindness (SB), defined as study eyes with Snellen visual acuity readings of 20/200 or worse at two separate visits ≥3 months apart that did not improve beyond 20/100. RESULTS Among 53,535 eligible eyes (mean follow-up 662.5 days), 678 (1.3%) eyes developed SB. Eyes with PDR at index represented 10.5% (5,629 of 53,535) of the analysis population but made up 26.5% (180 of 678) of eyes that developed SB. Kaplan-Meier analysis revealed that eyes with moderate NPDR, severe NPDR, and PDR at index were 2.6, 3.6, and 4.0 times more likely, respectively, to develop SB after 2 years of DR diagnosis versus eyes with mild DR at index. In a Cox proportional hazards model adjusted for index characteristics/development of ocular conditions during follow-up, eyes with PDR had an increased risk of developing SB versus eyes with mild NPDR at index (hazard ratio 2.26 [95% CI 2.09-2.45]). CONCLUSIONS In this longitudinal ophthalmologic registry population involving eyes with good vision, more advanced DR at first diagnosis was a significant risk factor for developing SB.
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Affiliation(s)
- Charles C Wykoff
- Retina Consultants of Texas, Blanton Eye Institute, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, CA
| | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA
| | - Scott P Kelly
- American Academy of Ophthalmology, San Francisco, CA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA
| | - Rebecca Hall
- American Academy of Ophthalmology, San Francisco, CA
| | | | | | | | - Tu My To
- Genentech, Inc., South San Francisco, CA
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Abstract
BACKGROUND However, whether the whole-brain functional network hub changes occur in diabetic retinopathy patients remains unknown. PURPOSE The purpose of the study was to investigate the function network centrality and connectivity changes in diabetic retinopathy patients using the voxel-wise degree centrality method. MATERIALS AND METHODS Thirty-four diabetic retinopathy patients (18 male and 16 female) and 38 healthy controls (18 male and 20 female) closely matched in age, sex, and education were enrolled in the study. Graph theory-based network analysis was performed to investigate the degree centrality between two groups. RESULTS Compared with healthy controls, diabetic retinopathy patients had significantly higher degree centrality values in the pons and bilateral caudate and had significantly lower degree centrality values in the left lingual and right lingual, and right angular/middle occipital gyrus (MOG). Moreover, diabetic retinopathy patients exhibited increased functional connectivity between the bilateral lingual and right cerebellum lobe and right fusiform/bilateral caudate and increased functional connectivity between the right angular/MOG and bilateral anterior cingulum and right cuneus/bilateral precuneus and increased functional connectivity between the bilateral caudate and right lingual and right superior occipital gyrus. In contrast, diabetic retinopathy patients showed decreased functional connectivity between bilateral lingual and left lingual and right lingual and left superior occipital gyrus and decreased functional connectivity between the angular/MOG and right inferior occipital gyrus/right fusiform and left MOG/inferior occipital gyrus and decreased functional connectivity between the bilateral caudate and bilateral cerebellum crus1. CONCLUSION Our results highlight that reorganization of the hierarchy of the cortical connectivity network related to visual network.
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Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
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Mitchell W, Resnick H, Zebardast N. Age-Related Macular Degeneration and Visual and Physical Disability in a Nationally Representative Sample from the United States. Transl Vis Sci Technol 2021; 9:42. [PMID: 33442496 PMCID: PMC7774103 DOI: 10.1167/tvst.9.13.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/21/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose Outline the association between age-related macular degeneration (AMD) and functional difficulty using novel item response theory (IRT) psychometric techniques, and highlight populations particularly at risk of functional impairment. Methods This cross-sectional study included 5604 US adults. Primary outcomes were item response theory–adjusted visual and physical difficulty scores. Secondary analyses of AMD populations at highest risk of reporting greater functional difficulty were undertaken. Results In total, there were 386 participants with early AMD (mean presenting visual acuity [pVA], 0.12) and 55 with late AMD (mean pVA, 0.35). Those with late AMD reported substantially higher item visual difficulty, whereas those with both early/late AMD reported significantly higher item physical difficulty versus those with no AMD (P < .05). In univariate regression, only those with late AMD reported significantly higher visual difficulty versus those with no AMD (10.1 points [95% confidence interval (CI), 8.2–12.1 points] vs 7.1 points [95% CI, 7.0–7.2 points]; P = .003). Both early/late AMD reported higher physical difficulty versus those with no AMD (11.6 points [95% CI, 11.1–12.1 points; P = .005]; 13.4 points [95% CI, 11.8–15.0 points; P = .03], respectively, versus 11.0 points [95% CI, 10.9–11.1 points]. After adjustment for sociodemographic and medical variables (excluding pVA), only those with late AMD reported significantly greater visual and physical difficulty versus those with no AMD (10.0 points [95% CI, 8.2–11.9 points] vs 7.1 [95% CI, 7.0–7.2 points; P = .002]; and 12.7 points [95% CI, 11.3–14.0 points] vs 11.0 [95% CI, 10.9–11.1 points; P = .02], respectively); greater visual difficulty in those with late AMD persisted after additionally adjusting for pVA versus those with no AMD (9.1 points [95% CI, 7.6–10.6 points] vs 7.1 points [95% CI, 7.0–7.2 points; P = .01]). Among individuals with AMD, lower income, higher medical comorbidities, depression, and pVA predicted greater visual and physical difficulties. Conclusions AMD confers significant functional difficulty among US adults with sociodemographic characteristics influencing dysfunction; highlighting the value of alternatives to Snellen visual acuity in assessing visual characteristics. With aging populations and the increasing prevalence of AMD, health care professionals should be aware of the functional burden of AMD and recognize those at higher risk of functional difficulty. Translational Relevance Contemporary psychometric validation techniques can be effective in accurately describing the level of functional impairment for those with visual impairment.
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Affiliation(s)
- William Mitchell
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Nazlee Zebardast
- Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Bheemidi AR, Valentim CCS, Singh RP. Aflibercept in Diabetic Retinopathy. Ophthalmology 2021. [DOI: 10.17925/opht.2021.15.1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Santos T, Warren LH, Santos AR, Marques IP, Kubach S, Mendes LG, Sisternes LD, Madeira MH, Durbin M, Cunha-Vaz JG. Swept-source OCTA quantification of capillary closure predicts ETDRS severity staging of NPDR. Br J Ophthalmol 2020; 106:712-718. [PMID: 33355147 PMCID: PMC9046755 DOI: 10.1136/bjophthalmol-2020-317890] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 12/05/2020] [Indexed: 11/12/2022]
Abstract
Purpose To test whether a single or composite set of parameters evaluated with optical coherence tomography angiography (OCTA), representing retinal capillary closure, can predict non-proliferative diabetic retinopathy (NPDR) staging according to the gold standard ETDRS grading scheme. Methods 105 patients with diabetes, either without retinopathy or with different degrees of retinopathy (NPDR up to ETDRS grade 53), were prospectively evaluated using swept-source OCTA (SS-OCTA, PlexElite, Carl Zeiss Meditec) with 15×9 mm and 3×3 mm angiography protocols. Seven-field photographs of the fundus were obtained for ETDRS staging. Eyes from age-matched healthy subjects were also imaged as control. Results In eyes of patients with type 2 diabetes without retinopathy or ETDRS levels 20 and 35, retinal capillary closure was in the macular area, with predominant alterations in the parafoveal retinal circulation (inner ring). Retinal capillary closure in ETDRS stages 43–53 becomes predominant in the retinal midperiphery with vessel density average values of 25.2±7.9 (p=0.001) in ETDRS 43 and 23.5±3.4 (p=0.001) in ETDRS 47–53, when evaluating extended areas of 15×9 protocol. Combination of acquisition protocols 3×3 mm and 15×9 mm, using SS-OCTA, allows discrimination between eyes with mild NPDR (ETDRS 10, 20, 35) and eyes with moderate-to-severe NPDR (ETDRS grades 43–53). Conclusions Retinal capillary closure, quantified by SS-OCTA, can identify NPDR severity progression. It is located mainly in the perifoveal retinal capillary circulation in the initial stages of NPDR, whereas the retinal midperiphery is predominantly affected in moderate-to-severe NPDR.
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Affiliation(s)
- Torcato Santos
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | | | - Ana Rita Santos
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Department of Orthoptics, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Inês Pereira Marques
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Luís G Mendes
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | | | - Maria H Madeira
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Mary Durbin
- R&D, Carl Zeiss Meditec, Dublin, California, USA
| | - Jose G Cunha-Vaz
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal .,Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Moshfeghi A, Garmo V, Sheinson D, Ghanekar A, Abbass I. Five-Year Patterns of Diabetic Retinopathy Progression in US Clinical Practice. Clin Ophthalmol 2020; 14:3651-3659. [PMID: 33154625 PMCID: PMC7605957 DOI: 10.2147/opth.s275968] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To characterize the natural course of diabetic retinopathy (DR) in contemporary clinical practice. Patients and Methods This was a retrospective analysis of US claims data collected between January 1, 2006, and April 30, 2017. Patients aged ≥18 years with continuous medical and prescription insurance coverage for 18 months before DR diagnosis (index date) and for a follow-up period of 5 years were included (N=14,490). The time and risk of progressing to severe nonproliferative DR (NPDR) or proliferative DR (PDR) and of developing diabetic macular edema (DME) were evaluated over 5 years in patients stratified by DR severity at initial diagnosis. Results The estimated probability of progressing to severe NPDR or PDR within 5 years of diagnosis was 17.6% for patients with moderate NPDR versus 5.8% for mild NPDR. The probability of developing DME within 5 years was 62.6%, 44.6%, and 28.4% for patients diagnosed with severe NPDR, moderate NPDR, and PDR, respectively, versus 15.6% for mild NPDR. Among those observed to progress, median time to severe NPDR or PDR was approximately 2.0 years in patients with moderate NPDR, whereas median time to DME was approximately 0.5 years in patients with severe NPDR, 1.3 years in moderate NPDR, and 1.6 years in PDR. Relative to mild NPDR, adjusted hazard ratios (95% confidence interval) for progression to severe NPDR or PDR within 5 years were 3.12 (2.61–3.72) in patients with moderate NPDR, and for incident DME were 5.92 (5.13–6.82), 3.54 (3.22–3.91), and 1.96 (1.80–2.14) in patients with severe NPDR, moderate NPDR, and PDR, respectively. Conclusion The risk of DR progression and DME over 5 years was highest among patients diagnosed with moderate and severe NPDR, respectively. Our findings reinforce the importance of close monitoring for these patients to avoid unobserved disease progression toward PDR and/or DME.
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Affiliation(s)
- Andrew Moshfeghi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Feng PW, Ahluwalia A, Feng H, Adelman RA. National Trends in the United States Eye Care Workforce from 1995 to 2017. Am J Ophthalmol 2020; 218:128-135. [PMID: 32445703 DOI: 10.1016/j.ajo.2020.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe temporal and geographic trends in the US eye care workforce. DESIGN Cross-sectional study. METHODS We obtained data from the 2017 Area Health Resources File. The main outcomes were ophthalmologist and optometrist density, as defined as the number of providers per 100,000 individuals, the ratio of ophthalmologists ≥55 years of age to those <55 years of age, and county characteristics associated with the availability of an ophthalmologist. RESULTS From 1995 to 2017, the national ophthalmologist density decreased from 6.30 to 5.68 ophthalmologists per 100,000 individuals. Although rural counties experienced a mean annual increase in ophthalmologist density by 2.26%, they still had a lower mean ophthalmologist density (0.58/100,000 individuals) compared with nonmetropolitan (2.19/100,000 individuals) and metropolitan counties (6.29/100,000 individuals) in 2017. The ratio of older to younger ophthalmologists increased from 0.37 in 1995 to 0.82 in 2017, with the greatest ratio increase occurring in rural counties (0.29 to 1.90). The presence of an ophthalmologist was significantly associated with a greater proportion of individuals with a college degree and health insurance, and more developed health care infrastructure. From 1990 to 2017, the density of optometrists increased from 11.06 to 16.16 optometrists per 100,000 individuals. CONCLUSIONS Over the last 2 decades, the national density of ophthalmologists has decreased and the workforce has aged. In contrast, the density of optometrists has increased. Rural counties continue to have a disproportionately lower supply of eye care providers, although some growth has occurred. Given the rising ratio of optometrists to ophthalmologists, it is of interest for future work to determine how the optometrist workforce can best complement potential shortages of ophthalmologists.
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Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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A critical review: Psychophysical assessments of diabetic retinopathy. Surv Ophthalmol 2020; 66:213-230. [PMID: 32866468 DOI: 10.1016/j.survophthal.2020.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
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THREE-YEAR OUTCOMES IN A RANDOMIZED SINGLE-BLIND CONTROLLED TRIAL OF INTRAVITREAL RANIBIZUMAB AND ORAL SUPPLEMENTATION WITH DOCOSAHEXAENOIC ACID AND ANTIOXIDANTS FOR DIABETIC MACULAR EDEMA. Retina 2020; 39:1083-1090. [PMID: 29474306 PMCID: PMC6553973 DOI: 10.1097/iae.0000000000002114] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The decrease in macular thickness observed at 24 months was maintained at Month 36 in patients with diabetic macular edema treated with a combination of intravitreal ranibizumab and oral supplementation with high-dose docosahexaenoic acid and antioxidants. Purpose: To report 3-year results of a randomized single-blind controlled trial of intravitreal ranibizumab combined with oral docosahexaenoic acid (DHA) supplementation versus ranibizumab alone in patients with diabetic macular edema. Methods: There were 26 patients (31 eyes) in the DHA group and 29 (38 eyes) in the control group. Ranibizumab (0.5 mg) was administered monthly for the first 4 months followed by a pro re nata (PRN) regimen. In the experimental group, patients received oral DHA supplementation (1,050 mg/day) (Brudyretina 1.5 g). Results: At 36 months, mean decrease of central subfield macular thickness was higher in the DHA-supplementation group than in controls (275 ± 50 μm vs. 310 ± 97 μm) with significant differences at Months 25, 30, 33, and 34. Between-group differences in best-corrected visual acuity were not found, but the percentages of ETRDS gains >5 and >10 letters were higher in the DHA-supplementation group. Differences serum HbA1c, plasma total antioxidant capacity values, erythrocyte DHA content, and serum IL-6 levels were all significant in favor of the DHA-supplementation group. Conclusion: The addition of a high-rich DHA dietary supplement to intravitreal ranibizumab was effective to achieve better sustained improvement of central subfield macular thickness outcomes after 3 years of follow-up as compared with intravitreal ranibizumab alone.
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