Prevalence of Diabetic Retinopathy in the US in 2021

Practical Applications of Artificial Intelligence Diagnostic Systems in Fundus Retinal Disease Screening

Purpose

This study aims to evaluate the performance of a deep learning-based artificial intelligence (AI) diagnostic system in the analysis of retinal diseases, assessing its consistency with expert diagnoses and its overall utility in screening applications.

Methods

A total of 3076 patients attending our hospital underwent comprehensive ophthalmic examinations. Initial assessments were performed using the AI, the Comprehensive AI Retinal Expert (CARE) system, followed by thorough manual reviews to establish final diagnoses. A comparative analysis was conducted between the AI-generated results and the evaluations by senior ophthalmologists to assess the diagnostic reliability and feasibility of the AI system in the context of ophthalmic screening.

Results

: The AI diagnostic system demonstrated a sensitivity of 94.12% and specificity of 98.60% for diabetic retinopathy (DR); 89.50% sensitivity and 98.33% specificity for age-related macular degeneration (AMD); 91.55% sensitivity and 97.40% specificity for suspected glaucoma; 90.77% sensitivity and 99.10% specificity for pathological myopia; 81.58% sensitivity and 99.49% specificity for retinal vein occlusion (RVO); 88.64% sensitivity and 99.18% specificity for retinal detachment; 83.33% sensitivity and 99.80% specificity for macular hole; 82.26% sensitivity and 99.23% specificity for epiretinal membrane; 94.55% sensitivity and 97.82% specificity for hypertensive retinopathy; 83.33% sensitivity and 99.74% specificity for myelinated fibers; and 75.00% sensitivity and 99.95% specificity for retinitis pigmentosa. Additionally, the system exhibited notable performance in screening for other prevalent conditions, including DR, suspected glaucoma, suspected glaucoma, pathological myopia, and hypertensive retinopathy.

Conclusions

: The AI-assisted screening system exhibits high sensitivity and specificity for a majority of retinal diseases, suggesting its potential as a valuable tool for screening practices. Its implementation is particularly beneficial for grassroots and community healthcare settings, facilitating initial diagnostic efforts and enhancing the efficacy of tiered ophthalmic care, with important implications for broader clinical adoption.

Impact of teleretinal screening program on diabetic retinopathy screening compliance rates in community health centers: a quasi-experimental study

BACKGROUND

Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with inadequate screening rates even in urban areas with high concentrations of medical professionals. While medical guidelines recommend annual diabetic retinopathy screening for patients with diabetes mellitus, adherence to these recommendations remains low. This study evaluates the impact of a novel teleretinal DR screening program on screening compliance across urban community health centers in Boston, Massachusetts.

METHODS

We conducted a quasi-experimental study comparing DR screening compliance between intervention and comparison community health centers before and after implementing a teleretinal screening program. Participants included patients diagnosed with diabetes mellitus with primary care providers at the studied sites. We defined compliance as completion of either teleretinal screening or a documented eye care professional examination within the previous 365 days. Monthly compliance rates were analyzed using two-way fixed effects regression and event study techniques.

RESULTS

The study included 10,247 patients with diabetes mellitus who received care at six participating sites, generating 222 monthly compliance rate estimates. Baseline compliance rates before implementation ranged from 25 to 40% across sites. The two-way fixed effects regression analysis revealed that the screening program significantly increased DR compliance rates by an average of 7.2% points (p < 0.001). Event study analysis showed positive effects across all sites, though the initial improvement tended to diminish over time.

CONCLUSIONS

Implementation of a community-based teleretinal DR screening program significantly improved compliance with annual screening guidelines in urban communities. These findings support the broader adoption of teleretinal screening as an effective strategy for preventing DR-related vision loss in vulnerable populations. Further research is needed to assess long-term clinical outcomes and optimize program sustainability.

Diagnostic Accuracy of IDX-DR for Detecting Diabetic Retinopathy: A Systematic Review and Meta-Analysis

PURPOSE

Diabetic retinopathy (DR) is a leading cause of vision loss worldwide, making early detection critical to prevent blindness. IDX-DR, an FDA-approved autonomous artificial intelligence (AI) system, has emerged as an innovative solution to improve access to DR screening. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of IDX-DR in detecting diabetic retinopathy.

DESIGN

Systematic review and meta-analysis METHODS: A comprehensive literature search was conducted across PubMed, Embase, Scopus and Web of Science, identifying studies published through October 5, 2024. Studies involving adult patients with Type 1 or Type 2 diabetes and reporting diagnostic metrics such as sensitivity and specificity were included. The primary outcomes were pooled sensitivity and specificity of IDX-DR. A bivariate random-effects model was used for meta-analysis, and summary receiver operating characteristic (SROC) curves were generated to assess diagnostic performance. Statistical analyses were performed using MetaDisc software version 2.0.

RESULTS

Thirteen studies involving 13,233 participants met the inclusion criteria. IDX-DR's pooled sensitivity was 0.95 (95% CI: 0.82-0.99), and its pooled specificity was 0.91 (95% CI: 0.84-0.95). The SROC curve confirmed IDX-DR's high diagnostic accuracy in detecting diabetic retinopathy across various clinical environments. The AUC value of 0.95 demonstrated high sensitivity and specificity, indicating a robust diagnostic performance for IDX-DR in detecting diabetic retinopathy.

CONCLUSION

IDX-DR is a highly effective diagnostic tool for diabetic retinopathy screening, with robust sensitivity and good specificity. Its integration into clinical practice, especially in resource-limited settings, can potentially improve early detection and reduce vision loss. However, careful implementation is needed to address challenges such as over-diagnosis and ensure the tool complements clinical judgment. Future studies should explore the long-term impacts of AI-based screening and address ethical considerations surrounding its use.

Anti-VEGF monotherapy versus anti-VEGF therapy combined with laser or intravitreal glucocorticoid therapy for diabetic macular edema: A Bayesian network meta-analysis

AIMS

To conduct a network meta-analysis (NMA) comparing the efficacy of anti-vascular endothelial growth factor (VEGF) monotherapy versus anti-VEGF therapy combined with laser or intravitreal glucocorticoid therapy for diabetic macular edema (DME).

MATERIALS AND METHODS

PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials comparing anti-VEGF monotherapy with anti-VEGF therapy combined with laser or intravitreal glucocorticoid therapy for DME. The primary outcomes included the mean best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes from the baseline. A NMA for continuous outcomes was conducted using a fixed-effects model, with mean difference (MD) and corresponding 95% credible interval (CI) reported.

RESULTS

The NMA included 21 randomized controlled trials involving 1798 eyes. Anti-VEGF monotherapy and anti-VEGF combined with laser or intravitreal glucocorticoid therapy did not significantly change the mean CMT and BCVA at 6 and 12 months from the baseline. Simulation-based ranking results for mean BCVA changes suggested that anti-VEGF therapy combined with laser therapy was likely the most effective at 6 (70.7515%) and 12 (70.9315%) months. Similar results were observed in the simulation-based ranking of mean CMT changes, suggesting that anti-VEGF therapy combined with laser therapy was likely the most effective at 6 (83.6350%) and 12 (74.7730%) months.

CONCLUSIONS

Anti-VEGF monotherapy and anti-VEGF therapy combined with laser or intravitreal glucocorticoid therapy exerted comparable effects. However, the ranking chart recommends anti-VEGF therapy combined with laser therapy. Meanwhile, anti-VEGF therapy combined with intravitreal glucocorticoid therapy did not demonstrate significant benefits.

High Prevalence of Diabetic Retinopathy in an Outpatient Podiatry Clinic and Associated Barriers to Ophthalmic Care

Background

Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults. However, the prevalence of DR among patients with diabetic foot disease-a signal of advanced systemic diabetes complications-is underexplored. Additionally, the substantial comorbidity burden associated with diabetic foot disease may result in a higher incidence of or distinct barriers to ophthalmic care, including structural (access to healthcare), behavioral (prioritization of care), and economic (cost of care) factors, compounding risk of vision loss. This study assesses the prevalence of DR in a podiatric clinic while also investigating participant-reported barriers to routine ophthalmic follow-up.

Methods

We conducted a cross-sectional study that included patients age ≥18 (n=62) receiving diabetic foot care at an outpatient podiatric clinic in 2021 and 2022. DR status was determined through point-of-care digital retinal images or prior DR diagnosis documented in the electronic medical record. Retinal images were interpreted remotely by a board-certified ophthalmologist. Self-reported barriers to regular ophthalmic care were recorded among participants who were lost to follow-up ophthalmic care. Participants were also surveyed for favorable incentives to promote ophthalmic follow-up.

Results

Our findings revealed a high prevalence of DR, with 32 (54%) participants diagnosed with DR and 10 (17%) participants having sight-threatening DR. Notably, 17 (29%) participants were newly diagnosed with DR as a direct result of this study. Of the 62 participants enrolled, 29 (47%) were lost to ophthalmic care. All of these participations reported one or more barriers to receiving ophthalmic care, predominantly related to competing social, economic, and medical challenges, with ophthalmic care being chronically underprioritized. Financial incentives were most favored by participants as an effective means to promote ophthalmic follow-up.

Conclusion

The high prevalence of DR, especially undiagnosed DR, in conjunction with significant barriers to ophthalmic care highlights a critical need for improved screening in outpatient podiatric settings. Integrating digital fundus cameras into outpatient podiatric clinic workflow may enhance DR detection and prevent vision loss in this high-risk population. Addressing identified barriers to routine ophthalmic care may further improve the rate of follow-up care and reduce the burden of DR-related vision loss among patients with diabetic foot disease.

Genetic association of MIR-449B, GCLC, eNOS, SORD, and ENPP1 with diabetic retinopathy

Identifying the genetic risk factors of diabetic retinopathy (DR) is essential for discovering the potential pathogenesis of DR. This study determined the association of DR with five single nucleotide polymorphisms (SNPs) specifically in type 2 diabetes mellitus (T2DM) patients, including rs10061133(MIR-449B), rs17883901(GCLC), rs2070744(eNOS), rs3759890 (SORD) and rs7754561 (ENPP1). A total of 1433 individuals were enrolled in this study, comprising healthy controls (ctrls = 480), individuals with diabetes mellitus without retinopathy (DNR = 480), non-proliferative DR(NPDR = 378), and proliferative DR(PDR = 95). The five SNPs were genotyped utilizing Mass ARRAY MALDI-TOF technology. Odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the risk of genotype and allele. We performed a literature search in PubMed published before July 16, 2023. The Newcastle Ottawa Scale was used to evaluate the overall quality of the case-control studies. Consequently, we found that there were statistically significant differences between PDR cases and healthy controls for rs10061133 (P = 0.007, OR = 1.59, 95% CI = 1.32-2.23) and rs17883901 (P = 0.020, OR = 1.67, 95% CI = 1.08-2.57), rs17883901 was significantly associated with NPDR (P = 0.023, OR = 1.39, 95% CI = 1.05-1.85), there was a significant association between DR cases and healthy controls (P = 0.048, OR = 1.22, 95% CI = 1.00-1.48) for rs3759890 in the allelic model. DR show no relationships with the other two SNPs compared to healthy controls. In multivariate analyses comparing the DR and DNR groups, rs7754561(A), rs10061133(G), and rs17883901(A) were identified as risk loci for DR in individuals with a duration of diabetes of ≥5 years (P = 0.0023, P = 0.0037, and P = 0.0376, respectively). Furthermore, individuals carrying rs10061133(G) exhibited a higher risk of DR in the hyperglycemic group (glucose ≥8 mmol/L). Secondly, we showed that one polymorphism in eNOS (rs2070744, T > C) showed a suggestive association with DR in the meta-analysis (allelic model:P < 0.05, OR = 1.18, 95% CI: 1.07-1.30, Z = 3.46, I2 = 34%). Subsequently, including studies that used either healthy subjects or diabetic subjects without DR as controls, the association of eNOS rs2070744 with DR was consistently significant (P = 0.002) and exhibited intermediate heterogeneity (I2 = 48%). Furthermore, polymorphisms in GCLC (rs17883901) and SORD (rs3759890) were also associated with DR, with P-values of 0.004 (I2 = 93%) and 0.03 (I2 = 3%), respectively, suggesting their potential involvement in the disease. In conclusion, this study documented that rs10061133(G), rs17883901(A), and rs3759890(G) could be the independent risk factors for retinopathy in Chinese patients with T2DM, offering a foundation for genetic risk assessment in clinical practice. Furthermore, our meta-analysis reveals a significant association between rs2070744 and DR, implying the potential involvement of the MIR-449B, GCLC, SORD, and eNOS variants in the development of DR, which could be a promising direction for developing new treatments aimed at mitigating the risk of DR in susceptible populations.

Promising therapeutic targets for neuroprotection in retinal disease

PURPOSE OF REVIEW

Neurodegeneration is a common endpoint of various blinding retinal diseases. Yet, despite exciting advances in disease treatment, there continues to exist a critical need for the development of neuroprotective strategies to prevent retinal cell death. Here, we summarize the recent advances in neuroprotective strategies.

RECENT FINDINGS

From laboratory deciphering of the mechanisms involved in disease, many novel neuroprotective strategies have emerged and are currently under investigation for the treatment of various retinal and ocular diseases such as inherited retinal degeneration, retinal detachment, diabetic retinopathy, age-related macular degeneration, macular telangiectasia type 2, and glaucoma. These strategies include gene therapies, Fas inhibition, and targeting inflammatory, metabolic and reduction-oxidation abnormalities. Interestingly, investigation of several treatments across different diseases suggests shared neuroprotection mechanisms that can be targeted regardless of the particular disease.

SUMMARY

Retinal neuroprotection can improve treatment of different retinal diseases. Fortunately, the current landscape, with a plethora of novel neuroprotective therapies, portends a better future for patients.

Causal role of plasma liposome in diabetic retinopathy: mendelian randomization (MR) study

BACKGROUND

Research indicates that there may be an association between plasma lipidome levels and the incidence of diabetic retinopathy (DR) in patients. However, the potential causality of this relationship is yet to be determined. To investigate this matter further, we employed a two-sample Mendelian randomization (MR) analysis to comprehensively assess the causality between lipidome levels and DR.

METHODS

Summary statistics for lipid levels and DR were obtained from the Genome-Wide Association Studies (GWAS) Catalog database and the FinnGen Consortium, respectively. We conducted a two-sample MR analysis, and statistical analysis were performed using the inverse variance weighted (IVW) with the addition of the MR-Egger, weighted median (WM), constrained maximum likelihood and model averaging (cML-MA) to test for causal associations between lipid levels and DR. Heterogeneity was checked using Cochran's Q statistic. The MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) global test and the MR-Egger regression were used to detect horizontal pleiotropy. The robustness of our findings was assessed using leave-one-out and funnel plots. To further assess the reliability of the results, linkage disequilibrium score regressions, colocalization analysis and reverse MR analysis were also performed.

RESULTS

Analysis of the pooled MR results and after correction for the false discovery rate (FDR) revealed that five lipid levels were associated with DR risk. Phosphatidylcholine (16:0_16:0) levels [OR = 0.869 (0.810 to 0.933), Pfdr = 0.006], phosphatidylcholine (16:0_20:2) levels [OR = 0.893 (0.834 to 0.956), Pfdr = 0.043] and phosphatidylethanolamine (18:0_20:4) levels [OR = 0.906 (0.863 to 0.951), Pfdr = 0.006] were protective against DR, whereas sphingomyelin (d36:1) levels [OR = 1.120 (1.061 to 1.183), Pfdr = 0.006], and sphingomyelin (d40:1) levels [OR = 1.081 (1.031 to 1.134), Pfdr = 0.043] were associated with a greater risk of DR. Further sensitivity analysis did not reveal heterogeneity or horizontal pleiotropy.

CONCLUSION

In summary, genetic evidence suggests a causal relationship between the levels of specific lipid levels and DR. These findings may provide valuable insights into the causal relationships between lipid levels and DR, potentially informing future prevention and treatment strategies.

BMAL1 Overexpression in Suprachiasmatic Nucleus Protects from Retinal Neurovascular Deficits in Diabetes

The suprachiasmatic nucleus (SCN) regulates circadian rhythms and influences physiological and behavioral processes. Disruptions in circadian rhythms (CRD) are observed in type 2 diabetes (T2D), and importantly, CRD acts as an independent risk factor for T2D and its associated complications. BMAL1, a circadian clock gene, is vital for sustaining an optimal circadian rhythm and physiological function. However, the therapeutic potential of BMAL1 overexpression in the SCN to rectify the neurovascular deficits of T2D has yet to be investigated. In this study, db/db mice, a well-established model of T2D exhibiting arrhythmic behavior and the complications of diabetes, were injected stereotaxically with AAV8-Bmal1 or a control virus in the SCN to evaluate the protective effects of correcting the central clock on neurovascular deficits. Given the complex neurovascular network and the eye's unique accessibility as a transparent system, ocular complications were selected as a model to examine the neuronal functional, behavioral, and vascular benefits of correcting the central clock. BMAL1 overexpression normalized the circadian rhythms, as demonstrated by improvements in the free-running period. The retinal neuronal function improved on electroretinogram, along with optomotor behavior and visual acuity enhancements. Retinal vascular deficits were also significantly reduced. Notably, our approach helped decrease fat content in genetically predisposed obese animals. Since the SCN is known to regulate hepatic glucose production via sympathetic mechanisms, glycemic control, and pyruvate tolerance tests were conducted. Systemically, we observed improved glucose homeostasis in BMAL1-overexpressing mice alongside a substantial reduction in hepatic gluconeogenesis. BMAL1 overexpression lowered plasma norepinephrine and liver TH levels, indicating a protective regulation of adrenergic signaling. Thus, this study underscores the therapeutic potential of targeting circadian clock genes like BMAL1 in the SCN to alleviate metabolic and neurovascular deficits associated with T2D. Our research offers a compelling framework for integrating circadian rhythms into managing diabetes and its complications.

A Systematic Review and Meta-Analysis Assessing Diversity and Representation in Diabetic Retinopathy Clinical Trials in the U.S

PURPOSE

To perform a systematic review and meta-analysis assessing the diversity and representation of diabetic retinopathy (DR) patients in clinical trials conducted in the United States from January 1, 2018, to December 31, 2023.

METHODS

A comprehensive search strategy was conducted on May 28th, 2024 using MEDLINE (PubMed) and Embase (Elsevier) to identify relevant clinical trials. Inclusion criteria included trials published between January 1, 2018 and December 31, 2023, focusing on interventions for DR that were conducted in the United States. Screening and data extraction were independently performed by three reviewers.

RESULTS

Eleven clinical trials met the inclusion criteria and were analyzed for participant representation based on sex, age, and race/ethnicity. Sex representation was rated as good in 9 of the 11 studies. However, age representation was rarely reported (only 1/11 studies) and race/ethnicity representation was poor in 6 of the 11 studies. The findings highlight significant underrepresentation of Asian and Black populations.

CONCLUSION

This study reveals substantial disparities in the demographic representation within DR clinical trials in the United States, emphasizing the critical need for improved inclusion strategies. Enhancing diversity in these trials is essential for producing research findings that are more applicable to the broader population affected by DR, ultimately contributing to more equitable healthcare outcomes and advancing the effectiveness of treatments across diverse demographic groups.

The association between age at diagnosis of diabetes and development of diabetic retinopathy and assessment of healthcare access as an effect modifier

AIMS

To examine if healthcare access modifies the association between age at diagnosis of diabetes and the prevalence of retinopathy.

METHODS

BRFSS 2020 survey data was obtained from 12,198 adults. Participants with missing information in the variables "retinopathy" (N = 569) and "insurance-cost barrier" (N = 75) were excluded. The final sample included 11,556 participants. Age at diagnosis of diabetes was the main exposure and retinopathy was the main outcome. We tested if the main association was different among the insurance-cost barrier variable. Binary logistic regression models were used to calculate odds ratios (OR) and 95 % confidence intervals (CI).

RESULTS

The odds of retinopathy decreased by 22 % in patients 46-64 years-of-age (OR 0.78; 95 CI 0.6-1.0) and 57 % in those 65+ (OR 0.43; 95 CI 0.28-0.65). The odds decreased by 39 % if female (OR 0.61; 95 CI 0.48-0.77). An increase in odds by 86 % (OR 1.86; 95 CI 1.07-3.21) occurred in other non-Hispanics, 50 % (OR 1.50; 95 CI 1.13-1.99) in black non-Hispanics and 70 % (OR 1.70; 95 CI 1.17-2.46) in Hispanics. There was no evidence that age at diagnosis of diabetes and presence of retinopathy varied by insurance cost (p > 0.05).

CONCLUSION

Health professionals may utilize these results to advocate for early disease intervention.

Reassessment of arterial versus venous perfusion of diabetic retinal neovascularization using ultrawide-field fluorescein angiography

PURPOSE

The purpose of this study was to assess whether diabetic NV is perfused by the arterial or the venous circulation.

METHODS

This is a retrospective, consecutive case series evaluating patients with proliferative diabetic retinopathy (PDR) imaged with ultrawide-field (UWF) fluorescein angiography (FA). Areas of neovascularization elsewhere (NVE) and neovascularization of the disc (NVD) were assessed. Perfusion was defined as arterial, arteriovenous, or venous if the area of diabetic neovascularization (NV) began to hyperfluoresce either prior, during, or after laminar venous flow, respectively.

RESULTS

A total of 180 eyes from 176 patients with 928 NV were identified (830 NVE, 98 NVD). Of those, 5.1% of NVE were classified as arterial and 58.2% of NVD were classified as arterial. The remaining NV were classified as arteriovenous except for a small subset (6.1%) which were indeterminate. None of the NV were classified as venous. Noteworthy examples demonstrated NV that nearly fully perfused prior to any detectable fluorescence within nearby veins as well as clear shunting of blood from a feeding artery to a draining vein.

CONCLUSIONS

UWF FA images suggest that some NV is perfused by retinal arteries. This may be useful in devising strategies for early detection and treatment of NV precursors.

KEY MESSAGES

What is known • Diabetic retinal neovascularization has long been thought to be perfused by the retinal venous circulation. • Vascular endothelial growth factor has been shown to play key roles in both angiogenesis and arteriogenesis. What is new • Ultrawide-field fluorescein angiography demonstrates that at least some diabetic neovascularization is perfused by the retinal arterial circulation. • This supports the hypothesis that diabetic neovascularization may arise from arterially-perfused intraretinal microvascular abnormalities in the capillary bed.

Estradiol impacts Müller glia and endothelial cell responses in hyperglycemic microenvironments with advanced glycation end products

Diabetic retinopathy is a leading cause of vision loss in working adults, with disproportionate impact on women with lowered estrogen. Sex hormones and their receptors are significant to neuroprotection of the inner blood-retinal barrier (iBRB), a tissue that regulates transport across the neuroretina and vasculature. Moreover, high glucose levels in diabetes lead to the formation of advanced glycation end products (AGEs), which promote inflammation and iBRB breakdown to result in vision loss. This study examined the effects of supplemental estradiol on cell reactivity and cell barrier resistance within an in vitro model of hyperglycemia. Changes in morphology and expression of reactive oxygen species were examined when cells were exposed to a hyperglycemic medium containing AGEs, with and without supplemental estradiol. Cell morphology was assessed via changes in cell area and cell shape index, while intracellular ROS levels were measured using a ROS-sensitive dye. In addition, trans endothelial resistance (TEER) assays were used to measure changes in cell barrier function in response to hyperglycemic conditions, with and without supplemental estradiol. Results show that ROS levels in Müller glia in hyperglycemic conditions significantly decreased in response to supplemental estradiol. The estradiol further increased the resistivity of Müller glia and endothelial cell barriers cultured in high glucose and AGEs. This project illustrates the restorative effects of estradiol in collective responses of cell barriers formed by endothelial cells and Müller glia.

Twenty year trends in prevalence and incidence of diabetic retinal disease

OBJECTIVE

To determine how the rates of diabetic retinal disease (DRD) and its vision-threatening components (VTDR), diabetic macular edema (DME), and proliferative diabetic retinopathy (PDR) among patients with diabetes mellitus (DM) have changed over the past 20 years.

DESIGN

Retrospective cohort study.

SUBJECTS

All individuals in a US administrative medical claims database comprised of patients insured by commercial and Medicare Advantage insurance plans from 2000-2022 with DM and at least one full calendar year of data. Cohorts of patients with DM were created using ICD codes to determine the yearly prevalence and incidence of DRD, VTDR DME, and PDR.

METHODS

Logistic and Poisson regression models were used to create prevalence and incidence estimates, respectively.

MAIN OUTCOME MEASURE

The main outcomes were the unadjusted prevalence and incidence of DRD, DME, and PDR.

RESULTS

Among patients with DM, the prevalence of DRD initially decreased from 2001 (13.6%) to 2007 (10.9%) but then increased every year through 2021 (20.8%)(adjusted test for trend[aTT] p<0.001). DRD incidence varied considerably, ranging from 17.7 cases/1000 patient-years in 2013 to its highest of 32.2 in 2022 (aTT p<0.001). The prevalence of VTDR and DME trended similarly, with increases from 2007 (VTDR:5.2%; DME:3.2%) through 2016 (VTDR:7.5%; DME:5.4%) followed by decreases each year through 2021 (VTDR:6.9%; DME:4.9%)(aTT p<0.001). The VTDR and DME incidence rates also tracked similarly, with multi-year peaks in 2009 (VTDR:12.4; DME:8.6) and general decreases through 2022 (VTDR:6.1; DME:5.0)(aTT p<0.001 for both VTDR and DME). PDR prevalence varied between 3.2% and 4.0% throughout the 20-year observation, measuring 3.5% in 2021(aTT p<0.001). PDR incidence varied from 8.3 in 2002 to 7.0 in 2008, then decreased every year to 2.6 in 2022 (aTT p<0.001).

CONCLUSIONS AND RELEVANCE

DRD Prevalence (through 2007) and incidence (through 2014) initially decreased, but the rate of each has since doubled. Despite increases in DRD, incidence rates of VTDR, DME, and PDR have dramatically improved over the past 20 years.

Single-cell sequencing in diabetic retinopathy: progress and prospects

Diabetic retinopathy is a major ocular complication of diabetes, characterized by progressive retinal microvascular damage and significant visual impairment in working-age adults. Traditional bulk RNA sequencing offers overall gene expression profiles but does not account for cellular heterogeneity. Single-cell RNA sequencing overcomes this limitation by providing transcriptomic data at the individual cell level and distinguishing novel cell subtypes, developmental trajectories, and intercellular communications. Researchers can use single-cell sequencing to draw retinal cell atlases and identify the transcriptomic features of retinal cells, enhancing our understanding of the pathogenesis and pathological changes in diabetic retinopathy. Additionally, single-cell sequencing is widely employed to analyze retinal organoids and single extracellular vesicles. Single-cell multi-omics sequencing integrates omics information, whereas stereo-sequencing analyzes gene expression and spatiotemporal data simultaneously. This review discusses the protocols of single-cell sequencing for obtaining single cells from retina and accurate sequencing data. It highlights the applications and advancements of single-cell sequencing in the study of normal retinas and the pathological changes associated with diabetic retinopathy. This underscores the potential of these technologies to deepen our understanding of the pathogenesis of diabetic retinopathy that may lead to the introduction of new therapeutic strategies.

Revolutionizing Diabetic Retinopathy Screening: Integrating AI-Based Retinal Imaging in Primary Care

Diabetic retinopathy (DR) is a public health issue affecting millions in the United States and Europe. However, despite strong recommendations for screening at regular intervals by many professional societies, including the American Diabetes Association and the American Academy of Ophthalmology, screening rates remain suboptimal, with only 50-70% of patients with diabetes adhering to recommended annual eye exams. Barriers to screening include lack of awareness, socioeconomic factors, health care system fragmentation, and workforce shortages, among others. Artificial intelligence (AI)-based retinal screening tools offer promising solutions to improve DR detection in primary care settings. We describe a quality improvement and continuing medical education programme, starting in 2020, which has so far deployed 198 AI-equipped cameras in 5 health systems, covering approximately 151,000 patients with diabetes. To date, over 20,000 screenings were completed, with more than mild DR detected in more than 3,450 people, leading to specialist referrals for follow-up care. Notably, negative screenings potentially represent deferred specialist care. While AI adoption in healthcare presents challenges, its potential benefits in improving patient care and optimising resources are significant. Integrating AI-based DR screening with a comprehensive education and process improvement initiative in primary care practices warrants serious consideration, promising to enhance patient outcomes.

Use of Home Optical Coherence Tomography for Retinal Diseases

Modern treatment protocols for retinal diseases involve frequent in-office monitoring with optical coherence tomography (OCT) and treatment with anti-vascular endothelial growth factor injections. Monthly injections may yield the greatest visual outcomes but are the most burdensome for patients and physicians, while as-needed injections may lead to undertreatment. Hybrid protocols, such as treat-and-extend (TREX) have been conceived to bridge this gap. Device-based home monitoring protocols for retinal disease may iterate further and allow more precise treatment tailored to individualized disease activity curves. Prior non-OCT home monitoring strategies have been developed with varying efficacy. These range from the ubiquitous but low-sensitivity Amsler grid to recent innovations such as the ForeseeHome preferential hyperacuity perimeter. Most recently, home OCT devices have been studied for remote monitoring, largely for use with age-related macular degeneration (AMD). Currently, the only Food and Drug Administration (FDA) approved device that utilizes OCT for monitoring retinal disease is the SCANLY Home OCT. Paired with an artificial intelligence (AI) algorithm that allows automated monitoring and alerting of retinal fluid volumes in AMD, SCANLY has demonstrated feasibility in limited trials to date, and a multicenter randomized controlled trial is currently underway to assess its efficacy in comparison to TREX regimens. Additional non-FDA-approved devices are being developed with varying degrees of study to date. Questions remain regarding its efficacy, real-world implementation, and financial considerations; nevertheless, home OCT has the potential to address many current barriers in retinal care, including travel and treatment burdens, while facilitating increased treatment precision.

Impact of glucagon-like peptide-1 receptor agonists on diabetic retinopathy: A meta-analysis of clinical studies emphasising retinal changes as a primary outcome

BACKGROUND

To determine if glucagon-like peptide-1 receptor agonists (GLP-1RA) are associated with the development and progression of diabetic retinopathy (DR).

METHODS

A systematic search was conducted on PubMed, Cochrane Library, and Embase from inception to February 2024 to identify clinical studies reporting the development of and changes in DR as the primary outcome in patients with type 2 diabetes taking GLP-1RA, insulin, or oral antidiabetic medication (OAD). Two researchers independently completed the search and referred to a third as necessary. Data for meta-analysis was pooled using a random-effects model.

RESULTS

Analysis of seven studies representing 242 537 patients showed a significantly decreased risk of incidence of DR between GLP-1RA and insulin use (RR = 0.66, 95% CI (0.48, 0.91), p = 0.01). There was no difference in the risk of DR complications (e.g., vitreous haemorrhage, retinal detachment, or requiring treatment with intravitreal injections, lasers, vitrectomy). Between GLP-1RA and OAD use, there was no difference in the risk of incidence of DR, while there was a significantly increased risk of DR complications (RR = 1.39, 95% CI (1.07, 1.80), p = 0.01).

CONCLUSION

Our findings indicate no elevated risk of incidence of DR linked to GLP-1RA compared to insulin. In fact, GLP-1RA may offer potential advantages over insulin regarding the overall incidence of DR. The increased risk of DR requiring treatment and associated complications in the GLP-1RA group compared to OAD may be due to the transient progression of DR associated with a rapid decrease in HbA1c - a phenomenon not specific to GLP-1RA and warrants further investigation.

Empagliflozin and the Risk of Retinopathy in Patients With Type 2 Diabetes

Importance

Empagliflozin might lower the risk of diabetic retinopathy (DR) by preventing retinal pericyte loss. However, the role of empagliflozin with respect to DR in patients with type 2 diabetes (T2D) remains unclear.

Objective

To compare the risk of incident nonproliferative DR (NPDR) and DR progression in patients with T2D initiating empagliflozin vs a dipeptidyl peptidase 4 inhibitor (DPP4i).

Design, Setting, and Participants

A new-user active-comparator cohort study was conducted using US nationwide insurance claims data from 2 commercial insurers and Medicare from August 2014 to September 2019. Adults with T2D initiating study drugs without prior diagnosis or treatment for proliferative DR or other advanced retinal diseases were included. To assess incident NPDR, patients with a history of NPDR were additionally excluded, while for the DR progression outcome, patients were required to have a history of NPDR. Data were analyzed from August 2022 to May 2024.

Exposures

Initiation of empagliflozin or a DPP4i.

Main Outcomes and Measures

Incident NPDR was defined using diagnostic codes for mild, moderate, or severe NPDR. The DR progression outcome was defined as a composite of incident proliferative DR, vitreous hemorrhage, initiation of intravitreal anti-vascular endothelial growth factor injection, or panretinal photocoagulation. Incidence rates, hazard ratios (HRs), and rate differences (RDs) with 95% CIs were estimated.

Results

A total of 34 239 pairs of propensity-score matched adults were identified in the incident NPDR cohort and 7831 pairs in the DR progression cohort. In the incident NPDR cohort, 35 867 patients (52.4%) were male, and the mean (SD) age was 65.6 (10.3) years. In the DR progression cohort, 8229 patients (52.5%) were male, and the mean (SD) age was 67.0 (10.0) years. Over a mean (SD) follow-up period of 8 (7.5) months receiving treatment, the risk of incident NPDR was not different across groups (HR, 1.04; 95% CI, 0.94 to 1.15; RD, 1.30; 95% CI, -1.83 to 4.44), while the risk of DR progression was lower among individuals who initiated empagliflozin compared with those who began DPP4i therapy (HR, 0.78; 95% CI, 0.63 to 0.96; RD, -9.44; 95% CI, -16.90 to -1.98). Results were consistent across multiple subgroups and sensitivity analyses.

Conclusions and Relevance

Compared with initiation of a DPP4i, empagliflozin initiation was not associated with incident NPDR, although it may be associated with a lower risk of DR progression. Although residual confounding cannot be entirely ruled out due to the observational nature of our study, these findings may be helpful when weighing the risks and benefits of various glucose-lowering agents in adults with T2D.

The Role of Urban Residence, Race and Ethnicity, and Glycemic Control in Receiving Standards of Care and Progression to Vision-Threatening Diabetic Retinopathy

OBJECTIVE

Among patients with diabetes living in the U.S. with newly detected mild or moderate nonproliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), we aimed to characterize determinants for receiving standards of care and progression to vision-threatening diabetic retinopathy (VTDR) (severe NPDR, proliferative diabetic retinopathy, DME).

RESEARCH DESIGN AND METHODS

Electronic health records of patients newly detected with NPDR without DME between 2015 and 2023 were analyzed with use of the Epic Cosmos research platform. We characterized the adjusted associations of urban versus rural residence, race and ethnicity (Hispanic, non-Hispanic [NH] White, NH Black, other), and glycemic control (HbA1c <7.0%, 7.0%-8.9%, ≥9%, unavailable) separately with guideline-recommended care (two of three: ophthalmology visit, primary care visit, and measurement of HbA1c, blood pressure, and LDL cholesterol) in the 2 years after diagnosis and with progression to VTDR.

RESULTS

Average (SD) age for the analytic sample (n = 102,919) was 63 (13.5) years, and 51% were female, 59% NH White, and 7% rural residents. Only 40% received guideline-recommended care, and 14% progressed to VTDR (median follow-up 35 months [interquartile range 18-63]). Urban residence was associated with receiving standards of care in both years (risk ratio 1.08 [95% CI 1.05-1.12]) and progression to VTDR (hazard ratio 1.07 [95% CI 0.99-1.15]). Racial and ethnic minority individulas were more likely to progress to VTDR. Individuals with poor or unknown glycemic control were less likely to receive standards of care and more likely to progress to VTDR.

CONCLUSIONS

Understanding the management and progression of newly detected NPDR will require disentangling the independent and interdependent contributions of geography, race and ethnicity, and glycemia.

Diabetes Care Disparities in Deaf/Hard of Hearing and Blind/Low Vision Populations

PURPOSE OF REVIEW

Describe the connection between Deaf/hard of hearing (DHH) and diabetes, explain the bidirectional relationship of blind/low vision (BLV) and diabetes, characterize challenges DHH and BLV populations face when seeking healthcare regarding their diabetes management. Highlight the inaccessibility of diabetes technology in these populations. Provide best practices when communicating with DHH and BLV people in the clinical setting.

RECENT FINDINGS

Diabetes disparities exist in DHH and BLV populations due to systemic barriers to health equity related to access and communication. Structural barriers, risk factors, social determinants of health, and the U.S. healthcare system do not support the DHH and BLV communities. Importantly, healthcare professionals do not receive adequate training on communication and treatment of DHH and BLV populations. Together, social determinants of health, such as healthcare access and quality, education access and quality, and lack of adequate clinician training allow ableism to persist and drive health disparities in these communities. Health disparities faced by DHH and BLV populations are driven by barriers to diabetes standards of care. These inequities must be rectified to improve and maintain high quality care.

Single-cell analysis of the epigenome and 3D chromatin architecture in the human retina

Most genetic risk variants linked to ocular diseases are non-protein coding and presumably contribute to disease through dysregulation of gene expression, however, deeper understanding of their mechanisms of action has been impeded by an incomplete annotation of the transcriptional regulatory elements across different retinal cell types. To address this knowledge gap, we carried out single-cell multiomics assays to investigate gene expression, chromatin accessibility, DNA methylome and 3D chromatin architecture in human retina, macula, and retinal pigment epithelium (RPE)/choroid. We identified 420,824 unique candidate regulatory elements and characterized their chromatin states in 23 sub-classes of retinal cells. Comparative analysis of chromatin landscapes between human and mouse retina cells further revealed both evolutionarily conserved and divergent retinal gene-regulatory programs. Leveraging the rapid advancements in deep-learning techniques, we developed sequence-based predictors to interpret non-coding risk variants of retina diseases. Our study establishes retina-wide, single-cell transcriptome, epigenome, and 3D genome atlases, and provides a resource for studying the gene regulatory programs of the human retina and relevant diseases.

Targeting endothelial ERG to mitigate vascular regression and neuronal ischemia in retinopathies

Retinopathy of prematurity (ROP) and diabetic retinopathy (DR) are ocular disorders in which a loss of retinal vasculature leads to ischemia followed by a compensatory neovascularization response. In mice, this is modeled using oxygen-induced retinopathy (OIR), whereby neonatal animals are transiently housed under hyperoxic conditions that result in central retina vessel regression and subsequent neovascularization. Using endothelial cell (EC)-specific gene deletion, we found that loss of two ETS-family transcription factors, ERG and FLI1, led to regression of OIR-induced neovascular vessels but failed to improve visual function, suggesting that relevant retinal damage occurs prior to and independently of neovascularization. Turning our attention to the initial stage of OIR, we found that hyperoxia repressed ERG expression in retinal ECs of wild type mice, raising the possibility that oxygen-induced ERG downregulation promotes vessel regression during the initiation of OIR-induced pathology. We therefore developed a murine model of EC-specific ERG overexpression and found it sufficient to prevent hyperoxia-induced vascular regression, neuronal cell death, and neovascularization in the OIR model. Importantly, ERG overexpression also improved visual function in OIR-challenged mice. Moreover, we show that both ERG and FLI1 are downregulated in the retinal vessels of human patients with early stages of DR, suggesting that neovascular disorders of the eye may share common mechanisms underlying pathological retinal capillary regression. Collectively, these data suggest that the regulation of vascular regression by EC-expressed ETS transcription factors may be adapted towards novel therapeutic approaches for the prevention and/or alleviation of ocular neovascular disorders.

Prostanoid signaling in retinal cells elicits inflammatory responses relevant to early-stage diabetic retinopathy

Inflammation is a critical driver of the early stages of diabetic retinopathy (DR) and offers an opportunity for therapeutic intervention before irreversible damage and vision loss associated with later stages of DR ensue. Nonsteroidal anti-inflammatory drugs (NSAIDs) have shown mixed efficacy in slowing early DR progression, notably including severe adverse side effects likely due to their nonselective inhibition of all downstream signaling intermediates. In this study, we investigated the role of prostanoids, the downstream signaling lipids whose production is inhibited by NSAIDs, in promoting inflammation relevant to early-stage DR in two human retinal cell types: Müller glia and retinal microvascular endothelial cells. When cultured in multiple conditions modeling distinct aspects of systemic diabetes, Müller glia significantly increased production of prostaglandin E2 (PGE2), whereas retinal endothelial cells significantly increased production of prostaglandin F2α (PGF2α). Müller glia stimulated with PGE2 or PGF2α increased proinflammatory cytokine levels dose-dependently. These effects were blocked by selective antagonists to the EP2 receptor of PGE2 or the FP receptor of PGF2α, respectively. In contrast, only PGF2α stimulated adhesion molecule expression in retinal endothelial cells and leukocyte adhesion to cultured endothelial monolayers, effects that were fully prevented by FP receptor antagonist treatment. Together these results identify PGE2-EP2 and PGF2α-FP signaling as novel, selective targets for future studies and therapeutic development to mitigate or prevent retinal inflammation characteristic of early-stage DR.

Mitigation of AI adoption bias through an improved autonomous AI system for diabetic retinal disease

Where adopted, Autonomous artificial Intelligence (AI) for Diabetic Retinal Disease (DRD) resolves longstanding racial, ethnic, and socioeconomic disparities, but AI adoption bias persists. This preregistered trial determined sensitivity and specificity of a previously FDA authorized AI, improved to compensate for lower contrast and smaller imaged area of a widely adopted, lower cost, handheld fundus camera (RetinaVue700, Baxter Healthcare, Deerfield, IL) to identify DRD in participants with diabetes without known DRD, in primary care. In 626 participants (1252 eyes) 50.8% male, 45.7% Hispanic, 17.3% Black, DRD prevalence was 29.0%, all prespecified non-inferiority endpoints were met and no racial, ethnic or sex bias was identified, against a Wisconsin Reading Center level I prognostic standard using widefield stereoscopic photography and macular Optical Coherence Tomography. Results suggest this improved autonomous AI system can mitigate AI adoption bias, while preserving safety and efficacy, potentially contributing to rapid scaling of health access equity. ClinicalTrials.gov NCT05808699 (3/29/2023).

Prevalence of Diabetic Retinopathy Among Native Americans with Diabetes at a Tribal Clinic in Oklahoma

PURPOSE

Native Americans (NAs) have the highest prevalence of diabetes mellitus (DM) of any racial group in the USA and are therefore at higher risk for diabetic retinopathy (DR) and diabetic macular edema (DME). This study estimated the prevalence of DR and DME among NAs receiving eye exams at the Citizen Potawatomi Nation (CPN) clinic, a tribal clinic in Oklahoma serving members of multiple tribes, and characterized risk markers associated with the presence and severity of DR.

METHODS

A retrospective chart review identified tribal members with DM who received dilated retinal fundus exams at the CPN clinic between 2021 and 2023. The presence and stage of DR and DME among participants were recorded. Hypotheses of association between the presence or severity of DR and medical and socioeconomic factors were tested.

RESULTS

Among the 504 participants, the prevalence of DR was 19.4% (95% CI 16.1-23.2%), including 16.3% (95% CI 13.2-19.8%) with non-proliferative DR and 3.2% (95% CI 1.8-5.1%) with proliferative DR, and 3.4% (95% CI 2.0-5.4%) with DME. Nephropathy, longer duration of DM, higher HbA1c, insulin use, and Medicaid insurance were associated with the presence of DR (p < 0.05).

CONCLUSIONS

This study found a lower prevalence of DR than did earlier studies of NAs with DM. The mean HbA1c in this cohort was lower than in earlier studies, suggesting that diabetes management has improved. Several medical or socioeconomic factors were associated with the presence and severity of DR.

Dopamine: A New Player in the Pathogenesis of Diabetic Retinopathy?

Diabetic retinopathy (DR) is a leading cause of blindness. The pathogenesis of diabetic retinopathy is multifactorial and incompletely understood. Accordingly, treatment options are limited. Recent data suggest that dopamine might play a role in the development and progression of DR. In the present review, we discuss these data and comment on the potential role of dopamine modulation in the management of this devastating microvascular complication of diabetes mellitus.

Diabetes Eye Disease Sufferers and Non-Sufferers Are Differentiated by Sleep Hours, Physical Activity, Diet, and Demographic Variables: A CRT Analysis

INTRODUCTION

Diabetic eye disease is the most common microvascular complication of diabetes mellitus. This complication has some direct impact on an individual's well-being and health. Some lifestyle habits have been associated with the incidence of these co-morbidities.

OBJECTIVE

To classify the diabetic population into sufferers or non-sufferers of diabetes eye disease according to lifestyle and demographic variables, and to identify which of these variables are significant for this classification.

METHODS

The present cross-sectional study based on the NHANES 2011-2020 used the Classification and Regression Tree (CRT) analysis for classifying the diabetic population into sufferers and non-sufferers of diabetes eye disease. The odds ratio (OR) and relative risks (RR) of suffering this diabetes complication of the subgroups formed by the model were studied. The final sample formed 2657 individuals (1537 males and 1120 females).

RESULTS

A 79.4% accuracy was found for the CRT model. The independent variables of sleep hours (100.0%), physical activity (PA) group (92.8%), gender (76.2%), age (46.4%), education level (38.4%), sedentary time (38.1%), and diet (10.0%) were found to be significant for the classification of cases. The variable high alcohol consumption was not found significant. The analysis of the OR and RR of the subgroups formed by the model evidenced greater odds of suffering diabetes eye disease for diabetes sufferers from the inactive and walk/bicycle PA group compared to those from the Low, Moderate, and High PA groups (OR: 1.48 and RR: 1.36), for males compared to females (OR: 1.77 and RR: 1.61), for those sleeping less than 6 h or more than 9 compared to those who sleep between 6 and 8 h (OR: 1.61 and RR: 1.43), and for diabetes sufferers aged over 62 compared to younger ones (OR: 1.53 and RR: 1.40).

CONCLUSIONS

sleep hours, PA group, gender, age, education level, sedentary time, and diet are significant variables for classifying the diabetic population into sufferers and non-sufferers of diabetes eye disease. Additionally, being in the inactive or walk/bicycle PA group, being a male, sleeping less than 6 or more than 9 h, and being aged over 62 were identified as risk factors for suffering this diabetes complication.

Factors related to type 2 diabetic retinopathy and their clinical application value

Objective

To compare the differences in clinical-related factors between patients with type 2 diabetes (T2DM) and those without diabetic retinopathy (DR) and to explore the risk factors or protective factors affecting DR in T2DM patients.

Methods

We performed a retrospective analysis of 380 patients with type 2 diabetes admitted to Handan Central Hospital from June 2023 to May 2024. Clinical data collected included baseline characteristics, hematological tests, metabolic indicators, and information on diabetic complications and comorbidities.

Results

Our findings identified intervention, neck vascular disease, bilateral lower limb venous thrombosis, high creatinine, high glomerular filtration rate, high chloride, high fasting C-peptide, and high lactate dehydrogenase as risk factors for DR. In contrast, High 2-hour postprandial C-peptide is a protective factor for diabetic retinopathy. A logistic regression model was constructed using stepwise regression to predict DR occurrence, achieving an accuracy of 0.80 and an AUC of 0.83.

Evaluation of the effect of full-process blood glucose management on T2DM cataract patients based on visual electrophysiology and OCTA

To investigate the difference in preoperative retinal function in patients with type 2 diabetes cataract (DC) without obvious retinopathy and to explore the clinical application of full blood glucose management for improving the postoperative vision in DC patients. This was a retrospective analysis in which we estimated the changes in visual electrophysiology (N75, P100, photopic flash electroretinogram(FERG), and scotopic FERG, paraoptic retinal nerve fibre layer thickness (pRNFL) and paraoptic radial capillary network blood flow density (ppVD) of type 2 diabetes (T2DM) patients at different phases of disease progression along with fasting blood glucose (FBG) and glycosylated haemoglobin (HbAlC) levels before and after DC surgery at Ziyang Central Hospital from January 2020 to December 2022. Additionally, trends in the above data throughout the entire process of glucose management intervention were examined. As the course of T2DM progressed, FBG and HbA1c increased, the N75 and P100 latency periods of patients gradually increased, and the values of photopic FERG, scotopic FERG, pRNFL, and ppVD gradually decreased at each postoperative time point. Moreover, the best corrected visual acuity(BCVA) of patients after surgery gradually decreased (P < 0.05). The BCVA of Group B (with full process blood glucose management) gradually stabilized at 1 month after surgery, and the BCVA of Group B was better than that of Group A at all time points after surgery. The results revealed that N75 and P100 in Group A were greater than those in Group B, whereas the photopic and scotopic FERG, pRNFL, and ppVD (%) values in Group A were lower than those in Group B. In addition, N75 and P100 in Group A gradually increased at various time points after surgery, whereas the photopic FERG, scotopic FERG, pRNFL, and ppVD (%) values gradually decreased. In the state of full blood glucose management, although N75 and P100 both reached their longest durations at one week after surgery, N75, the P100, photopic FERG, scotopic FERG, and pRNFL showed a gradually decreasing trend at 1 month and 3 months after surgery, whereas ppVD (%) gradually increased (P < 0.05). According to the results of the quantitative analysis of visual electrophysiology and OCTA, with the aggravation of diabetes, the retinal function of DC patients without obvious retinopathy tends to decrease, but full-process blood glucose management can effectively recover the retinal function of DC patients and improve visual quality after surgery.

Baseline Characteristics and Clinical Outcomes of Patients Seen Through the Free Diabetes Screening (FDS) Program

Purpose

To characterize the baseline characteristics and clinical outcomes of patients seen through the Free Diabetic Screening (FDS) program, a free diabetic retinopathy screening program for uninsured patients, in the ophthalmology resident clinic at the Wilmer Eye Institute.

Patients and Methods

This retrospective longitudinal cohort study included uninsured patients ≥18 years with diabetes mellitus seen through the FDS clinic from 2013 to 2023. Data extraction was performed using manual chart review of the first FDS visit, and automated extraction of the data warehouse related to all other office visits. Patient demographic and clinical characteristics at presentation, treatments, and follow-ups were collected.

Results

A total of 422 patients were included in this study (mean age 52 years; 59% female; 47% Hispanic; 49% Spanish as primary language). One-third of patients had some form of diabetic retinopathy or diabetic macular edema, and 12% had vision-threatening diabetic retinopathy at presentation. In all, nearly 10% of patients were referred for further specialty care, and 71% of these patients completed at least one follow-up visit. The majority of patients (55%) returned for care as recommended and were followed for a mean length of 200 weeks and 10 office visits.

Conclusion

The FDS clinic provided much needed diabetic retinopathy screening and treatment for uninsured patients in Baltimore City and surrounding areas. This study highlights the need for strong integration between initial screening and downstream services, as nearly 10% of patients require further sub-specialty intervention or care.

Prevalence of Glaucoma Among US Adults in 2022

Importance

Glaucoma is the leading cause of irreversible blindness worldwide and, in the US, disproportionately affects people from racial and ethnic minority groups. Glaucoma prevalence has not been estimated for the US in more than a decade, and state- and county-level estimates are not available.

Objective

To estimate glaucoma and vision-affecting glaucoma prevalence by demographic factors and US state and county for the Centers for Disease Control and Prevention's Vision and Eye Health Surveillance System (VEHSS).

Data Sources

This meta-analysis used data from the National Health and Nutrition Examination Survey (2005-2008), Medicare fee-for-service claims (2019), IBM MarketScan commercial insurance claims (2016), population-based studies of eye disease (1985-2003), and 2022 population estimates from the US Census Bureau.

Study Selection

PubMed was searched for population-based studies of glaucoma prevalence published between 1991 and 2016.

Data Extraction and Synthesis

Bayesian meta-regression methods were used to estimate the prevalence of glaucoma and vision-affecting glaucoma stratified by age, undifferentiated sex/gender (a measure that captures an unclear mix of aspects of sex and or gender), race and ethnicity, and US county and state.

Main Outcomes and Measures

Prevalence of any type of glaucoma (open or closed angle) among people 18 years or older and vision-affecting glaucoma, defined as glaucoma and a visual field abnormality.

Results

For 2022, an estimated 4.22 million people (95% uncertainty interval [UI], 3.46 million to 5.23 million) in the US were living with glaucoma, with a prevalence of 1.62% (UI, 1.33%-2.00%) among people 18 years or older and 2.56% (UI, 2.10%-3.16%) among people 40 years or older. An estimated 1.49 million people (UI, 1.17 million to 1.90 million) were living with vision-affecting glaucoma, with a prevalence of 0.57% (UI, 0.45%-0.73%) among people 18 years or older and 0.91% (UI, 0.71%-1.16%) among people 40 years or older. Prevalence of glaucoma among people 18 years or older ranged from 1.11% (UI, 0.89%-1.40%) in Utah to 1.95% (UI, 1.57%-2.39%) in Mississippi. Black adults had a prevalence of 3.15% (UI, 2.32%-4.09%) compared with 1.42% (UI, 1.10%-1.85%) among White adults; adults in the Hispanic and all other racial and ethnic categories combined had a prevalence of 1.56% (UI, 1.13%-2.06%).

Conclusions and Relevance

This meta-analysis found that an estimated 2.56% of people 40 years or older have glaucoma, slightly more than estimated by previous studies. Black individuals are disproportionately affected. Prevalence estimates at the state and county level can help guide public health planning.

Improving the Identification of Diabetic Retinopathy and Related Conditions in the Electronic Health Record Using Natural Language Processing Methods

Purpose

To compare the performance of 3 phenotyping methods in identifying diabetic retinopathy (DR) and related clinical conditions.

Design

Three phenotyping methods were used to identify clinical conditions including unspecified DR, nonproliferative DR (NPDR) (mild, moderate, severe), consolidated NPDR (unspecified DR or any NPDR), proliferative DR, diabetic macular edema (DME), vitreous hemorrhage, retinal detachment (RD) (tractional RD or combined tractional and rhegmatogenous RD), and neovascular glaucoma (NVG). The first method used only International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes (ICD-10 Lookup System). The next 2 methods used a Bidirectional Encoder Representations from Transformers with a dense Multilayer Perceptron output layer natural language processing (NLP) framework. The NLP framework was applied either to free-text of provider notes (Text-Only NLP System) or both free-text and ICD-10 diagnosis codes (Text-and-International Classification of Diseases [ICD] NLP System).

Subjects

Adults ≥18 years with diabetes mellitus seen at the Wilmer Eye Institute.

Methods

We compared the performance of the 3 phenotyping methods in identifying the DR related conditions with gold standard chart review. We also compared the estimated disease prevalence using each method.

Main Outcome Measures

Performance of each method was reported as the macro F1 score. The agreement between the methods was calculated using the kappa statistic. Prevalence estimates were also calculated for each method.

Results

A total of 91 097 patients and 692 486 office visits were included in the study. Compared with the gold standard, the Text-and-ICD NLP System had the highest F1 score for most clinical conditions (range 0.39-0.64). The agreement between the ICD-10 Lookup System and Text-Only NLP System varied (kappa of 0.21-0.81). The prevalence of DR and related conditions ranged from 1.1% for NVG to 17.9% for DME (using the Text-and-ICD NLP System).

Conclusions

The prevalence of DR and related conditions varied significantly depending on the methodology of identifying cases. The best performing phenotyping method was the Text-and-ICD NLP System that used information in both diagnosis codes as well as free-text notes.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Prevalence of Diabetic Retinopathy Among Diabetic Patients from Northeastern Bulgaria

BACKGROUND

Diabetic retinopathy (DR) is a leading cause of visual impairment globally among working-aged individuals. This study aims to update data on DR prevalence in Bulgaria.

METHODS

The present cross-sectional study was conducted between 1 January 2022 and 1 January 2023, using a local diabetes registry from the city of Varna as a sampling framework. In total, 587 diabetic patients underwent DR examination. Data included demographics, diabetes type/duration, treatment, and ophthalmic history. DR status was assessed using indirect slit-lamp biomicroscopy or digital fundus photography, graded by the International Clinical Diabetic Retinopathy Scale.

RESULTS

Of 587 participants, 13 were excluded due to cataract-related ungradable images. The median age was 65 years (IQR 56-73), with a slight female predominance (54%). The overall prevalence of any DR was 39.9% (95% CI 35.9-44.0), with non-proliferative DR (NPDR) at 27.5%, proliferative DR (PDR) at 7.3%, and macular edema (DME) at 5%. Type 1 diabetes patients had significantly higher DR prevalence (68.8%) than type 2 (34.1%, p < 0.001). Men exhibited higher DR prevalence. Age and diabetes duration correlated positively with DR prevalence. Insulin treatment was associated with higher DR prevalence (55.6%) than oral antidiabetic treatment (22.5%, p < 0.001) for type 2 diabetes patients. Among those diagnosed with DR, 70.9% received treatment, mainly laser therapy.

CONCLUSIONS

These findings provide epidemiological insights for future research and emphasize the need for a comprehensive national DR screening program in Bulgaria. Technological advancements enable proactive measures to mitigate DR-related visual impairment and blindness, including widespread screening, even in rural areas.

Access to a Patient Portal is Associated with a Higher Rate of Diabetic Eye Examination Completion

PURPOSE

To evaluate factors associated with a higher completion rate of annual diabetic eye examinations.

METHODS

This retrospective, cross-sectional study included patients diagnosed with diabetes mellitus (DM) who were aged 18-75 years and receiving primary care in a suburban integrated delivery network (IDN). Patient demographic, sociomedical, biometric characteristics, and Healthcare Effectiveness Data and Information Set (HEDIS) measures within the Comprehensive Diabetes Care bundle were extracted from the electronic health record (EHR) and analyzed by using multivariate logistic regression to assess factors associated with completion of an eye exam (retinal) performed during the study year.

RESULTS

Among 19,901 primary care patients with DM, 35.15% completed an eye examination in 2021. After adjusting for demographic and biometric characteristics, the two factors most closely associated with completing a diabetic eye examination were having had a primary care office visit (adjusted odds ratio [aOR], 3.525; 95% confidence interval [CI], 3.210-3.871, p < 0.001) or an eye examination in the prior year (aOR, 2.948; 95% CI, 2.752-3.158, p < 0.001). The next most important factor to emerge was having an activated, online patient portal (PP; aOR, 1.737; 95% CI, 1.592-1.896; p < 0.001) or PP recently activated within the prior year (aOR, 1.387; 95% CI, 1.220-1.576, p < 0.001).

CONCLUSIONS

Surveillance for diabetic retinopathy relies on annual diabetic eye examinations yet adherence to that standard remains unacceptably low. Our study suggests that engagement of patients through an online PP could help increase this rate.

A Review of the Utility and Limitations of Artificial Intelligence in Retinal Disorders and Pediatric Ophthalmology

Artificial intelligence (AI) is reshaping ophthalmology by enhancing diagnostic precision and treatment strategies, particularly in retinal disorders and pediatric ophthalmology. This review examines AI's efficacy in diagnosing conditions such as diabetic retinopathy (DR) and age-related macular degeneration (AMD) using imaging techniques, such as optical coherence tomography (OCT) and fundus photography. AI also shows promise in pediatric care, aiding in the screening of retinopathy of prematurity (ROP) and the management of conditions, including pediatric cataracts and strabismus. However, the integration of AI in ophthalmology presents challenges, including ethical concerns regarding algorithm biases, privacy issues, and limitations in data set quality. Addressing these challenges is crucial to ensure AI's responsible and effective deployment in clinical settings. This review synthesizes current research, underscoring AI's transformative potential in ophthalmology while highlighting critical considerations for its ethical use and technological advancement.

Race, Social Determinants of Health, and the Quality of Diabetic Eye Care

Importance

Besides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.

Objective

To evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).

Design, Setting, and Participants

This cohort study was conducted in 11 US medical centers and included adult patients (18-75 years old) with diabetes. Patients received care from 2012 to 2023 and had 18 months or more of follow-up.

Exposures

Multiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.

Main Outcomes and Measures

Adjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.

Results

The study cohort included 37 397 adults with diabetes: 10 157 Black patients and 27 240 White patients. The mean (SD) age was 58 (11) years for Black patients and 59 (11) years for White patients. Of the Black patients, 6422 (63.2%) were female and 3735 (36.8%) male; of the White patients, 13 120 (48.1) were female and 14 120 (51.8) were male. Compared with those of the same race in urban communities, Black patients (aOR, 0.12; 95% CI, 0.04-0.31) and White patients (aOR, 0.75; 95% CI, 0.62-0.91) with diabetes living in rural communities had 88% and 25% lower odds of having eye-care visits, respectively. Sicker Black and White patients, defined by the Charlson Comorbidity Index, had 4% (aOR, 1.04; 95% CI, 1.02-1.06) and 5% (aOR, 1.05, CI 1.04-1.06) higher odds of having an eye-care visit, respectively. Black patients with preexisting DR had 15% lower odds of visits (aOR, 0.85, CI 0.73-0.99) compared with those without preexisting DR while White patients with preexisting DR had 16% higher odds of eye-care visits (aOR, 1.16; 95% CI, 1.05-1.28). White patients with Medicare (aOR, 0.85; 95% CI, 0.80-0.91) and Medicaid (aOR, 0.81; 95% CI, 0.68-0.96) had lower odds of eye-care visits vs patients with commercial health insurance. Hispanic White patients had 15% lower odds of eye-care visits (aOR, 0.85; 95% CI, 0.74-0.98) vs non-Hispanic White patients. White patients with type 1 diabetes had 17% lower odds of eye-care visits (aOR, 0.83; 95% CI, 0.76-0.90) vs those with type 2 diabetes. Among patients who had eye-care visits, those with preexisting DR (Black: aOR, 1.68; 95% CI, 1.11-2.53; White: aOR, 1.51; 95% CI, 1.16-1.96) were more likely to undergo dilated fundus examinations.

Conclusions and Relevance

This study found that certain SDOH affected monitoring for DR similarly for Black and White patients with diabetes while others affected them differently. Patients living in rural communities, Black patients with preexisting DR, and Hispanic White patients were not receiving eye care in accordance with CPGs, which may contribute to worse outcomes.

The associations between single nucleotide polymorphisms and diabetic retinopathy risk: an umbrella review

This umbrella review was conducted aiming to assess the association between genetic variations and the development of diabetic retinopathy (DR) by collecting and evaluating available systematic reviews and meta-analysis results. We evaluated the methodological quality using the Measurement Tool to Assess Systematic Reviews (AMSTAR) 2.0, estimated the summary effect size by using the random effects model and calculated the 95% prediction intervals (PIs). Evidence from the included meta-analyses was graded according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. This umbrella review included 32 meta-analyses of 52 candidate SNPs. The 12 selected meta-analyses were rated as "high," 2 studies were rated as "moderate," 11 studies were graded as "low," and the remaining 7 studies were graded as "critically low" in terms of methodological quality. Carriers of specific genotypes and alleles of the transcription Factor 7-like 2 C/T (TCF7L2 C/T) polymorphism (rs7903146, p < 0.001) might be more susceptible to the occurrence of DR in the homozygous and recessive models, and these associations were supported by "convincing" evidence. Significant associations were also found between interleukin-6 (IL-6) -174 G/C (rs1800795; p < 0.05) or vascular endothelial growth factor (VEGF) polymorphisms (rs2010963, rs699947, rs1570360, rs2010963, rs699947, rs2146323; all p values <0.05) and DR risk, but these associations were supported by "weak" evidence. The TCF7L2 C/T variant could be identified as a definitive genetic risk factor for the development and progression of DR. Data from additional in-depth studies are needed to establish robust evidence for the associations between polymorphisms of IL-6 or VEGF and DR.

Visual Function Measurements in Eyes With Diabetic Retinopathy: An Expert Opinion on Available Measures

Clinical Relevance

Visual function impairment from diabetic retinopathy can have a considerable impact on patient's quality of life. Best-corrected visual acuity (BCVA) is most commonly used to assess visual function and guide clinical trials. However, BCVA is affected late in the disease process, is not affected in early disease, and does not capture some of the visual disturbances described by patients with diabetes. The goal of this report is to evaluate the relationship between diabetic retinal disease (DRD) and visual function parameters to determine which if any of them may be used in a future DRD staging system.

Methods

The visual functions working group was 1 of 6 areas of DRD studied as part of the DRD staging system update, a project of the Mary Tyler Moore Vision Initiative. The working group identified 12 variables of possible interest, 7 of which were judged to have sufficient preliminary data to suggest an association with DR to warrant further review: microperimetry, static automated perimetry, electroretinogram (ERG) oscillatory potentials, flicker ERG, low luminance visual acuity (LLVA), contrast sensitivity (CS), and BCVA. The objective field analyzer (OFA) was added after subsequent in-person workshops.

Results

Currently, the only visual function test available for immediate use is BCVA; the remaining tests are either promising (within 5 years) or have potential (>5 years) use. Besides BCVA, most visual function tests had a limited role in current clinical care; however, LLVA, CS, flicker ERG, and OFA demonstrated potential for screening and research purposes.

Conclusions

Although current visual function tests are promising, future prospective studies involving patients with early and more advanced retinopathy are necessary to determine if these tests can be used clinically or as endpoints for clinical studies.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Adaptive selection at G6PD and disparities in diabetes complications

Diabetes complications occur at higher rates in individuals of African ancestry. Glucose-6-phosphate dehydrogenase deficiency (G6PDdef), common in some African populations, confers malaria resistance, and reduces hemoglobin A1c (HbA1c) levels by shortening erythrocyte lifespan. In a combined-ancestry genome-wide association study of diabetic retinopathy, we identified nine loci including a G6PDdef causal variant, rs1050828 -T (Val98Met), which was also associated with increased risk of other diabetes complications. The effect of rs1050828 -T on retinopathy was fully mediated by glucose levels. In the years preceding diabetes diagnosis and insulin prescription, glucose levels were significantly higher and HbA1c significantly lower in those with versus without G6PDdef. In the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, participants with G6PDdef had significantly higher hazards of incident retinopathy and neuropathy. At the same HbA1c levels, G6PDdef participants in both ACCORD and the Million Veteran Program had significantly increased risk of retinopathy. We estimate that 12% and 9% of diabetic retinopathy and neuropathy cases, respectively, in participants of African ancestry are due to this exposure. Across continentally defined ancestral populations, the differences in frequency of rs1050828 -T and other G6PDdef alleles contribute to disparities in diabetes complications. Diabetes management guided by glucose or potentially genotype-adjusted HbA1c levels could lead to more timely diagnoses and appropriate intensification of therapy, decreasing the risk of diabetes complications in patients with G6PDdef alleles.

Intensive Glycemic Management Is Associated With Reduced Retinal Structure Abnormalities on Ocular Coherence Tomography in the DCCT/EDIC Study

OBJECTIVE

To investigate quantitative and qualitative changes in retinal structure using optical coherence tomography (OCT) and their associations with systemic or other risk factors in individuals with type 1 diabetes (T1D).

RESEARCH DESIGN AND METHODS

In the Epidemiology of Diabetes Interventions and Complications (EDIC) study, OCT images were obtained during study years 25-28 (2019-2022) in 937 participants; 54% and 46% were from the original intensive (INT) and conventional (CONV) glycemic management treatment groups, respectively.

RESULTS

Average age for participants was 61 years old, diabetes duration 39 years, and HbA1c 7.6%. Participants originally in the CONV group were more likely to have disorganization of retinal inner layers (DRIL) (CONV 27.3% vs. INT 18.7%; P = 0.0003), intraretinal fluid (CONV 24.4% vs. INT 19.2%; P = 0.0222), and intraretinal cysts (CONV 20.8% vs. INT 16.6%; P = 0.0471). In multivariable models, sex, age, smoking, mean updated systolic blood pressure, and history of "clinically significant" macular edema (CSME) and of anti-VEGF treatment were independently associated with changes in central subfield thickness, while HbA1c, BMI, and history of CSME and of ocular surgery were associated with DRIL. Visual acuity (VA) decline was associated with significant thinning of all retinal subfields except for the central and inner nasal subfields.

CONCLUSIONS

Early intensive glycemic management in T1D is associated with a decreased risk of DRIL. This important morphological abnormality was associated with a history of macular edema, a history of ocular surgery, and worse VA. This study reveals benefits of intensive glycemic management on the retina beyond features detected by fundus photographs and ophthalmoscopy.

Differences in macular thickness associated with peripheral retinal vessel whitening in diabetic patients

This study aimed to determine the difference in macular thickness among patients with diabetes mellitus (DM) with and without peripheral retinal vessel whitening (PRVW). PRVW was defined by retinal vessel whitening outside the standard seven ETDRS fields. Subjects were divided into DM with PRVW, DM without PRVW, and normal age-matched controls. Optical coherence tomography scans were divided into total, inner, and outer retinal layer thicknesses and were compared in the macula's central, inner, and outer rings. Forty-seven eyes were included: DM with PRVW = 15, DM without PRVW = 16, and Controls = 16. Overall, the mean retinal thickness in patients with DM with PRVW was lower than in patients with DM without PRVW and controls. In the inner macula, DM patients with PRVW showed a significantly lower mean inner superior, nasal, inferior, and temporal macula compared to DM patients without PRVW (p = 0.014, 0.008, 0.005, < 0.001, respectively). DM patients with PRVW also showed a significantly lower mean outer superior, nasal, inferior, and temporal macula than controls (p = 0.005, 0.005, 0.016, 0.025, respectively). This study demonstrates that PRVW in DM patients may be associated with global structural changes to the macular region, promoting a decrease in inner and outer retinal thickness. Further studies should investigate the functional correlation with PRVW in DM patients in order to better understand its potential implications in diabetic patients.

Modern Approach to Diabetic Retinopathy Diagnostics

This article reviews innovative diagnostic approaches for diabetic retinopathy as the prevalence of diabetes mellitus and its complications continue to escalate. Novel techniques focus on early disease detection. Technological innovations, such as teleophthalmology, smartphone-based photography, artificial intelligence with deep learning, or widefield photography, can enhance diagnostic accuracy and accelerate the treatment. The review highlights teleophthalmology and handheld photography as promising solutions for remote eye care. These methods revolutionize diabetic retinopathy screening, offering cost-effective and accessible solutions. However, the use of these techniques may be limited by insurance coverage in certain world regions. Ultra-widefield photography offers a comprehensive view of up to 80.0% of the retina in a single image, compared to the 34.0% coverage of the traditional seven-field imaging protocol. It allows retinal imaging without pupil dilation, especially for individuals with compromised mydriasis. However, they also have drawbacks, including high costs, artifacts from eyelashes, eyelid margins, and peripheral distortion. Recent advances in artificial intelligence and machine learning, particularly through convolutional neural networks, are revolutionizing diabetic retinopathy diagnostics, enhancing screening efficiency and accuracy. FDA-approved Artificial Intelligence-powered devices such as LumineticsCore™, EyeArt, and AEYE Diagnostic Screening demonstrate high sensitivity and specificity in diabetic retinopathy detection. While Artificial Intelligence offers the potential to improve patient outcomes and reduce treatment costs, challenges such as dataset biases, high initial costs, and cybersecurity risks must be considered to ensure safety and efficiency. Nanotechnology advancements further enhance diagnosis, offering highly branched polyethyleneimine particles with fluorescein sodium (PEI-NHAc-FS) for better fluorescein angiography or vanadium oxide-based metabolic fingerprinting for early detection.

FTY720 Suppresses Pathogenic Retinal Müller Cell Activation and Chronic Progression by Inhibiting the mTOR/NF-κB Signaling Pathway and Regulating Autophagy

PURPOSE

FTY720 is an agonist of the Sphingosine-1-phosphate (S1P) receptor 1, 3, 4, and 5 and a functional antagonist of the S1P1 receptor; it can inhibit the activation of mTOR/NF-κB and has therapeutic potential in inflammatory disease. This study was designed to determine the role of the inflammatory process in diabetic retinopathy and investigate the effect of FTY720 on high glucose (HG)-induced rat retinal Müller cells (rMC-1 cells).

METHODS

In the present study, the role of FTY720 in inhibiting inflammation and its underlying mechanism were investigated. rMC-1 cells were treated without or with HG, FTY720, CQ, or RAP. Cell viability was examined by CCK-8 assay; cell activation was assessed by western blot analysis and IF staining; and cell migration was evaluated by a scratch wound healing assay. The expression of inflammation-associated proteins and autophagy-related proteins was evaluated by transmission electron microscopy, AO staining, MDC-labeled autophagic vacuoles, western blot analysis and ELISA.

RESULTS

Western blot analysis and IF staining showed that the level of the rMC-1 cell marker GFAP was decreased, while GS was increased in FTY720 groups compared to that in the HG group. The healing assay results showed that compared with HG treatment, FTY720 treatment significantly reduced cell migration. Western blot analysis, ELISA and IF staining showed that compared with HG, FTY720 reduced proinflammatory proteins by inhibiting the mechanistic target of the mTOR/NF-κB signaling pathway and regulating autophagy.

CONCLUSIONS

This study suggests that in an HG-induced rMC-1 cell model, FTY720 significantly inhibited the production of inflammatory cytokines by inhibiting mTOR/NF-κB signaling and regulating autophagy. These findings were associated with a decrease in rMC-1 cell injury, suggesting that FTY720 or related compounds may be valuable modulators of HG-induced retinal injury.

The association between composite dietary antioxidant index and diabetic retinopathy in type 2 diabetic patients: evidence from the NHANES

Background

Although diabetic retinopathy (DR) is closely related to dietary patterns and oxidative stress, there is little research on the relationship between the compound dietary antioxidant index (CDAI) and DR. This study aims to fill this gap by analyzing data from the National Health and Nutrition Examination Survey (NHANES) to explore the association between CDAI and DR in patients with type 2 diabetes, in order to provide a basis for dietary guidance to prevent DR.

Methods

Data for this study was obtained from NHANES conducted between 1999 and 2020. Information regarding dietary intake was collected through 24 h dietary recall interviews. Multivariate logistic regression analyses and restricted cubic splines (RCS) were employed to explore the association between CDAI and DR. Furthermore, subgroup analyses were conducted to further examine the relationship.

Results

In this study, a total of 2,158 participants were included, with a mean age of 58.87 years. After adjusting for all potential confounding factors, multivariate logistic regression analyses consistently demonstrated a negative correlation between CDAI and DR (OR = 0.94, 95%CI: 0.90-0.98, p = 0.007). Specifically, individuals in the highest quartile of CDAI had a significantly reduced risk of DR compared to those in the lowest quartile (OR = 0.51, 95%CI: 0.34-0.75, p < 0.001). The RCS analyses further confirmed the linear negative correlation between CDAI and DR (non-linear p = 0.101). Additionally, subgroup analyses provided further evidence for the robustness of this association across different subpopulations.

Conclusion

Our study highlights the linear negative correlation between CDAI and DR in type 2 diabetic patients. Further prospective studies are still needed in the future to confirm the role of CDAI in the risk of developing DR.

Trends and Barriers in Diabetic Retinopathy Screening: Korea National Health and Nutritional Examination Survey 2016-2021

BACKGROUND

The prevalence of diabetes is increasing globally, highlighting the importance of preventive healthcare. This study aimed to identify the diabetic retinopathy (DR) screening rates and risk factors linked to DR screening nonadherence in the Korean population through a nationally representative sample survey.

METHODS

Among the Korea National Health and Nutrition Examination Survey database from 2016 to 2021, participants aged ≥ 40 years with diabetes were included. The weighted estimate for nonadherence to DR screening within a year was calculated. Risk factor analyses were conducted using univariate and multivariate logistic regression.

RESULTS

Among the 3,717 participants, 1,109 (29.5%) underwent DR screening within the past year, and this national estimate exhibited no statistically significant difference from 2016 to 2021 (P = 0.809). Nonadherence to annual DR screening was associated with residing in rural areas, age ≥ 80 years, low educational level, self-reported good health, absence of ocular disease, current smoking, lack of exercise and dietary diabetes treatment, and no activity limitation (all P < 0.05).

CONCLUSION

The recent DR screening rate in Korea was relatively low. Factors associated with apathy and complacency towards personal health were associated with the nonadherence to DR screening. Educational interventions have the potential to enhance the annual screening rate for diabetic patients.

Comprehensive insights into a decade-long journey: The evolution, impact, and human factors of an asynchronous telemedicine program for diabetic retinopathy screening in Pennsylvania, United States

Diabetic Retinopathy stands as a leading cause of irreversible blindness, necessitating frequent examinations, especially in the early stages where effective treatments are available. However, current examination rates vary widely, ranging from 25-60%. This study scrutinizes the Point-of-Care Diabetic Retinopathy Examination Program at the University of Pittsburgh/UPMC, delving into its composition, evolution, challenges, solutions, and improvement opportunities. Employing a narrative approach, insights are gathered from key stakeholders, including ophthalmologists and staff from primary care clinics. A quantitative analysis from 2008 to 2020 provides a comprehensive overview of program outcomes, covering 94 primary care offices with 51 retinal cameras. Program components feature automated non-mydriatic 45° retinal cameras, a dedicated coordinator, rigorous training, and standardized workflows. Over this period, the program conducted 21,960 exams in 16,458 unique individuals, revealing a diverse population with an average age of 58.5 and a balanced gender distribution. Average body mass index (33.96±8.02 kg/m2) and hemoglobin A1c (7.58%±1.88%) surpassed normal ranges, indicating prevalent risk factors for diabetes-related complications. Notably, 24.2% of patients underwent more than one exam, emphasizing program engagement. Findings indicated that 86.3% of exams were gradable, with 59.0% within normal limits, 12.1% showing some evidence of diabetic retinopathy, and 6.4% exhibiting vision-threatening diabetic retinopathy. Follow-up appointments with ophthalmologists were recommended in 31.5% of exams due to indeterminate results, positive diabetic retinopathy (≥moderate or macular exudate), or other findings like age-related macular degeneration or suspected glaucoma. The program demonstrated high reproducibility across diverse healthcare settings, featuring a sustainable model with minimal camera downtime, standardized workflows, and financial support from grants, health systems, and clinical revenues. Despite COVID-19 pandemic challenges, this research emphasizes the program's reproducibility, user-friendly evolution, and promising outcomes. Beyond technical contributions, it highlights human factors influencing program success. Future research could explore adherence to follow-up ophthalmological recommendations and its associated factors.