1
|
Manafi N, Oncel D, Verma A, Corradetti G, Kadomoto S, Mahmoudi A, Alagorie AR, Yadav NK, Pappuru RR, Tufail A, Esmaeilkhanian H, Nittala MG, Raman R, Sadda S. Relationship between macular perfusion and lesion distribution in diabetic retinopathy. Eye (Lond) 2024; 38:2724-2730. [PMID: 38724702 PMCID: PMC11427675 DOI: 10.1038/s41433-024-03105-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/17/2024] [Accepted: 04/19/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES To assess the relationship between macular vessel density metrics and foveal avascular zone (FAZ) characteristics on optical coherence tomography angiography (OCTA) and lesion distribution in eyes with diabetic retinopathy (DR). SUBJECTS/METHODS Patients with DR who underwent both Optos ultrawidefield (UWF) pseudocolor imaging and macular OCTA (Cirrus Angioplex, 6 × 6 mm) were included in this cross-sectional observational study. The distribution of DR lesions was assessed by comparing each of the peripheral ETDRS extended fields (3-7) against their corresponding ETDRS field, hence eyes were defined as either having predominantly peripheral lesions (PPL) or predominantly central lesions (PCL). En face OCTA images from the superficial and deep capillary plexuses (SCP and DCP) were then analysed using Image J software. Perfusion density (PD), vessel length density (VLD), and fractal dimensions (FD) were calculated following binarization and skeletonization of the images. RESULTS Out of 344 eyes, 116 (33.72%) eyes had PPL and 228 (66.28%) eyes had PCL. For all DRSS levels, VLD, PD, and FD were not significantly different between eyes with PPL and PCL. The FAZ in eyes with PPL, however, was found to be more circular in shape compared to eyes with PCL (p = 0.037). CONCLUSION Although the presence of PPL has been associated with a higher risk for diabetic retinopathy progression, the macular perfusion is similar in eyes with PPL and PCL. The FAZ is more circular in eyes with PPL, but the clinical relevance of this difference remains to be defined.
Collapse
Affiliation(s)
- Navid Manafi
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Deniz Oncel
- Loyola University, Chicago, Stritch School of Medicine, Chicago, IL, 60153, USA
| | - Aditya Verma
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, USA
| | - Giulia Corradetti
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Shin Kadomoto
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Alireza Mahmoudi
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Ahmed Roshdy Alagorie
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Naresh Kumar Yadav
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, India
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, London, UK
| | - Houri Esmaeilkhanian
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Muneeswar G Nittala
- Doheny Eye Institute, Pasadena, CA, USA
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Srinivas Sadda
- Doheny Eye Institute, Pasadena, CA, USA.
- Department of Ophthalmology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Duncan N, Barrett N, Schildroth K, Chang JS, Channa R, Rickels K, Domalpally A, Blodi B. Comparison of Standard 7-Field, Clarus, and Optos Ultrawidefield Imaging Systems for Diabetic Retinopathy (COCO Study). OPHTHALMOLOGY SCIENCE 2024; 4:100427. [PMID: 38284100 PMCID: PMC10818251 DOI: 10.1016/j.xops.2023.100427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 01/30/2024]
Abstract
Purpose The purpose of this study was to compare diabetic retinopathy (DR) severity levels assessed from 7 standard-field stereoscopic color photographs on a 35° fundus camera to both Clarus and Optos ultrawidefield color images. Design Cross-sectional, comparative imaging study. Participants Participants with DR imaged at a single-center retina practice. Methods Participants were imaged on 3 cameras at a single visit with the Topcon 35° fundus camera, Clarus, and Optos. The DR Severity Scale (DRSS) level was determined within the 7-field (7F) area of each image set using the ETDRS scale. An additional global DRSS was assigned for both Clarus and Optos images using the entire visible retina. Weighted kappa (wκ) measured the agreement between cameras. Main Outcome Measures The primary outcome was a 3-way comparison of DRSS level within the 7F area imaged on the 3 cameras. Secondary outcomes included a comparison of the DRSS obtained with standard 7F imaging to the global DRSS of Clarus and Optos and a comparison of the global DRSS between Clarus and Optos only. Results Ninety-seven eyes (50 participants) were evaluated. Agreement within 1-step of ETDRS levels between standard 7F imaging and Clarus 7F was 90.1% (wκ = 0.65), and with Optos 7F in 85.9%, (wκ = 0.58). Agreement within 1-step between standard 7F imaging and Clarus global was 88.9% of eyes (wκ = 0.63), and Optos global was 85.7%, (wκ = 0.54). Agreement between Clarus and Optos global DR level within 1-step was 89.1% (wκ = 0.68). Intergrader agreement for the 7F ETDRS level was 96% for standard 7F imaging, 98% for Clarus, and 95.5% for Optos. Conclusions These findings suggest that when evaluating the 7F area on Clarus and Optos, DR severity grades are comparable to standard 7F imaging. However, it is important to understand the unique attributes and differences of each fundus camera when changing the type of system used in a clinical setting due to upgrading equipment. Additionally, if the facility has access to > 1 device, there should not be an exchange between cameras for the same patient. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Nicole Duncan
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nancy Barrett
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kathleen Schildroth
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jonathan S. Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kelsey Rickels
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin
| | - Barbara Blodi
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
3
|
Ashrafkhorasani M, Habibi A, Nittala MG, Corradetti G, Emamverdi M, Sadda SR. Peripheral retinal lesions in diabetic retinopathy on ultra-widefield imaging. Saudi J Ophthalmol 2024; 38:123-131. [PMID: 38988777 PMCID: PMC11232752 DOI: 10.4103/sjopt.sjopt_151_23] [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: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 07/12/2024] Open
Abstract
Peripheral retinal imaging plays a crucial role in the diagnosis, management, and prognosis of diabetic retinopathy (DR). Traditional fundus imaging techniques have limited coverage of the retina, resulting in missed peripheral lesions. The advent of ultra-widefield (UWF) imaging has revolutionized the assessment of the peripheral retina. UWF imaging modalities provide comprehensive visualization of the retina, enabling the detection of peripheral lesions without the need for mydriasis. Integration of UWF imaging with other modalities, including fluorescein angiography (FA), indocyanine green angiography, pseudocolor imaging, and fundus autofluorescence, further enhances our understanding of peripheral retinal lesions. UWF imaging has demonstrated improved detection of DR lesions and presumably more accurate management of DR compared to traditional fundus photography and dilated fundus examination. UWF-FA and UWF-optical coherence tomography angiography have emerged as valuable tools for assessing retinal and choroidal vascular abnormalities, nonperfusion areas, neovascularization, and microvascular abnormalities. The presence and increasing extent of predominantly peripheral lesions detected using UWF FA are associated with a higher risk of DR progression and proliferative DR. UWF imaging provides a comprehensive evaluation of DR severity, aiding in more accurate risk stratification and treatment decision-making. Overall, UWF imaging modalities have significantly advanced our understanding of peripheral retinal lesions in DR, facilitating early detection and targeted management for better visual outcomes.
Collapse
Affiliation(s)
- Maryam Ashrafkhorasani
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Abbas Habibi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Muneeswar G. Nittala
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
| | - Giulia Corradetti
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Mehdi Emamverdi
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Srinivas R. Sadda
- Doheny Image Reading and Research Lab, Doheny Eye Institute, Los Angeles, California, USA
- Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
4
|
Murphy TI, Douglass AG, van Wijngaarden P, Armitage JA. Programmatically Localizing Diabetic Retinopathy Features in 45-Degree Retinal Photographs Using Anatomical Colocation. J Clin Med 2024; 13:807. [PMID: 38337501 PMCID: PMC10856732 DOI: 10.3390/jcm13030807] [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: 12/20/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
Background: The aim in this study was to investigate the localization of diabetic retinopathy features at the posterior pole. Methods: This study extracted diabetic retinopathy feature locations from 757 macula-centered 45-degree fundus photographs in the publicly available DDR dataset. Arteriole and venule locations were also extracted from the RITE (n = 35) and IOSTAR (n = 29) datasets. Images were normalized to collocate optic disc and macula positions, and feature positions were collated to generate a frequency distribution matrix. Sørensen-Dice coefficients were calculated to compare the location of different features. Results: Arterioles occurred in two main, distinct arcuate patterns. Venules showed a more diffuse distribution. Microaneurysms were diffusely located around the posterior pole. Hemorrhages and exudates occurred more frequently at the temporal aspect of the macula. Cotton wool spots occurred in a region approximating the radial peripapillary capillaries. Intraretinal microvascular abnormalities and neovascularization were seen throughout the posterior pole, with neovascularization at the disc (n = 65) being more common than neovascularization elsewhere (n = 46). Venous beading occurred primarily between the first and third bifurcations of the venules. Diabetic retinopathy overall was more frequent in the temporal aspect of the macula. The location of cotton wool spots and exudates showed moderate similarity (0.52) when all data were considered, reducing to low similarity (0.18) when areas of low frequency were removed. Conclusions: Diabetic retinopathy occurs throughout the posterior pole but is more frequent in the temporal aspect of the macula. Understanding the location of diabetic retinopathy features may help inform visual search strategies for diabetic retinopathy screening.
Collapse
Affiliation(s)
- Timothy I. Murphy
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
| | - Amanda G. Douglass
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia;
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, VIC 3002, Australia
| | - James A. Armitage
- School of Medicine (Optometry), Deakin University, Geelong, VIC 3216, Australia; (T.I.M.); (A.G.D.)
| |
Collapse
|
5
|
Zhuang X, Chen R, Liang A, Yao J, Wang Z, Chen Y, Zheng K, Lu P, Zhang L, Cao D. Multimodal imaging analysis for the impact of retinal peripheral lesions on central neurovascular structure and retinal function in type 2 diabetes with diabetic retinopathy. Br J Ophthalmol 2023; 107:1496-1501. [PMID: 35772851 DOI: 10.1136/bjo-2022-321297] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore the possible role of peripheral lesions (PLs) detected by ultrawide field (UWF) imaging system on central neurovascular structure and retinal function. METHODS Ninety-seven diabetic patients were included in this cross-sectional study using UWF pseudocolour colour imaging with Optos Daytona (Optos, PLC). UWF images were graded as with predominantly peripheral lesions (PPLs) and without PPL. Macular neurovascular alterations and retinal function were measured by optical coherence tomography angiography (OCTA) and RETeval device, respectively. Central microcirculation and retinal function were compared between eyes with and without PPL. RESULTS The study evaluated 186 eyes (97 patients; 43 females (44.3%)), including 92 eyes without PPL and 94 eyes with PPL. Central retinal vessel density was comparable between eyes with and without PPL. Delayed implicit time and decreased pupil area ratio were found in the PPL group compared with eyes without PPL, and this difference remained unchanged after adjusting for systemic factors (all p<0.01). CONCLUSIONS Our study suggests that retinal function is worse in diabetic eyes with PPL. These findings challenged the conventional ETDRS protocols which ignored peripheral retina in determining DR severity. Furthermore, combining UWF imaging with RETeval system to detect more retinal abnormalities may be helpful in DR management.
Collapse
Affiliation(s)
- Xuenan Zhuang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Key Laboratory of Ophthalmology, Zhongshan Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ruoyu Chen
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Anyi Liang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jie Yao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Zicheng Wang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Yesheng Chen
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Kangyan Zheng
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Shantou University Medical College, Shantou, China
| | - Peiyao Lu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| | - Dan Cao
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
| |
Collapse
|
6
|
Attiku Y, Nittala MG, Velaga SB, Ramachandra C, Bhat S, Solanki K, Jayadev C, Choudhry N, Orr SMA, Jiang S, He Y, Sadda SR. Comparison of diabetic retinopathy severity grading on ETDRS 7-field versus ultrawide-field assessment. Eye (Lond) 2023; 37:2946-2949. [PMID: 37165011 PMCID: PMC10517125 DOI: 10.1038/s41433-023-02445-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 12/20/2022] [Accepted: 02/07/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To compare the diabetic retinopathy (DR) severity level determined when considering only the ETDRS 7-field region versus the entire ultrawidefield (UWF) image. METHODS In this retrospective, cross-sectional study, UWF pseudocolor images were graded on the Eyenuk image viewing, grading, and annotation platform for the severity of DR considering only the regions within the ETDRS 7-fields as well as the entire UWF image using two different protocols: 1) the simple International Classification of Diabetic Retinopathy (ICDR) scale and 2) the more complex DRCR.net Protocol AA grading scale. RESULTS A total of 250 eyes from 157 patients were included in this analysis. Six eyes (2.4%) demonstrated a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ICDR classification system. The discrepancies were due to the presence of lesions [intraretinal haemorrhage (n = 2), neovascular disease (n = 4)] in the peripheral fields which were not identified in the ETDRS 7-fields. Fourteen eyes (5.6%) had a discrepancy in severity level between the ETDRS 7-field region and the entire UWF image when using the ETDRS DRSS Protocol AA grading scale. The discrepancies were due to the presence of a higher level of disease [intraretinal haemorrhage (n = 4), neovascularization (n = 4), preretinal haemorrhage (n = 2), scatter laser scars (n = 4)] in the peripheral fields. CONCLUSION Although considering regions outside of the ETDRS 7-fields altered the DR severity level assessment in <5% of cases in this cohort, significant and potentially vision-threatening lesions including neovascularization and preretinal haemorrhage were identified in these peripheral regions. This highlights the importance of evaluating the entire UWF region when assessing patients with diabetic retinopathy.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Chaitra Jayadev
- Department of Cataract and Refractive Lens Surgery, Narayana Nethralaya, Bengaluru, India
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
- Octane Imaging Lab, Toronto, Ontario, Canada
| | - Samantha Miyoko Ashlyn Orr
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
- Octane Imaging Lab, Toronto, Ontario, Canada
| | - Shangjun Jiang
- Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada
- Octane Imaging Lab, Toronto, Ontario, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Ye He
- Doheny Eye Institute, Pasadena, CA, USA
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin, China
- Tianjin Branch of National Clinical Research Center for Ocular Disease, Tianjin, China
- Tianjin Medical University Eye Institute, Tianjin, China
| | - SriniVas R Sadda
- Doheny Eye Institute, Pasadena, CA, USA.
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA.
| |
Collapse
|
7
|
He Y, Verma A, Nittala MG, Velaga SB, Esmaeilkhanian H, Li X, Su L, Li X, Jayadev C, Tsui I, Prasad P, Sadda SR. Ethnic Variation in Diabetic Retinopathy Lesion Distribution on Ultra-widefield Imaging. Am J Ophthalmol 2023; 247:61-69. [PMID: 36368347 DOI: 10.1016/j.ajo.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate whether the distribution of diabetic retinopathy (DR) lesions differs among various ethnicities. DESIGN Multi-center, retrospective cohort study. METHODS We accrued a cohort of 226 eyes with DR consisting of 51 East Asian eyes, 102 South Asian eyes, 30 Caucasian eyes, and 43 Latino eyes, all evaluated with ultrawide field pseudocolor images. Images were manually annotated for DR lesions and were classified as having predominantly peripheral lesions (PPL) or predominantly central lesions (PCL) using 4 quantitative methods. The percent distribution of PCL to PPL was compared among different ethnicities. RESULTS Using a single-field lesion frequency-based method, East Asian eyes more frequently demonstrated a PPL distribution (86.3%), whereas South Asian eyes more frequently demonstrated a PCL distribution (64.7%). These findings were also observed when considering only the subset of treatment-naïve eyes. Furthermore, in treatment-naïve eyes without proliferative DR, the percent distribution of PPL to PCL in East Asian eyes was significantly different when compared to other ethnicities (P < .0001 South Asian, P = .035 Caucasian, P = .0003 Latino). The majority of patients (60%-78%) in all ethnic groups had moderate nonproliferative diabetic retinopathy(NPDR), and the same difference between East Asian and South Asian eyes was observed in this subgroup. CONCLUSIONS The distribution of DR lesions appears to vary among different ethnicities. DR lesions tend to be distributed more peripherally in East Asian eyes compared to other ethnic groups, particularly South Asian eyes, which tend to have more central disease. The prognostic implications of these ethnic differences in DR lesion distribution require further investigation.
Collapse
Affiliation(s)
- Ye He
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Aditya Verma
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA
| | - Muneeswar G Nittala
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA
| | - Swetha Bindu Velaga
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA
| | - Houri Esmaeilkhanian
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Long Su
- The Second Hospital of Tianjin Medical University (L.S., X.L.), Tianjin, China; Narayana Nethralaya Eye Institute (C.J.), Bangalore, India
| | - Xiao Li
- Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; The Second Hospital of Tianjin Medical University (L.S., X.L.), Tianjin, China; Narayana Nethralaya Eye Institute (C.J.), Bangalore, India
| | - Chaitra Jayadev
- The Second Hospital of Tianjin Medical University (L.S., X.L.), Tianjin, China; Narayana Nethralaya Eye Institute (C.J.), Bangalore, India
| | - Irena Tsui
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Stein Eye Institute (I.T., P.P.), Los Angeles, California, USA
| | - Pradeep Prasad
- Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Stein Eye Institute (I.T., P.P.), Los Angeles, California, USA; Department of Ophthalmology (P.P.), Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, California, USA
| | - Srinivas R Sadda
- From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
| |
Collapse
|
8
|
Widefield and Ultra-Widefield Retinal Imaging: A Geometrical Analysis. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010202. [PMID: 36676151 PMCID: PMC9867331 DOI: 10.3390/life13010202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
Diabetic retinopathy (DR) often causes a wide range of lesions in the peripheral retina, which can be undetected when using a traditional fundus camera. Widefield (WF) and Ultra-Widefield (UWF) technologies aim to significantly expand the photographable retinal field. We conducted a geometrical analysis to assess the field of view (FOV) of WF and UWF imaging, comparing it to the angular extension of the retina. For this task, we shot WF images using the Zeiss Clarus 500 fundus camera (Carl Zeiss Meditec, Jena, Germany). Approximating the ocular bulb to an ideal sphere, the angular extension of the theoretically photographable retinal surface was 242 degrees. Performing one shot, centered on the macula, it was possible to photograph a retinal surface of ~570 mm2, with a FOV of 133 degrees. Performing four shots with automatic montage, we obtained a retinal surface area of ~1100 mm2 and an FOV of 200 degrees. Finally, performing six shots with semi-automatic montage, we obtained a retinal surface area of ~1400 mm2 and an FOV of 236.27 degrees, which is close to the entire surface of the retina. WF and UWF imaging allow the detailed visualization of the peripheral retina, with significant impact on the diagnosis and management of DR.
Collapse
|
9
|
Studnička J, Němčanský J, Vysloužilová D, Ernest J, Němec P. Diabetic Retinopathy – Diagnostics and Treatment Guidelines. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2023; 79:238-247. [PMID: 37993272 DOI: 10.31348/2023/28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Diabetic retinopathy is one of the most common complications of diabetes mellitus and represents a serious health, social and economic problem. With the expected increase in the number of patients with diabetes, it is becoming the leading cause of severe vision loss in the working-age population. The presented guidelines summarize the current knowledge about this disease in order to standardize and update the procedures for the diagnosis, classification and treatment of diabetic retinopathy.
Collapse
|
10
|
Vujosevic S, Limoli C, Luzi L, Nucci P. Digital innovations for retinal care in diabetic retinopathy. Acta Diabetol 2022; 59:1521-1530. [PMID: 35962258 PMCID: PMC9374293 DOI: 10.1007/s00592-022-01941-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022]
Abstract
AIM The purpose of this review is to examine the applications of novel digital technology domains for the screening and management of patients with diabetic retinopathy (DR). METHODS A PubMed engine search was performed, using the terms "Telemedicine", "Digital health", "Telehealth", "Telescreening", "Artificial intelligence", "Deep learning", "Smartphone", "Triage", "Screening", "Home-based", "Monitoring", "Ophthalmology", "Diabetes", "Diabetic Retinopathy", "Retinal imaging". Full-text English language studies from January 1, 2010, to February 1, 2022, and reference lists were considered for the conceptual framework of this review. RESULTS Diabetes mellitus and its eye complications, including DR, are particularly well suited to digital technologies, providing an ideal model for telehealth initiatives and real-world applications. The current development in the adoption of telemedicine, artificial intelligence and remote monitoring as an alternative to or in addition to traditional forms of care will be discussed. CONCLUSIONS Advances in digital health have created an ecosystem ripe for telemedicine in the field of DR to thrive. Stakeholders and policymakers should adopt a participatory approach to ensure sustained implementation of these technologies after the COVID-19 pandemic. This article belongs to the Topical Collection "Diabetic Eye Disease", managed by Giuseppe Querques.
Collapse
Affiliation(s)
- Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy.
| | - Celeste Limoli
- Eye Clinic, IRCCS MultiMedica, Via San Vittore 12, 20123, Milan, Italy
- University of Milan, Milan, Italy
| | - Livio Luzi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| |
Collapse
|
11
|
Marcus DM, Silva PS, Liu D, Aiello LP, Antoszyk A, Elman M, Friedman S, Glassman AR, Googe JM, Jampol LM, Martin DF, Melia M, Preston CM, Wykoff CC, Sun JK. Association of Predominantly Peripheral Lesions on Ultra-Widefield Imaging and the Risk of Diabetic Retinopathy Worsening Over Time. JAMA Ophthalmol 2022; 140:946-954. [PMID: 35980608 PMCID: PMC9389433 DOI: 10.1001/jamaophthalmol.2022.3131] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/26/2022] [Indexed: 02/03/2023]
Abstract
Importance Ultra-widefield (UWF) imaging improves the ability to identify peripheral diabetic retinopathy (DR) lesions compared with standard imaging. Whether detection of predominantly peripheral lesions (PPLs) better predicts rates of disease worsening over time is unknown. Objective To determine whether PPLs identified on UWF imaging are associated with increased disease worsening beyond the risk associated with baseline Early Treatment Diabetic Retinopathy Study (ETDRS) Diabetic Retinopathy Severity Scale (DRSS) score. Design, Setting, and Participants This cohort study was a prospective, multicenter, longitudinal observational study conducted at 37 US and Canadian sites with 388 participants enrolled between February and December 2015. At baseline and annually through 4 years, 200° UWF-color images were obtained and graded for DRSS at a reading center. Baseline UWF-color and UWF-fluorescein angiography (FA) images were evaluated for the presence of PPL. Data were analyzed from May 2020 to June 2022. Interventions Treatment of DR or diabetic macular edema was at investigator discretion. Main Outcomes and Measures Predominantly peripheral lesions were defined as DR lesions with a greater extent outside vs inside the 7 standard ETDRS fields. Primary outcome was disease worsening defined as worsening 2 steps or more on the DRSS or receipt of DR treatment. Analyses were adjusted for baseline DRSS score and correlation between 2 study eyes of the same participant. Results Data for 544 study eyes with nonproliferative DR (NPDR) were analyzed (182 [50%] female participants; median age, 62 years; 68% White). The 4-year disease worsening rates were 45% for eyes with baseline mild NPDR, 40% for moderate NPDR, 26% for moderately severe NPDR, and 43% for severe NPDR. Disease worsening was not associated with color PPL at baseline (present vs absent: 38% vs 43%; HR, 0.78; 95% CI, 0.57-1.08; P = .13) but was associated with FA PPL at baseline (present vs absent: 50% vs 31%; HR, 1.72; 95% CI, 1.25-2.36; P < .001). Conclusions and Relevance Although no association was identified with color PPL, presence of FA PPL was associated with greater risk of disease worsening over 4 years, independent of baseline DRSS score. These results suggest that use of UWF-FA to evaluate retinas peripheral to standard ETDRS fields may improve the ability to predict disease worsening in NPDR eyes. These findings support use of UWF-FA for future DR staging systems and clinical care to more accurately determine prognosis in NPDR eyes.
Collapse
Affiliation(s)
- Dennis M. Marcus
- Southeast Retina Center, Augusta, Georgia
- Medical College of Georgia, Augusta University, Augusta
| | - Paolo S. Silva
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts
- Harvard Department of Ophthalmology, Boston, Massachusetts
| | - Danni Liu
- Jaeb Center for Health Research, Tampa, Florida
| | - Lloyd Paul Aiello
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts
- Harvard Department of Ophthalmology, Boston, Massachusetts
| | - Andrew Antoszyk
- Charlotte Eye Ear Nose and Throat Associates, Charlotte, North Carolina
| | | | | | | | | | | | | | | | | | | | - Jennifer K. Sun
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts
- Harvard Department of Ophthalmology, Boston, Massachusetts
| |
Collapse
|
12
|
Cherian J, Giridhar A, Sivaprasad S, Rajalakshmi R, Raman R, Khan R, Prakash N, Rodrigues AM. Predominant peripheral lesions in patients with diabetic retinopathy and its association with systemic comorbidities. Indian J Ophthalmol 2022; 70:3021-3025. [PMID: 35918965 PMCID: PMC9672741 DOI: 10.4103/ijo.ijo_172_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To determine the associations of predominant peripheral lesions (PPLs) with systemic comorbidities in individuals with diabetic retinopathy. Methods: This is a multicenter cross-sectional observational study conducted across three tertiary eye care centers in south India between January 2019 and July 2021. Ultra-widefield fundus images of consecutive patients with varying severity of diabetic retinopathy with data on systemic comorbidities were classified based on the presence or absence of PPL. Systemic comorbidities (hypertension, diabetic kidney disease, coronary artery disease, dyslipidemia, and anemia) were compared between the two groups. Results: A total of 879 participants (70.1% males) were included in the study, of which 443 (50.4%) patients had PPL. The mean age of the study participants was 56 ± 10 years, mean age of onset of diabetes was 41.24 ± 11.6 years, and mean duration of diabetes was 15.39 ± 7.6 years. The number of PPL increased with increasing severity of DR. Of all the systemic comorbidities analyzed, we found that coronary artery disease (CAD) had a significant association with PPL (Odds ratio [OR]-1.69; 95% confidence interval [CI], 1.12–2.55; P = 0.013) after adjusting for diabetic retinopathy severity, duration of diabetes, and age of onset of diabetes. Conclusion: The presence of PPL is a marker for coronary artery disease and early referral to cardiology is warranted.
Collapse
Affiliation(s)
| | | | | | - R Rajalakshmi
- Dr. Mohan's Diabetes Specialities Centre (DMDSC) and Madras Diabetes Research Foundation (MDRF), Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rehana Khan
- Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | | |
Collapse
|
13
|
Horie S, Ohno-Matsui K. Progress of Imaging in Diabetic Retinopathy-From the Past to the Present. Diagnostics (Basel) 2022; 12:diagnostics12071684. [PMID: 35885588 PMCID: PMC9319818 DOI: 10.3390/diagnostics12071684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Advancement of imaging technology in retinal diseases provides us more precise understanding and new insights into the diseases' pathologies. Diabetic retinopathy (DR) is one of the leading causes of sight-threatening retinal diseases worldwide. Colour fundus photography and fluorescein angiography have long been golden standard methods in detecting retinal vascular pathology in this disease. One of the major advancements is macular observation given by optical coherence tomography (OCT). OCT dramatically improves the diagnostic quality in macular edema in DR. The technology of OCT is also applied to angiography (OCT angiograph: OCTA), which enables retinal vascular imaging without venous dye injection. Similar to OCTA, in terms of their low invasiveness, single blue color SLO image could be an alternative method in detecting non-perfused areas. Conventional optical photography has been gradually replaced to scanning laser ophthalmoscopy (SLO), which also make it possible to produce spectacular ultra-widefield (UWF) images. Since retinal vascular changes of DR are found in the whole retina up to periphery, it would be one of the best targets in UWF imaging. Additionally, evolvement of artificial intelligence (AI) has been applied to automated diagnosis of DR, and AI-based DR management is one of the major topics in this field. This review is trying to look back on the progress of imaging of DR comprehensively from the past to the present.
Collapse
Affiliation(s)
- Shintaro Horie
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo 113-8519, Japan;
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
- Correspondence: ; Tel.: +81-3-5803-5302
| |
Collapse
|
14
|
Inter-observer agreement in grading severity of diabetic retinopathy in wide-field fundus photographs. Eye (Lond) 2022; 37:1231-1235. [PMID: 35595962 PMCID: PMC10102141 DOI: 10.1038/s41433-022-02107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 04/22/2022] [Accepted: 05/11/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To examine the inter-observer agreement between two retina specialists in grading diabetic retinopathy (DR) severity in ultra-wide-field fundus photographs. METHODS Two hundred and seventy patients with diabetes, who visited the vitreoretinal specialty at a tertiary eye care hospital, with or without DR underwent comprehensive ophthalmic examination, dilated retinal exam and Optos ultra-wide-field (UWF) retinal photography. Optos images were graded for DR severity based on the International Clinical Diabetic Retinopathy Disease Severity Scale by two retina specialists with same number of years of experience, masked to the clinical details of the participants. RESULTS The two graders showed agreement in 229/270 images (84.8%) and disagreement in 41/270 images (15.2%). The unweighted kappa for agreement between graders was k = 0.715, SE = 0.037 and the weighted kappa was k = 0.838, SE = 0.022. No DR was identified in 170/270 (62.9%) patients, mild NPDR in 15/270 (5.6%) patients, moderate NPDR in 35/270 (12.9%) patients, severe NPDR in 4/270 (1.48%) patient and PDR in 5/270 (1.85%) patients by both graders. Disagreement was neither related to the learning curve of graders nor with the patient's age (p = 0.574), gender (p = 0.169), duration of diabetes (0.660) or the lens being phakic or pseudophakic (p = 0.171) on logistic regression. CONCLUSIONS The impact of disagreement noted between observers in grading DR on UWF fundus photographs should be considered when utilizing UWF system in clinical studies.
Collapse
|
15
|
Yang D, Li M, Li W, Wang Y, Niu L, Shen Y, Zhang X, Fu B, Zhou X. Prediction of Refractive Error Based on Ultrawide Field Images With Deep Learning Models in Myopia Patients. Front Med (Lausanne) 2022; 9:834281. [PMID: 35433763 PMCID: PMC9007166 DOI: 10.3389/fmed.2022.834281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Summary Ultrawide field fundus images could be applied in deep learning models to predict the refractive error of myopic patients. The predicted error was related to the older age and greater spherical power. Purpose To explore the possibility of predicting the refractive error of myopic patients by applying deep learning models trained with ultrawide field (UWF) images. Methods UWF fundus images were collected from left eyes of 987 myopia patients of Eye and ENT Hospital, Fudan University between November 2015 and January 2019. The fundus images were all captured with Optomap Daytona, a 200° UWF imaging device. Three deep learning models (ResNet-50, Inception-v3, Inception-ResNet-v2) were trained with the UWF images for predicting refractive error. 133 UWF fundus images were also collected after January 2021 as an the external validation data set. The predicted refractive error was compared with the “true value” measured by subjective refraction. Mean absolute error (MAE), mean absolute percentage error (MAPE) and coefficient (R2) value were calculated in the test set. The Spearman rank correlation test was applied for univariate analysis and multivariate linear regression analysis on variables affecting MAE. The weighted heat map was generated by averaging the predicted weight of each pixel. Results ResNet-50, Inception-v3 and Inception-ResNet-v2 models were trained with the UWF images for refractive error prediction with R2 of 0.9562, 0.9555, 0.9563 and MAE of 1.72(95%CI: 1.62–1.82), 1.75(95%CI: 1.65–1.86) and 1.76(95%CI: 1.66–1.86), respectively. 29.95%, 31.47% and 29.44% of the test set were within the predictive error of 0.75D in the three models. 64.97%, 64.97%, and 64.47% was within 2.00D predictive error. The predicted MAE was related to older age (P < 0.01) and greater spherical power(P < 0.01). The optic papilla and macular region had significant predictive power in the weighted heat map. Conclusions It was feasible to predict refractive error in myopic patients with deep learning models trained by UWF images with the accuracy to be improved.
Collapse
Affiliation(s)
- Danjuan Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Weizhen Li
- School of Data Science, Fudan University, Shanghai, China
| | - Yunzhe Wang
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingling Niu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Yang Shen
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Xiaoyu Zhang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Bo Fu
- School of Data Science, Fudan University, Shanghai, China
- Bo Fu
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
- *Correspondence: Xingtao Zhou
| |
Collapse
|
16
|
Macular Edema and Visual Acuity Observation after Cataract Surgery in Patients with Diabetic Retinopathy. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3311751. [PMID: 35126918 PMCID: PMC8808216 DOI: 10.1155/2022/3311751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/17/2022]
Abstract
Objective. The purpose was to explore the effect of cataract surgery on postoperative macular edema and visual acuity in patients with diabetic retinopathy. Methods. 88 patients with diabetic retinopathy treated in our hospital (December 2019–December 2020) were chosen as research subjects and divided into experimental group of 44 patients (52 eyes) and control group of 44 patients (54 eyes) according to the odd and even admission numbers. The control group received laser photocoagulation treatment, while the experimental group underwent cataract surgery. The central macular thickness (CMT) and visual acuity of the two groups after treatment were detected to evaluate the therapeutic effect of different treatment methods on diabetic retinopathy. Results. No obvious differences in sex ratio, average age, average course of disease, average weight, average BMI, average glycosylated hemoglobin, and residence were found between the two groups
. The total clinical effective rate in the experimental group was obviously higher compared with the control group
. The CMT at T1, T2, and T3 in the experimental group was obviously lower compared with the control group
. The BCVA in the experimental group at 1 month and 3 months after treatment was obviously higher compared with the control group
. The VEGF levels of both groups after treatment were obviously lower
, and the VEGF level in the experimental group after treatment was obviously lower compared with the control group
. The total incidence of complications in the experimental group was obviously lower compared with the control group
. Conclusion. Cataract surgery is a reliable method to improve visual acuity and reduce serum inflammatory indicators in patients with diabetic retinopathy, with better clinical effect than laser photocoagulation, which is recommended for the treatment of diabetic retinopathy.
Collapse
|
17
|
Kalra G, Kar SS, Sevgi DD, Madabhushi A, Srivastava SK, Ehlers JP. Quantitative Imaging Biomarkers in Age-Related Macular Degeneration and Diabetic Eye Disease: A Step Closer to Precision Medicine. J Pers Med 2021; 11:1161. [PMID: 34834513 PMCID: PMC8622761 DOI: 10.3390/jpm11111161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 01/21/2023] Open
Abstract
The management of retinal diseases relies heavily on digital imaging data, including optical coherence tomography (OCT) and fluorescein angiography (FA). Targeted feature extraction and the objective quantification of features provide important opportunities in biomarker discovery, disease burden assessment, and predicting treatment response. Additional important advantages include increased objectivity in interpretation, longitudinal tracking, and ability to incorporate computational models to create automated diagnostic and clinical decision support systems. Advances in computational technology, including deep learning and radiomics, open new doors for developing an imaging phenotype that may provide in-depth personalized disease characterization and enhance opportunities in precision medicine. In this review, we summarize current quantitative and radiomic imaging biomarkers described in the literature for age-related macular degeneration and diabetic eye disease using imaging modalities such as OCT, FA, and OCT angiography (OCTA). Various approaches used to identify and extract these biomarkers that utilize artificial intelligence and deep learning are also summarized in this review. These quantifiable biomarkers and automated approaches have unleashed new frontiers of personalized medicine where treatments are tailored, based on patient-specific longitudinally trackable biomarkers, and response monitoring can be achieved with a high degree of accuracy.
Collapse
Affiliation(s)
- Gagan Kalra
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Sudeshna Sil Kar
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Duriye Damla Sevgi
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA;
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH 44106, USA
| | - Sunil K. Srivastava
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Justis P. Ehlers
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (G.K.); (D.D.S.); (S.K.S.)
- Tony and Leona Campane Center for Excellence in Image-Guided Surgery & Advanced, Cleveland Clinic, Cleveland, OH 44195, USA;
| |
Collapse
|
18
|
Yim D, Chandra S, Sondh R, Thottarath S, Sivaprasad S. Barriers in establishing systematic diabetic retinopathy screening through telemedicine in low- and middle-income countries. Indian J Ophthalmol 2021; 69:2987-2992. [PMID: 34708733 PMCID: PMC8725078 DOI: 10.4103/ijo.ijo_1411_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vision-threatening diabetic retinopathy (VTDR) is one of the leading causes of impaired vision in the working-age population. Early identification, timely diagnosis, and prompt treatment of VTDR have to be tackled simultaneously to reduce the rate of blindness due to this condition. Considerable emphasis has been placed globally on establishing diabetic retinopathy screening (DRS) programs to enable early identification and referral of VTDR for treatment. However, there is an urgent need to shift from the common practice of opportunistic screening to a systematic DRS pathway to ensure that individuals with diabetes are screened at regular intervals and treated appropriately. While systematic DRS programs have been successfully established in countries such as the United Kingdom (UK), it continues to be a challenge to initiate and sustain such programs in low- and middle-income countries (LMIC), home to approximately 80% of people with diabetes. Telemedicine is widely recognized as an ideal DRS screening program. Although it has resulted in an upsurge of opportunistic screening, systematic recall of screened patients remains a challenge. In addition, the link between referred patients from the telemedicine programs to treatment centers is often not established or has failed to deliver; so, there is minimal impact of these telemedicine programs on VTDR blindness at present. This review covers the various barriers of establishing and sustaining systematic telemedicine DRS programs, especially in resource-constrained settings, and the challenges in aligning telemedicine to VTDR treatment pathways to ensure patients with VTDR are treated promptly and effectively.
Collapse
Affiliation(s)
- Daniel Yim
- St. George's Medical School, University of London, London, UK
| | - Shruti Chandra
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Rajan Sondh
- St. George's Medical School, University of London, London, UK
| | - Sridevi Thottarath
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| | - Sobha Sivaprasad
- University College London, Institute of Ophthalmology; NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK
| |
Collapse
|
19
|
Ramasamy K, Mishra C, Kannan NB, Namperumalsamy P, Sen S. Telemedicine in diabetic retinopathy screening in India. Indian J Ophthalmol 2021; 69:2977-2986. [PMID: 34708732 PMCID: PMC8725153 DOI: 10.4103/ijo.ijo_1442_21] [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] [Indexed: 11/18/2022] Open
Abstract
With ever-growing prevalence of diabetes mellitus and its most common microvascular complication diabetic retinopathy (DR) in Indian population, screening for DR early for prevention of development of vision-threatening stages of the disease is becoming increasingly important. Most of the programs in India for DR screening are opportunistic and a universal screening program does not exist. Globally, telemedicine programs have demonstrated accuracy in classification of DR into referable disease, as well as into stages, with accuracies reaching that of human graders, in a cost-effective manner and with sufficient patient satisfaction. In this major review, we have summarized the global experience of telemedicine in DR screening and the way ahead toward planning a national integrated DR screening program based on telemedicine.
Collapse
Affiliation(s)
- Kim Ramasamy
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Chitaranjan Mishra
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Naresh B Kannan
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - P Namperumalsamy
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sagnik Sen
- Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| |
Collapse
|
20
|
Khan R, Raman S, Karamcheti SKM, Srinivasan S, Sharma A, Surya J, Bhende M, Ramasamy K, Verma A, Raman R. Comparison of Two Ultra-Widefield Cameras With High Image Resolution and Wider View for Identifying Diabetic Retinopathy Lesions. Transl Vis Sci Technol 2021; 10:9. [PMID: 34614162 PMCID: PMC8496423 DOI: 10.1167/tvst.10.12.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the effectiveness of the Optos P200dTx and Zeiss Clarus 500 fundus cameras in detecting diabetic retinopathy (DR) lesions. Methods A cross-sectional study was conducted among 243 patients with clinically diagnosed diabetes mellitus who were referred for an eye examination from two tertiary eye care centers in Chennai, India. Patients underwent DR screening based on mydriatic fundal images acquired by both fundal cameras. Fundal images from the two separate devices for each eye were compared based on accurately identified pathological retinal lesions with respect to type and location. Results When studying lesions of the central retina, they were better identified by the Zeiss Clarus compared with the Optos P200dTx, with six out of eight being statistically significant (P < 0.05). However, lesions of the mid-peripheral retina and peripheral retina were better identified by the Optos P200dTx than the Zeiss Clarus, with three out of eight lesions and five out of eight lesions being statistically significant (P < 0.05), respectively. Based on the color and size of lesions, the Optos P200dTx had a higher chance (59.6%) of missing white lesions than did the Zeiss Clarus (17%) (P < 0.0001). Consequently, small- and medium-sized lesions were missed more by the Optos P200dTx (30.72% and 32.63%, respectively) than the Zeiss Clarus (22.3% and 19.30%, respectively). Conclusions The capability of detecting or missing a particular DR lesion among diabetics differed between the two cameras based on effective field of view, resolution, and the retinal zone being imaged. Translational Relevance The choice of which ultra-widefield camera to be used for screening DR can be based on the greater prevalence of central versus peripheral retinal lesions noted in the patient population seen in a clinical practice.
Collapse
Affiliation(s)
- Rehana Khan
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sundaresan Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.,Birla Institute of Technology and Science, Pilani, Rajasthan, India
| | | | | | - Abhishek Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India.,Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Janani Surya
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kim Ramasamy
- Retina and Vitreous Services, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Aditya Verma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
21
|
Cai S, Liu TYA. The Role of Ultra-Widefield Fundus Imaging and Fluorescein Angiography in Diagnosis and Treatment of Diabetic Retinopathy. Curr Diab Rep 2021; 21:30. [PMID: 34448948 DOI: 10.1007/s11892-021-01398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Early detection and treatment are important for preventing vision loss from diabetic retinopathy. Historically, the gold standard for grading diabetic retinopathy has been based on 7-field 30-degree color fundus photographs that capture roughly the central third of the retina. Our aim was to review recent literature on the role of ultra-widefield (allowing capture of up to 82% of the retina in one frame) fundus imaging in screening, prognostication, and treatment of diabetic retinopathy. RECENT FINDINGS Ultra-widefield fundus imaging can capture peripheral retinal lesions outside the traditional 7-field photographs that may correlate with increased risk of diabetic retinopathy progression. The speed and ability to image through undilated pupils make ultra-widefield imaging attractive for tele-ophthalmology screening. Ultra-widefield fluorescein angiography may help guide targeted laser treatment in eyes with proliferative diabetic retinopathy. Ultra-widefield imaging has potential to help shape new diabetic retinopathy screening, staging, and treatment protocols.
Collapse
Affiliation(s)
- Sophie Cai
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Wilmer B-29, Baltimore, MD, 21287, USA
| | - T Y Alvin Liu
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 726, Baltimore, MD, 21287, USA.
| |
Collapse
|
22
|
Ashraf M, Cavallerano JD, Sun JK, Silva PS, Aiello LP. Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics. J Clin Med 2021; 10:jcm10153300. [PMID: 34362084 PMCID: PMC8347462 DOI: 10.3390/jcm10153300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/25/2022] Open
Abstract
Ultrawide field imaging (UWF) has allowed the visualization of a significantly greater area of the retina than previous standard approaches. In diabetic retinopathy (DR), significantly more lesions are seen on UWF imaging compared to the seven-standard ETDRS fields. In addition, some eyes have lesions that are located predominantly in the peripheral retina that are associated with an increased risk of DR progression. The current DR severity scales are still largely based on clinically visible retinal microvascular lesions and do not incorporate retinal periphery, neuroretinal, or pathophysiologic changes. Thus, current scales are not well suited for documenting progression or regression in eyes with very early or advanced DR, nor in the setting of vascular endothelial growth factor inhibitors (antiVEGF). In addition, the categorical system is highly subjective, and grading is variable between different graders based on experience level and training background. Recently, there have been efforts to quantify DR lesions on UWF imaging in an attempt to generate objective metrics for classification, disease prognostication and prediction of treatment response. The purpose of this review is to examine current quantitative metrics derived from UWF fluorescein angiograms and UWF color imaging to determine their feasibility in any potential future DR classification.
Collapse
Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA; (J.D.C.); (J.K.S.); (P.S.S.); (L.P.A.)
- Ophthalmology Department, Alexandria Faculty of Medicine, Alexandria Governorate 21500, Egypt
- Ophthalmology, Harvard Medical School, Boston, MA 02215, USA
- Correspondence: ; Tel.: +1-(617)-309-2554
| | - Jerry D. Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA; (J.D.C.); (J.K.S.); (P.S.S.); (L.P.A.)
- Ophthalmology, Harvard Medical School, Boston, MA 02215, USA
| | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA; (J.D.C.); (J.K.S.); (P.S.S.); (L.P.A.)
- Ophthalmology, Harvard Medical School, Boston, MA 02215, USA
| | - Paolo S. Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA; (J.D.C.); (J.K.S.); (P.S.S.); (L.P.A.)
- Ophthalmology, Harvard Medical School, Boston, MA 02215, USA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA 02215, USA; (J.D.C.); (J.K.S.); (P.S.S.); (L.P.A.)
- Ophthalmology, Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
23
|
Ashraf M, Rageh A, Gilbert M, Tolls D, Fleming A, Souka A, El-Baha S, Cavallerano JD, Sun JK, Aiello LP, Silva PS. Factors Affecting Predominantly Peripheral Lesion Identification and Grading. Transl Vis Sci Technol 2021; 10:6. [PMID: 34100926 PMCID: PMC8196424 DOI: 10.1167/tvst.10.7.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose The purpose of this study was to determine factors affecting predominantly peripheral lesion (PPL) grading, such as qualitative versus quantitative assessment, device type, and severity of diabetic retinopathy (DR) in ultrawide field color images (UWF-CIs). Methods Patients with DR had UWF-CI qualitatively graded for PPL using standardized techniques and had hemorrhages/microaneurysms (H/Mas) individually annotated for quantitative PPL grading on two different ultrawide field devices. Results Among 791 eyes of 481 patients, 38.2% had mild nonproliferative DR (NPDR), 34.7% had moderate NPDR, and 27.1% had severe NPDR to proliferative DR (PDR). The overall agreement between qualitative and quantitative PPL grading was moderate (ĸ = 0.423, P < 0.001). Agreement rates were fair in eyes with mild NPDR (ĸ = 0.336, P < 0.001) but moderate in eyes with moderate NPDR (ĸ = 0.525, P < 0.001) and severe NPDR-PDR (ĸ = 0.409, P < 0.001). Increasing thresholds for quantitative PPL determination improved agreement rates, with peak agreements at H/Ma count differences of six for mild NPDR, five for moderate NPDR, and nine for severe NPDR-PDR. Based on ultrawide field device type (California = 412 eyes vs. 200Tx = 379 eyes), agreement between qualitative and quantitative PPL grading was moderate for all DR severities in both devices (ĸ = 0.369−0.526, P < 0.001) except for mild NPDR on the 200Tx, which had poor agreement (ĸ = 0.055, P = 0.478). Conclusions Determination of PPL varies between standard qualitative and quantitative grading and is dependent on NPDR severity, device type, and magnitude of lesion differences used for quantitative assessment. Translational Relevance Prior UWF studies have not accounted for imaging and grading factors that affect PPL, such factors need to be reviewed when assessing thresholds for DR progression rates.
Collapse
Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Ophthalmology Department, Alexandria Faculty of Medicine, Egypt
| | - Abdulrahman Rageh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Michael Gilbert
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
| | | | - Ahmed Souka
- Ophthalmology Department, Alexandria Faculty of Medicine, Egypt
| | - Samir El-Baha
- Ophthalmology Department, Alexandria Faculty of Medicine, Egypt
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
24
|
Ashraf M, Sampani K, Rageh A, Silva PS, Aiello LP, Sun JK. Interaction Between the Distribution of Diabetic Retinopathy Lesions and the Association of Optical Coherence Tomography Angiography Scans With Diabetic Retinopathy Severity. JAMA Ophthalmol 2021; 138:1291-1297. [PMID: 33119083 DOI: 10.1001/jamaophthalmol.2020.4516] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Studies have not yet determined whether the distribution of lesions in the retinal periphery alters the association between the severity of diabetic retinopathy (DR) and macular vessel density. Objective To evaluate the association of DR lesion distribution with optical coherence tomography angiography (OCTA) metrics and DR severity. Design, Setting, and Participants This cross-sectional observational study was conducted at a tertiary care center for diabetic eye disease among 225 patients with type 1 or 2 diabetes who had undergone imaging between February 15, 2016, and December 31, 2019. Exposures Optical coherence tomography angiography 3 × 3-mm macular scans and ultra-widefield color imaging. Main Outcomes and Measures Optical coherence tomography angiography vessel density in the superficial capillary plexus, intermediate capillary plexus, and deep capillary plexus and choriocapillaris flow density. The severity of DR and the predominantly peripheral lesions (PPL) were evaluated from ultra-widefield color imaging. Results The study evaluated 352 eyes (225 patients; 125 men [55.6%]; mean [SD] age, 52.1 [15.1] years), of which 183 eyes (52.0%) had mild nonproliferative diabetic retinopathy (NPDR), 71 eyes (20.2%) had moderate NPDR, and 98 eyes (27.8%) had severe NPDR or proliferative diabetic retinopathy (PDR). In eyes with no PPL (209 [59.4%]), the mean (SD) vessel density in the superficial capillary plexus (mild NPDR, 38.1% [4.7%]; moderate NPDR, 36.4% [4.6%]; severe NPDR or PDR, 34.1% [4.1%]; P < .001) and the deep capillary plexus (mild NPDR, 45.8% [3.0%]; moderate NPDR, 45.8% [2.2%]; severe NPDR or PDR, 44.5% [1.9%]; P = .002), as well as the mean (SD) choriocapillaris flow density (mild NPDR, 69.7% [6.2%]; moderate NPDR, 67.6% [5.6%]; severe NPDR or PDR, 67.1% [5.6%]; P = .01), decreased with increasing DR severity. These associations remained statistically significant even after correcting for age, signal strength index, spherical equivalent, duration of diabetes, type of diabetes, and correlation between eyes of the same patient. In eyes with PPL (143 [40.6%]), mean (SD) vessel density in the superficial capillary plexus (mild NPDR, 34.1% [4.1%]; moderate NPDR, 35.2% [4.1%]; severe NPDR or PDR, 36.0% [4.3%]; P = .42) and the deep capillary plexus (mild NPDR, 44.5% [1.7%]; moderate NPDR, 45.4% [1.4%]; severe NPDR or PDR, 44.9% [1.5%]; P = .81), as well as the mean (SD) choriocapillaris flow density (mild NPDR, 67.1% [5.6%]; moderate NPDR, 69.3% [4.6%]; severe NPDR or PDR, 68.3% [5.6%]; P = .49), did not appear to change with increasing DR severity. Conclusions and Relevance These results suggest that central retinal vessel density is associated with DR severity in eyes without, but not with, PPL. These findings suggest a potential need to stratify future optical coherence tomography angiography studies of eyes with DR by the presence or absence of PPL. If DR onset and worsening are associated with the location of retinal nonperfusion, assessment of global retinal nonperfusion using widefield angiography may improve the ability to evaluate DR severity and risk of DR worsening over time.
Collapse
Affiliation(s)
- Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Ophthalmology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Konstantina Sampani
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Abdulrahman Rageh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
25
|
Bilal A, Sun G, Mazhar S. Survey on recent developments in automatic detection of diabetic retinopathy. J Fr Ophtalmol 2021; 44:420-440. [PMID: 33526268 DOI: 10.1016/j.jfo.2020.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/24/2020] [Indexed: 12/13/2022]
Abstract
Diabetic retinopathy (DR) is a disease facilitated by the rapid spread of diabetes worldwide. DR can blind diabetic individuals. Early detection of DR is essential to restoring vision and providing timely treatment. DR can be detected manually by an ophthalmologist, examining the retinal and fundus images to analyze the macula, morphological changes in blood vessels, hemorrhage, exudates, and/or microaneurysms. This is a time consuming, costly, and challenging task. An automated system can easily perform this function by using artificial intelligence, especially in screening for early DR. Recently, much state-of-the-art research relevant to the identification of DR has been reported. This article describes the current methods of detecting non-proliferative diabetic retinopathy, exudates, hemorrhage, and microaneurysms. In addition, the authors point out future directions in overcoming current challenges in the field of DR research.
Collapse
Affiliation(s)
- A Bilal
- Faculty of Information Technology, Beijing University of Technology, Chaoyang District, Beijing 100124, China.
| | - G Sun
- Faculty of Information Technology, Beijing University of Technology, Chaoyang District, Beijing 100124, China
| | - S Mazhar
- Faculty of Information Technology, Beijing University of Technology, Chaoyang District, Beijing 100124, China
| |
Collapse
|
26
|
Li X, Xie J, Zhang L, Cui Y, Zhang G, Wang J, Zhang A, Chen X, Huang T, Meng Q. Differential distribution of manifest lesions in diabetic retinopathy by fundus fluorescein angiography and fundus photography. BMC Ophthalmol 2020; 20:471. [PMID: 33261573 PMCID: PMC7709243 DOI: 10.1186/s12886-020-01740-2] [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: 02/23/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background To analyze the distribution of manifest lesions of diabetic retinopathy (DR) by fundus fluorescein angiography (FFA) and color fundus photography (FP). Methods A total of 566 eyes of 324 Chinese patients diagnosed with DR were included in this retrospective study. DR severity was graded by the international grading criterion. The distributions of microaneurysms (MA), intraretinal hemorrhages/exudates (He/Ex), intraretinal microvascular abnormality (IRMA), capillary nonperfusion areas (NPA), and neovascularization (NV) were estimated by multiple logistic regression analyse based on nine-field FFA and FP images. Results In mild nonproliferative diabetic retinopathy (NPDR), the highest frequency of MA was found in the posterior pole (67.7%), followed by the inferior nasal (59.4%), and the nasal (55.4%) fields. In moderate NPDR, MA frequently distributed in the posterior pole (98.0%), nasal (97.0%), superior (96.0%), inferior nasal (94.9%), and inferior (92.9%) fields, whereas He/Ex were most prevalent in the posterior pole (69.7%). In severe NPDR and proliferative DR, IRMA, NPA, and NV were more frequent in the nasal field, particularly in the inferior nasal field (60.3, 38.7, and 76.0%, respectively). All lesions were more observed in the combined posterior pole, nasal, and inferior nasal fields than in the posterior pole or combined two fields in the early and severe stages of DR (P < 0.05). Conclusions The manifest lesions of DR were common in the nasal field besides the posterior pole in Chinese patients. A combined examination of the posterior pole, nasal, and inferior nasal mid-peripheral retina would help to detect different retinal lesions of DR. Trial registration ClinicalTrial. gov, NCT03528720. Registered 18 May 2018 - Retrospectively registered.
Collapse
Affiliation(s)
- Xiaoli Li
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jie Xie
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Ying Cui
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Guanrong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jun Wang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Aiping Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiangting Chen
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Tian Huang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qianli Meng
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, 106 Zhongshan Er Road, Guangzhou, 510080, People's Republic of China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| |
Collapse
|