1
|
Karabeg M, Petrovski G, Hertzberg SN, Erke MG, Fosmark DS, Russell G, Moe MC, Volke V, Raudonis V, Verkauskiene R, Sokolovska J, Haugen IBK, Petrovski BE. A pilot cost-analysis study comparing AI-based EyeArt® and ophthalmologist assessment of diabetic retinopathy in minority women in Oslo, Norway. Int J Retina Vitreous 2024; 10:40. [PMID: 38783384 PMCID: PMC11112837 DOI: 10.1186/s40942-024-00547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/17/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of adult blindness in the working age population worldwide, which can be prevented by early detection. Regular eye examinations are recommended and crucial for detecting sight-threatening DR. Use of artificial intelligence (AI) to lessen the burden on the healthcare system is needed. PURPOSE To perform a pilot cost-analysis study for detecting DR in a cohort of minority women with DM in Oslo, Norway, that have the highest prevalence of diabetes mellitus (DM) in the country, using both manual (ophthalmologist) and autonomous (AI) grading. This is the first study in Norway, as far as we know, that uses AI in DR- grading of retinal images. METHODS On Minority Women's Day, November 1, 2017, in Oslo, Norway, 33 patients (66 eyes) over 18 years of age diagnosed with DM (T1D and T2D) were screened. The Eidon - True Color Confocal Scanner (CenterVue, United States) was used for retinal imaging and graded for DR after screening had been completed, by an ophthalmologist and automatically, using EyeArt Automated DR Detection System, version 2.1.0 (EyeArt, EyeNuk, CA, USA). The gradings were based on the International Clinical Diabetic Retinopathy (ICDR) severity scale [1] detecting the presence or absence of referable DR. Cost-minimization analyses were performed for both grading methods. RESULTS 33 women (64 eyes) were eligible for the analysis. A very good inter-rater agreement was found: 0.98 (P < 0.01), between the human and AI-based EyeArt grading system for detecting DR. The prevalence of DR was 18.6% (95% CI: 11.4-25.8%), and the sensitivity and specificity were 100% (95% CI: 100-100% and 95% CI: 100-100%), respectively. The cost difference for AI screening compared to human screening was $143 lower per patient (cost-saving) in favour of AI. CONCLUSION Our results indicate that The EyeArt AI system is both a reliable, cost-saving, and useful tool for DR grading in clinical practice.
Collapse
Affiliation(s)
- Mia Karabeg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Goran Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000, Split, Croatia
- UKLONetwork, University St. Kliment Ohridski-Bitola, 7000, Bitola, Macedonia
| | - Silvia Nw Hertzberg
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Greg Russell
- Clinical Development, Eyenuk Inc, Woodland Hills, CA, USA
| | - Morten C Moe
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway
| | - Vallo Volke
- Faculty of Medicine, Tartu University, 50411, Tartu, Estonia
| | - Vidas Raudonis
- Automation Department, Kaunas University of Technology, 51368, Kaunas, Lithuania
| | - Rasa Verkauskiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania
| | | | | | - Beata Eva Petrovski
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, Kirkeveien 166, 0450, Oslo, Norway.
- Department of Ophthalmology, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.
- Institute of Endocrinology, Lithuanian University of Health Sciences, 50161, Kaunas, Lithuania.
| |
Collapse
|
2
|
Sauesund ES, Jørstad ØK, Brunborg C, Moe MC, Erke MG, Fosmark DS, Petrovski G. A Pilot Study of Implementing Diabetic Retinopathy Screening in the Oslo Region, Norway: Baseline Results. Biomedicines 2023; 11:biomedicines11041222. [PMID: 37189840 DOI: 10.3390/biomedicines11041222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE to gain insight into the baseline parameters of a population with diabetes mellitus (DM) included in a pilot diabetic retinopathy (DR) screening program at Oslo University Hospital (OUH), Norway. METHODS This was a cross-sectional study of a cohort of adult patients (≥18 years) with type 1 or 2 DM (T1D and T2D). We measured the best-corrected visual acuity (BCVA), blood pressure (BP), heart rate (HR), intraocular pressure (IOP), height and weight. We also collected HbA1c, total serum cholesterol and urine-albumin, -creatinine and -albumin-to-creatinine ratio (ACR), as well as socio-demographic parameters, medications and previous screening history. We obtained color fundus photographs, which were graded by two experienced ophthalmologists according to the International Clinical Disease Severity Scale for DR. RESULTS The study included 180 eyes of 90 patients: 12 patients (13.3%) had T1D and 78 (86.7%) had T2D. In the T1D group, 5 patients (41.7%) had no DR, and 7 (58.3%) had some degree of DR. In the T2D group, 60 patients (76.9%) had no DR, and 18 (23.1%) had some degree of DR. None of the patients had proliferative DR. Of the 43 patients not newly diagnosed (time of diagnosis > 5 years for T1D and >1 years for T2D), 37.5% of the T1D patients and 5.7% of the T2D patients had previously undergone regular screening. Univariate analyses found for the whole cohort significant associations between DR and age, HbA1c, urine albumin-to-creatinine ratio, body mass index (BMI) and duration of DM. For the T2D group alone, there were significant associations between DR and HbA1c, BMI, urine creatinine, urine albumin-to-creatinine ratio and duration of DM. The analysis also showed three times higher odds for DR in the T1D group than the T2D group. CONCLUSIONS This study underscores the need for implementing a systematic DR screening program in the Oslo region, Norway, to better reach out to patients with DM and improve their screening adherence. Timely and proper treatment can prevent or mitigate vision loss and improve the prognosis. A considerable number of patients were referred from general practitioners for not being followed by an ophthalmologist.Among patients not newly diagnosed with DM, 62.8% had never had an eye exam, and the duration of DM for these patients was up to 18 years (median: 8 years).
Collapse
Affiliation(s)
- Ellen Steffenssen Sauesund
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | | | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0450 Oslo, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Maja Gran Erke
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Dag Sigurd Fosmark
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Goran Petrovski
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Center for Eye Research and Innovative Diagnostics, Department of Ophthalmology, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| |
Collapse
|
3
|
Sandvik SA, Sundling V, Lagali N. Methods for evaluation of corneal nerve fibres in diabetes mellitus by in vivo confocal microscopy: a scoping review protocol. BMJ Open 2023; 13:e070017. [PMID: 37045576 PMCID: PMC10106056 DOI: 10.1136/bmjopen-2022-070017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Globally, 422 million people have diabetes. Late complications of diabetes are blindness, kidney failure, heart attack, stroke and lower limb amputation. The prevalence of diabetic peripheral neuropathy and diabetic retinopathy is 50% and 35%, respectively. In vivo confocal microscopy (IVCM) is a rapid, non-invasive method to evaluate subbasal corneal nerve fibres, which are small fibres of the peripheral nervous system. Corneal nerve fibre changes can be a marker of diabetic peripheral neuropathy. There is currently no gold-standard procedure for IVCM imaging, image processing or quantitative analysis of the corneal nerve fibres in the subbasal plexus. This protocol describes a scoping review to map, summarise and critically evaluate current methods used with IVCM evaluation in people with diabetes mellitus. METHODS The scoping review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping review. A comprehensive search of the literature will be conducted in MEDLINE, Embase, Cochrane, Scopus and Web of Science. The search strategy will include terms related to IVCM, diabetes and corneal nerve fibres. We will set inclusion and exclusion criteria prior to the search, and two reviewers will screen titles and abstracts independently. One reviewer will full text read eligible articles and chart data from the studies. A descriptive summary of the methods used in imaging, image processing and quantitative analysis of peripheral corneal nerve fibres by IVCM will be written. ETHICS AND DISSEMINATION Ethical approval is not required since this is a scoping review based on previously published articles. The findings will be published in a scientific peer-reviewed journal.
Collapse
Affiliation(s)
- Siv Aaseth Sandvik
- Department of Optometry, Radiology and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Vibeke Sundling
- Department of Optometry, Radiology and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Linkopings universitet, Linkoping, Sweden
| |
Collapse
|
4
|
Hertzberg SNW, Jørstad ØK, Petrovski BÉ, Bragadottir R, Steffensen LA, Moe MC, Burger EA, Petrovski G. Transition from Laser to Intravitreal Injections for Diabetic Retinopathy: Hospital Utilization and Costs from an Extended Healthcare Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12603. [PMID: 36231903 PMCID: PMC9564656 DOI: 10.3390/ijerph191912603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe the trends in hospital utilization and economic outcomes associated with the transition from laser to intravitreal injection (IVI) therapy for diabetic retinopathy (DR) at Oslo University Hospital (OUH), which provides the largest retina service in Norway. METHODS This descriptive study analyzed hospital administrative data and determined the average utilization and treatment proportions of laser therapy, IVIs and vitrectomy for each patient per year. The Chi-square test was used to compare resource use between treatment groups. From an extended healthcare perspective, the annual cost per patient was calculated using Norwegian tariff data from 2020 and the National Medication Price Registry for patients seen between 2010 and 2018. Bootstrapping was performed to generate 95% confidence intervals for the cost per patient per year. RESULTS Among the 1838 (41% female) patients treated for DR between 2005 and 2018, OUH provided on average 1.09 laser treatments per DR patient and 0.54 vitrectomies per DR patient in 2005, whose utilization declined to 0.54 and 0.05 treatments per DR patient, respectively, by 2018. Laser treatments declined from 64% to 10%, while vitrectomies declined from 32% to 1%. In contrast, IVI treatments increased from 4.5% to 89% of the total share, representing an average increase, from 0.08 injections per patient in 2005 to 4.73 injections per patient in 2018. Both the increasing number of DR patients and the shift in the type of treatment increased the economic costs of treating DR from a total of EUR 0.605 million (EUR 2935 per patient) in 2010 to EUR 2.240 million (EUR 3665 per patient) in 2018, with IVIs contributing considerably to these costs. CONCLUSIONS Despite the decline in the use of vitrectomies, the transition from laser to IVI therapy for DR increased the healthcare resource utilization and economic costs of its treatment over the observed time. A main cost driver was the need for long-term IVIs, in addition to the drug cost itself. Trade-offs can be achieved through effective alternative IVI delivery or appropriate drug choice that balances patient needs with the economic burden of treating DR.
Collapse
Affiliation(s)
| | - Øystein K. Jørstad
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Beáta Éva Petrovski
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
| | - Ragnheidur Bragadottir
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | | | - Morten Carstens Moe
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
| | - Emily A. Burger
- Department of Health Management and Health Economics, University of Oslo, 0317 Oslo, Norway
- Center for Health Decision Science, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Goran Petrovski
- Center for Eye Research, Department of Ophthalmology, Institute for Clinical Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, 0450 Oslo, Norway
- Department of Ophthalmology, University of Split School of Medicine and University Hospital Centre, 21000 Split, Croatia
| |
Collapse
|
5
|
Alsbirk KE, Seland JH, Assmus J. Diabetic retinopathy and visual impairment in a Norwegian diabetic coast population with a high dietary intake of fish oils. An observational study. Acta Ophthalmol 2022; 100:e532-e538. [PMID: 34472215 DOI: 10.1111/aos.14977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/19/2021] [Accepted: 07/01/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To present retinal and visual findings in a Norwegian west coast diabetic population and to elucidate the effect of dietary intake of marine polyunsaturated fatty acids (PUFAs) on the development of diabetic retinopathy (DR). METHODS In an eye practice in an archipelago of 314 km², serving a population of about 40 000, we recorded the prevalence of visual impairment and DR in a referred diabetic population. 510 consecutive patients were included, 238 females and 272 males. 50 patients had type I and 460 had type II diabetes mellitus (DM). Self-reported medication, diet supplements, HbA1c and fish consumption were registered. RESULTS In the type I group, the median age was 44.5 and median DM duration 11.5 years [1-44]. 48% had photographic evidence of DR, 8 patients (16%) had proliferative retinopathy (PDR), and 6 patients (12%) had diabetic macular oedema (DME). All had best-corrected visual acuity (BCVA) of 0.5 (log MAR 0.3) or better in the best eye. In the type II group, the median DM duration was 8 years [1-53], and median age was 66. 98% had best eye BCVA at or better than 0.5 (log MAR 0.3) in the best eye. CONCLUSION None of the 510 patients had BCVA worse than 0.3 (log MAR 0.48) due to diabetic retinopathy. Compared to similar studies, we found a very low visual impairment rate. A possible protective effect of PUFA on the prevalence and progression of diabetic microangiopathy including retinopathy is discussed.
Collapse
Affiliation(s)
| | | | - Jörg Assmus
- Centre for Clinical Research Haukeland University Hospital Bergen Norway
| |
Collapse
|
6
|
Madeira C, Lopes M, Laiginhas R, Neves J, Rosas V, Barbosa M, Carvalho D, Falcão-Reis F, Falcão M. Changing trends in the prevalence of diabetic retinopathy in type 1 diabetes mellitus from 1990 to 2018: A retrospective study in a Portuguese population. Diabetes Res Clin Pract 2019; 158:107891. [PMID: 31669626 DOI: 10.1016/j.diabres.2019.107891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To estimate the prevalence of diabetic retinopathy /(DR) in a Portuguese population with type 1 diabetes (T1DM). METHODS Retrospective review of all patients with T1DM, whose reference center was Centro Hospitalar de São João, a tertiary center in Portugal, who were diagnosed between 1990 and 2018. DR was classified based on fundus examination in medical records as (0) no evidence of retinopathy, (1) mild non-proliferative retinopathy (NPDR); (2) moderate to severe non-proliferative retinopathy (NPDR) and (3) proliferative retinopathy (PDR). Patients were classified according to the eye with a worse retinopathy stage. Follow-up was considered as time between the diagnosis of diabetes and the last funduscopic evaluation. RESULTS 233 patients met the inclusion and exclusion criteria. The prevalence of any DR at less than 5, 10, 15, 20 and more than 20-years of DM was 1.8%, 10.4%, 34.8%, 54.1% and 71.2% respectively. The overall prevalence of DR was 43.3% (n = 101). At the last observation, 43 patients (18.5%) had mild NPDR, 34 patients (14.6%) had moderate to severe NPDR and 24 patients (10.3%) had PDR. The longer the disease duration, the higher the number of patients with DR. CONCLUSION The prevalence of DR in our cohort was 34.8% after 15 years of systemic disease and 54.1% after 20 years, which is lower than what has been reported in the literature. Further multicentric prospective studies, are needed to clarify changes in the epidemiology of DR in type 1 diabetics.
Collapse
Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Miguel Lopes
- Faculty of Medicine, University of Porto, Portugal
| | - Rita Laiginhas
- Department of Ophthalmology, Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - João Neves
- Faculty of Medicine, University of Porto, Portugal; Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de São João Porto, Portugal
| | - Vitor Rosas
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Margarida Barbosa
- Department of Anesthesiology, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Davide Carvalho
- Faculty of Medicine, University of Porto, Portugal; Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de São João Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Portugal.
| |
Collapse
|
7
|
Li JQ, Welchowski T, Schmid M, Letow J, Wolpers C, Pascual-Camps I, Holz FG, Finger RP. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis. Eur J Epidemiol 2019; 35:11-23. [PMID: 31515657 DOI: 10.1007/s10654-019-00560-z] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022]
Abstract
To examine the prevalence and incidence of diabetic eye disease (DED) among individuals with diabetes in Europe, a systematic review to identify all published European prevalence and incidence studies of DED in individuals with diabetes managed in primary health care was performed according to the MOOSE and PRISMA guidelines. The databases Medline, Embase and Web of Science were searched to 2 September 2017. Meta-analyses and meta-regressions were performed. The pooled prevalence estimates were applied to diabetes prevalence rates provided by the International Diabetes Foundation atlas and Eurostat population data, and extrapolated to the year 2050. Data of 35 prevalence and four incidence studies were meta-analyzed. Any diabetic retinopathy (DR) and diabetic macular edema (DME) were prevalent in 25.7% (95% CI 22.8-28.8%) and 3.7% (95% CI 2.2-6.2%), respectively. In meta-regression, the prevalence of DR in persons with type 1 diabetes was significantly higher compared to persons with type 2 diabetes (54.4% vs. 25.0%). The pooled mean annual incidence of any DR and DME in in persons with type 2 diabetes was 4.6% (95% CI 2.3-8.8%) and 0.4% (95% CI 0.5-1.4%), respectively. We estimated that persons with diabetes affected by any DED in Europe will increase from 6.4 million today to 8.6 million in 2050, of whom 30% require close monitoring and/or treatment. DED is estimated to be present in more than a quarter of persons with type 2 diabetes and half of persons with type 1 diabetes underlining the importance of regular monitoring. Future health services need to be planned accordingly.
Collapse
Affiliation(s)
- Jeany Q Li
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Thomas Welchowski
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Julia Letow
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Caroline Wolpers
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Isabel Pascual-Camps
- Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, 46026, Valencia, Spain
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
| |
Collapse
|
8
|
Jansson RW, Hufthammer KO, Krohn J. Diabetic retinopathy in type 1 diabetes patients in Western Norway. Acta Ophthalmol 2018; 96:465-474. [PMID: 29369506 DOI: 10.1111/aos.13654] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/06/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe the prevalence of diabetic retinopathy (DR), associated risk factors and health-related quality of life (HRQoL) in a population-based cohort of patients with type 1 diabetes mellitus (DM1). METHODS All patients underwent a general and ophthalmic examination including seven-field stereo fundus photography for grading of DR and diabetic macular oedema (DMO). Kaplan-Meier survival analyses were performed to evaluate disease progression in relation to diabetes duration, age and year of diabetes onset. HRQoL and its association with DR were assessed by the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. RESULTS A total of 237 DM1 patients were included. Mean age at inclusion was 34 years (range, 4-75 years), and mean diabetes duration was 19 years (range, 5 months-63 years). A total of 145 patients (61%) had DR. Sixty-two patients (26%) had mild, 39 (16%) moderate and 13 (5%) severe nonproliferative DR, while 31 (13%) had proliferative DR. The prevalence of DMO was 8%. The most important risk factors predicting severity of DR were diabetes duration (p < 0.0001) and HbA1c level (p < 0.0001). Neuropathy (p = 0.006), nephropathy (p = 0.004) and male gender (p = 0.02) were also significant predictors of DR. Compared to normative SF-36 data, there was a linear trend of decreasing HRQoL with increasing severity of DR that was statistically significant for the four physical dimension scores. CONCLUSION The prevalence of DR in DM1 was largely within the range of previous reports. Diabetes duration, HbA1c level, neuropathy, nephropathy and male gender were all significant predictors of DR severity. The patients with more severe DR had lower HRQoL.
Collapse
Affiliation(s)
- Ragnhild W. Jansson
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
| | | | - Jørgen Krohn
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
| |
Collapse
|
9
|
Xiao D, Vignarajan J, Chen T, Ye T, Xiao B, Congdon N, Kanagasingam Y. Content Design and System Implementation of a Teleophthalmology System for Eye Disease Diagnosis and Treatment and Its Preliminary Practice in Guangdong, China. Telemed J E Health 2017; 23:964-975. [DOI: 10.1089/tmj.2016.0266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Di Xiao
- The Australian e-Health Research Center, CSIRO, Floreat, Western Australia, Australia
| | - Janardhan Vignarajan
- The Australian e-Health Research Center, CSIRO, Floreat, Western Australia, Australia
| | - Tingting Chen
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Tiantian Ye
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Baixiang Xiao
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Nathan Congdon
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yogessan Kanagasingam
- The Australian e-Health Research Center, CSIRO, Floreat, Western Australia, Australia
| |
Collapse
|
10
|
Soto-Pedre E, Navea A, Millan S, Hernaez-Ortega MC, Morales J, Desco MC, Pérez P. Evaluation of automated image analysis software for the detection of diabetic retinopathy to reduce the ophthalmologists' workload. Acta Ophthalmol 2015; 93:e52-6. [PMID: 24975456 DOI: 10.1111/aos.12481] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 05/17/2014] [Indexed: 11/30/2022]
Abstract
AIMS To assess the safety and workload reduction of an automated 'disease/no disease' grading system for diabetic retinopathy (DR) within a systematic screening programme. METHODS Single 45° macular field image per eye was obtained from consecutive patients attending a regional primary care based DR screening programme in Valencia (Spain). The sensitivity and specificity of automated system operating as 'one or more than one microaneurysm detection for disease presence' grader were determined relative to a manual grading as gold standard. Data on age, gender and diabetes mellitus were also recorded. RESULTS A total of 5278 patients with diabetes were screened. The median age and duration of diabetes was 69 years and 6.9 years, respectively. Estimated prevalence of DR was 15.6%. The software classified 43.9% of the patients as having no DR and 26.1% as having ungradable images. Detection of DR was achieved with 94.5% sensitivity (95% CI 92.6- 96.5) and 68.8% specificity (95%CI 67.2-70.4). The overall accuracy of the automated system was 72.5% (95%CI 71.1-73.9). CONCLUSIONS The present retinal image processing algorithm that can act as prefilter to flag out images with pathological lesions can be implemented in practice. Our results suggest that it could be considered when implementing DR screening programmes.
Collapse
Affiliation(s)
| | - Amparo Navea
- Fundación Oftalmológica del Mediterráneo (FOM); Valencia Spain
| | - Saray Millan
- Fundación Oftalmológica del Mediterráneo (FOM); Valencia Spain
| | | | - Jesús Morales
- Fundación Oftalmológica del Mediterráneo (FOM); Valencia Spain
| | - Maria C. Desco
- Fundación Oftalmológica del Mediterráneo (FOM); Valencia Spain
| | - Pablo Pérez
- Fundación Oftalmológica del Mediterráneo (FOM); Valencia Spain
| |
Collapse
|
11
|
Self-Declaration of Diabetes and Factors Associated with Having Regular Eye Examinations among Patients with Type 2 Diabetes in Turkey. Eur J Ophthalmol 2015; 25:333-7. [DOI: 10.5301/ejo.5000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 01/18/2023]
Abstract
Purpose To assess the awareness of diabetic retinopathy (DR), decided by self-declaration of diabetes, and the factors associated with having regular eye examinations among patients with type 2 diabetes in Turkey. Methods Between January and June 2014, 3322 adult patients attending an outpatient ophthalmology clinic were screened and 160 patients with type 2 diabetes with a known duration of at least 5 years were included. All patients were asked for their complaints and self-declaration of diabetes was noted. A questionnaire including questions about demographic characteristics, disease process, and follow-up was applied to responders, and all patients underwent a detailed ophthalmologic examination with dilation. Results A total of 31.9% of the patients self-declared that they had diabetes and/or requested examination for DR. A total of 29.4% reported that they had regular eye examinations. In regression analyses, factors associated with having regular eye examination were longer duration of diabetes (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.01-5.8; p = 0.049), insulin use (OR 4.45; 95% CI 1.7-10.7; p = 0.001), and self-declaration of diabetes (OR 8.16; 95% CI 3.5-19.2; p<0.001). Conclusions The rates of self-declaration of diabetes and having regular eye examinations among patients with type 2 diabetes are low in Turkey. All adults undergoing an eye examination should be questioned for diabetes. Education of both patients with diabetes and the health care stuff dealing with them could improve the rates of patients having regular eye examinations and enhance the early detection of DR.
Collapse
|
12
|
Hautala N, Hannula V, Palosaari T, Ebeling T, Falck A. Prevalence of diabetic retinopathy in young adults with type 1 diabetes since childhood: the Oulu cohort study of diabetic retinopathy. Acta Ophthalmol 2014; 92:749-52. [PMID: 24862935 DOI: 10.1111/aos.12426] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 03/21/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the prevalence and stage of diabetic retinopathy (DR) in a population-based cohort of young Finnish adults who have had type 1 diabetes (T1D) since childhood. MATERIAL AND METHODS The cohort includes all 5- to 16-year-old patients with T1D who lived in the Northern Ostrobothnia Hospital District of Finland, in 1989 (n = 216). DR was evaluated from fundus photographs taken in 1989-1990 and again in 2007. The patients were 7 ± 4 years age (range 0-15 years) at the time of diagnosis of T1D, and the average duration of diabetes at the re-evaluation was 23 ± 4 years (range 17-32 years). RESULTS The prevalence of DR was analysed in 172 patients (80% of the original cohort) at 22-35 years. Proliferative DR (PDR) was observed in 35% (60/172) and non-proliferative DR in 59% (101/172), with no signs of DR being present in the remaining 6% (11/172) of the subjects. The prevalence of DR did not differ by gender (p = 0.356). CONCLUSIONS After the 18-year follow-up, a high prevalence of DR and PDR (94% and 35%, respectively) was found in patients who have had T1D since childhood, with no difference between the genders.
Collapse
Affiliation(s)
- Nina Hautala
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu; Oulu Finland
| | - Virva Hannula
- Department of Ophthalmology; Päijät-Häme Central Hospital; Lahti Finland
| | - Tapani Palosaari
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
| | - Tapani Ebeling
- Department of Internal Medicine; Oulu University Hospital; Oulu Finland
| | - Aura Falck
- Department of Ophthalmology; Oulu University Hospital; Oulu Finland
- Medical Research Center; University of Oulu; Oulu Finland
| |
Collapse
|
13
|
Bhargava M, Cheung CYL, Sabanayagam C, Huang L, Lamoureux EL, Wang JJ, Tai ES, Heng CK, Ikram MK, Mitchell P, Wong TY. Prevalence and risk factors for retinopathy in persons without diabetes: the Singapore Indian Eye Study. Acta Ophthalmol 2014; 92:e602-9. [PMID: 24894034 DOI: 10.1111/aos.12446] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/16/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe prevalence and risk factors for retinopathy in an Asian Indian population without diabetes. METHODS A population-based cross-sectional study of 3400 Indians aged 40-80 years residing in Singapore was conducted. Retinopathy was assessed from retinal photographs by trained graders using modified Airlie House Classification System. Risk factors were assessed from standardized interviews, clinical examinations and laboratory investigations. Diabetes mellitus was defined as glycosylated haemoglobin ≥6.5%, use of diabetic medication or physician diagnosis of diabetes. RESULTS Among the 1900 individuals without diabetes, mean HbA1c was 5.7% and mean systolic blood pressure was 132.4 mmHg. Age-standardized prevalence of retinopathy was 5.05% (n = 98; 95% confidence interval [CI], 4.07-6.21), with no significant difference in retinopathy prevalence between males (6.15%) and females (4.13%). Among non-diabetic persons with retinopathy, 96.9% (n = 95) had signs of minimal-to-mild retinopathy while 3.06% (n = 3) had moderate-to-severe retinopathy. After adjusting for multiple covariables, retinopathy signs were associated with higher levels of HbA1c (odds ratio [OR], 2.4; 95% CI, 1.3-4.5; per% increase), systolic blood pressure (OR, 1.02; 95% CI, 1.01-1.03; per mmHg increase) and serum creatinine (OR, 1.005; 95% CI, 1.002-1.009; per mm increase), but not C-reactive protein, cigarette smoking or lipid levels. CONCLUSION One in 20 Asian Indian persons without diabetes had retinopathy signs. Risk factors for these signs include higher glycosylated haemoglobin, systolic blood pressure and serum creatinine.
Collapse
Affiliation(s)
- Mayuri Bhargava
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med 2013; 30:387-98. [PMID: 23331210 DOI: 10.1111/dme.12119] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world. METHODS A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied. RESULTS A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries. CONCLUSION Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.
Collapse
Affiliation(s)
- L M Ruta
- Baker IDI Heart and Diabetes Institute, The University of Melbourne, Melbourne, Vic., Australia
| | | | | | | | | | | |
Collapse
|
15
|
Sundling V, Gulbrandsen P, Straand J. Sensitivity and specificity of Norwegian optometrists' evaluation of diabetic retinopathy in single-field retinal images - a cross-sectional experimental study. BMC Health Serv Res 2013; 13:17. [PMID: 23305337 PMCID: PMC3562149 DOI: 10.1186/1472-6963-13-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 11/17/2012] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In the working age group, diabetic retinopathy is a leading cause of visual impairment. Regular eye examinations and early treatment of retinopathy can prevent visual loss, so screening for diabetic retinopathy is cost-effective. Dilated retinal digital photography with the additional use of ophthalmoscopy is the most effective and robust method of diabetic retinopathy screening. The aim of this study was to estimate the sensitivity and specificity of diabetic retinopathy screening when performed by Norwegian optometrists. METHODS This study employed a cross-sectional experimental design. Seventy-four optometrists working in private optometric practice were asked to screen 14 single-field retinal images for possible diabetic retinopathy. The screening was undertaken using a web-based visual identification and management of ophthalmological conditions (VIMOC) examination. The images used in the VIMOC examination were selected from a population survey and had been previously examined by two independent ophthalmologists. In order to establish a "gold standard", images were only chosen for use in the VIMOC examination if they had elicited diagnostic agreement between the two independent ophthalmologists. To reduce the possibility of falsely high specificity occurring by chance, half the presented images were of retinas that were not affected by diabetic retinopathy. Sensitivity and specificity for diabetic retinopathy was calculated with 95% confidence intervals (CIs). RESULTS The mean (95%CI) sensitivity for identifying eyes with any diabetic retinopathy was 67% (62% to 72%). The mean (95%CI) specificity for identifying eyes without diabetic retinopathy was 84% (80% to 89%). The mean (95%CI) sensitivity for identifying eyes with mild non-proliferative diabetic retinopathy or moderate non-proliferative diabetes was 54% (47% to 61%) and 100%, respectively. Only four optometrists (5%) met the required standard of at least 80% sensitivity and 95% specificity that has been previously set for diabetic retinopathy screening programmes. CONCLUSIONS The evaluation of retinal images for diabetic retinopathy by Norwegian optometrists does not meet the required screening standard of at least 80% sensitivity and 95% specificity. The introduction of measures to improve this situation could have implications for both formal optometric training and continuing optometric professional education.
Collapse
Affiliation(s)
- Vibeke Sundling
- Institute of Optometry and Visual Science, Faculty of Health Sciences, Buskerud University College, Kongsberg, Norway
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- HØKH, Research Centre, Akershus University Hospital, Oslo, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|