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Fan Z, Hu Y, Chen L, Lu X, Zheng L, Ma D, Li Z, Zhong J, Lin L, Zhang S, Zhang G. Multiplatform tear proteomic profiling reveals novel non-invasive biomarkers for diabetic retinopathy. Eye (Lond) 2024; 38:1509-1517. [PMID: 38336992 PMCID: PMC11126564 DOI: 10.1038/s41433-024-02938-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To investigate a comprehensive proteomic profile of the tear fluid in patients with diabetic retinopathy (DR) and further define non-invasive biomarkers. METHODS A cross-sectional, multicentre study that includes 46 patients with DR, 28 patients with diabetes mellitus (DM), and 30 healthy controls (HC). Tear samples were collected with Schirmer strips. As for the discovery set, data-independent acquisition mass spectrometry was used to characterize the tear proteomic profile. Differentially expressed proteins between groups were identified, with gene ontology enrichment analysis and Kyoto Encyclopedia of Genes and Genomes enrichment analysis further developed. Classifying performance of biomarkers for distinguishing DR from DM was compared by the combination of three machine-learning algorithms. The selected biomarker panel was tested in the validation cohort using parallel reaction monitoring mass spectrometry. RESULTS Among 3364 proteins quantified, 235 and 88 differentially expressed proteins were identified for DR when compared to HC and DM, respectively, which were fundamentally related to retina homeostasis, inflammation and immunity, oxidative stress, angiogenesis and coagulation, metabolism, and cellular adhesion processes. The biomarker panel consisting of NAD-dependent protein deacetylase sirtuin-2 (SIR2), amine oxidase [flavin-containing] B (AOFB), and U8 snoRNA-decapping enzyme (NUD16) exhibited the best diagnostic performance in discriminating DR from DM, with AUCs of 0.933 and 0.881 in the discovery and validation set, respectively. CONCLUSIONS Tear protein dysregulation is comprehensively revealed to be associated with DR onset. The combination of tear SIR2, AOFB, and NUD16 can be a novel potential approach for non-invasive detection or pre-screening of DR. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2100054263. https://www.chictr.org.cn/showproj.html?proj=143177 . Date of registration: 2021/12/12.
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Affiliation(s)
- Zixin Fan
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
- International Graduate School at Shenzhen, Tsinghua University, Shenzhen, Guangdong, 518040, China
| | - Yarou Hu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
| | - Laijiao Chen
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
| | - Xiaofeng Lu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
| | - Lei Zheng
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
| | - Dahui Ma
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China
| | - Zhiqiang Li
- Shenmei Eye Hospital, Meizhou, Guangdong, 514000, China
| | - Jingwen Zhong
- Shenmei Eye Hospital, Meizhou, Guangdong, 514000, China
| | - Lin Lin
- Southern University of Science and Technology, Shenzhen, Guangdong, 518040, China
| | - Sifan Zhang
- New York University, New York, NY 10003, USA
| | - Guoming Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, Guangdong, 518040, China.
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2
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Aravindhan A, Fenwick EK, Chan AWD, Man REK, Tan NC, Wong WT, Soo WF, Lim SW, Wee SYM, Sabanayagam C, Finkelstein E, Tan G, Hamzah H, Chakraborty B, Acharyya S, Shyong TE, Scanlon P, Wong TY, Lamoureux EL. Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study. BMC Public Health 2024; 24:786. [PMID: 38481239 PMCID: PMC10935797 DOI: 10.1186/s12889-024-18287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up. METHODS DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated. RESULTS Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline. CONCLUSIONS In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.
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Affiliation(s)
- Amudha Aravindhan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Eva K Fenwick
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Aurora Wing Dan Chan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | | | | | | | | | - Charumathi Sabanayagam
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | | | - Gavin Tan
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Tai E Shyong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Peter Scanlon
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- The University of Melbourne, Melbourne, Australia.
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3
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Qian B, Chen H, Wang X, Guan Z, Li T, Jin Y, Wu Y, Wen Y, Che H, Kwon G, Kim J, Choi S, Shin S, Krause F, Unterdechler M, Hou J, Feng R, Li Y, El Habib Daho M, Yang D, Wu Q, Zhang P, Yang X, Cai Y, Tan GSW, Cheung CY, Jia W, Li H, Tham YC, Wong TY, Sheng B. DRAC 2022: A public benchmark for diabetic retinopathy analysis on ultra-wide optical coherence tomography angiography images. PATTERNS (NEW YORK, N.Y.) 2024; 5:100929. [PMID: 38487802 PMCID: PMC10935505 DOI: 10.1016/j.patter.2024.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024]
Abstract
We described a challenge named "DRAC - Diabetic Retinopathy Analysis Challenge" in conjunction with the 25th International Conference on Medical Image Computing and Computer Assisted Intervention (MICCAI 2022). Within this challenge, we provided the DRAC datset, an ultra-wide optical coherence tomography angiography (UW-OCTA) dataset (1,103 images), addressing three primary clinical tasks: diabetic retinopathy (DR) lesion segmentation, image quality assessment, and DR grading. The scientific community responded positively to the challenge, with 11, 12, and 13 teams submitting different solutions for these three tasks, respectively. This paper presents a concise summary and analysis of the top-performing solutions and results across all challenge tasks. These solutions could provide practical guidance for developing accurate classification and segmentation models for image quality assessment and DR diagnosis using UW-OCTA images, potentially improving the diagnostic capabilities of healthcare professionals. The dataset has been released to support the development of computer-aided diagnostic systems for DR evaluation.
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Affiliation(s)
- Bo Qian
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | - Xiangning Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yixiao Jin
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yilan Wu
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
| | - Yang Wen
- School of Electronic and Information Engineering, Shenzhen University, Shenzhen 518060, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong 999077, China
| | | | | | - Sungjin Choi
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Seoyoung Shin
- AI/DX Convergence Business Group, KT, Seongnam 13606, Korea
| | - Felix Krause
- Johannes Kepler University Linz, Linz 4040, Austria
| | | | - Junlin Hou
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
| | - Rui Feng
- School of Computer Science, Shanghai Key Laboratory of Intelligent Information Processing, Fudan University, Shanghai 200433, China
- Academy for Engineering and Technology, Fudan University, Shanghai 200433, China
| | - Yihao Li
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Mostafa El Habib Daho
- LaTIM UMR 1101, INSERM, 29609 Brest, France
- University of Western Brittany, 29238 Brest, France
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Qiang Wu
- Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Ping Zhang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH 43210, USA
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH 43210, USA
- Translational Data Analytics Institute, The Ohio State University, Columbus, OH 43210, USA
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Yiyu Cai
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing 100084, China
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai 200240, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
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4
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Lam C, Wong YL, Tang Z, Hu X, Nguyen TX, Yang D, Zhang S, Ding J, Szeto SKH, Ran AR, Cheung CY. Performance of Artificial Intelligence in Detecting Diabetic Macular Edema From Fundus Photography and Optical Coherence Tomography Images: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:304-319. [PMID: 38241500 DOI: 10.2337/dc23-0993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/01/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Diabetic macular edema (DME) is the leading cause of vision loss in people with diabetes. Application of artificial intelligence (AI) in interpreting fundus photography (FP) and optical coherence tomography (OCT) images allows prompt detection and intervention. PURPOSE To evaluate the performance of AI in detecting DME from FP or OCT images and identify potential factors affecting model performances. DATA SOURCES We searched seven electronic libraries up to 12 February 2023. STUDY SELECTION We included studies using AI to detect DME from FP or OCT images. DATA EXTRACTION We extracted study characteristics and performance parameters. DATA SYNTHESIS Fifty-three studies were included in the meta-analysis. FP-based algorithms of 25 studies yielded pooled area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity of 0.964, 92.6%, and 91.1%, respectively. OCT-based algorithms of 28 studies yielded pooled AUROC, sensitivity, and specificity of 0.985, 95.9%, and 97.9%, respectively. Potential factors improving model performance included deep learning techniques, larger size, and more diversity in training data sets. Models demonstrated better performance when validated internally than externally, and those trained with multiple data sets showed better results upon external validation. LIMITATIONS Analyses were limited by unstandardized algorithm outcomes and insufficient data in patient demographics, OCT volumetric scans, and external validation. CONCLUSIONS This meta-analysis demonstrates satisfactory performance of AI in detecting DME from FP or OCT images. External validation is warranted for future studies to evaluate model generalizability. Further investigations may estimate optimal sample size, effect of class balance, patient demographics, and additional benefits of OCT volumetric scans.
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Affiliation(s)
- Ching Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yiu Lun Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaoyan Hu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Truong X Nguyen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shuyi Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
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5
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Dai L, Sheng B, Chen T, Wu Q, Liu R, Cai C, Wu L, Yang D, Hamzah H, Liu Y, Wang X, Guan Z, Yu S, Li T, Tang Z, Ran A, Che H, Chen H, Zheng Y, Shu J, Huang S, Wu C, Lin S, Liu D, Li J, Wang Z, Meng Z, Shen J, Hou X, Deng C, Ruan L, Lu F, Chee M, Quek TC, Srinivasan R, Raman R, Sun X, Wang YX, Wu J, Jin H, Dai R, Shen D, Yang X, Guo M, Zhang C, Cheung CY, Tan GSW, Tham YC, Cheng CY, Li H, Wong TY, Jia W. A deep learning system for predicting time to progression of diabetic retinopathy. Nat Med 2024; 30:584-594. [PMID: 38177850 PMCID: PMC10878973 DOI: 10.1038/s41591-023-02702-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/10/2023] [Indexed: 01/06/2024]
Abstract
Diabetic retinopathy (DR) is the leading cause of preventable blindness worldwide. The risk of DR progression is highly variable among different individuals, making it difficult to predict risk and personalize screening intervals. We developed and validated a deep learning system (DeepDR Plus) to predict time to DR progression within 5 years solely from fundus images. First, we used 717,308 fundus images from 179,327 participants with diabetes to pretrain the system. Subsequently, we trained and validated the system with a multiethnic dataset comprising 118,868 images from 29,868 participants with diabetes. For predicting time to DR progression, the system achieved concordance indexes of 0.754-0.846 and integrated Brier scores of 0.153-0.241 for all times up to 5 years. Furthermore, we validated the system in real-world cohorts of participants with diabetes. The integration with clinical workflow could potentially extend the mean screening interval from 12 months to 31.97 months, and the percentage of participants recommended to be screened at 1-5 years was 30.62%, 20.00%, 19.63%, 11.85% and 17.89%, respectively, while delayed detection of progression to vision-threatening DR was 0.18%. Altogether, the DeepDR Plus system could predict individualized risk and time to DR progression over 5 years, potentially allowing personalized screening intervals.
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Grants
- the National Key Research and Development Program of China (2022YFA1004804), the Shanghai Municipal Key Clinical Specialty, Shanghai Research Center for Endocrine and Metabolic Diseases (2022ZZ01002), and the Chinese Academy of Engineering (2022-XY-08)
- the General Program of NSFC (62272298), the National Key Research and Development Program of China (2022YFC2407000), the Interdisciplinary Program of Shanghai Jiao Tong University (YG2023LC11 and YG2022ZD007), National Natural Science Foundation of China (62272298 and 62077037), the College-level Project Fund of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital (ynlc201909), and the Medical-industrial Cross-fund of Shanghai Jiao Tong University (YG2022QN089)
- the Clinical Special Program of Shanghai Municipal Health Commission (20224044) and Three-year action plan to strengthen the construction of public health system in Shanghai (GWVI-11.1-28)
- the National Natural Science Foundation of China (82100879)
- the National Key Research and Development Program of China (2022YFA1004804), Excellent Young Scientists Fund of NSFC (82022012), General Fund of NSFC (81870598), Innovative research team of high-level local universities in Shanghai (SHSMU-ZDCX20212700)
- the National Key R & D Program of China (2022YFC2502800) and National Natural Science Fund of China (8238810007)
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Affiliation(s)
- Ling Dai
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Sheng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Tingli Chen
- Department of Ophthalmology, Huadong Sanatorium, Wuxi, China
| | - Qiang Wu
- Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruhan Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chun Cai
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Liang Wu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Yuexing Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Xiangning Wang
- Department of Ophthalmology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhouyu Guan
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Shujie Yu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Tingyao Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Anran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Haoxuan Che
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
- Department of Chemical and Biological Engineering, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Jia Shu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Huang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chan Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shiqun Lin
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dan Liu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Jiajia Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zheyuan Wang
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ziyao Meng
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Shen
- Medical Records and Statistics Office, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuhong Hou
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Chenxin Deng
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Ruan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Lu
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Miaoli Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ten Cheer Quek
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ramyaa Srinivasan
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Jiarui Wu
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
- Center for Excellence in Molecular Science, Chinese Academy of Sciences, Shanghai, China
| | - Hai Jin
- National Engineering Research Center for Big Data Technology and System, Services Computing Technology and System Lab, Cluster and Grid Computing Lab, School of Computer Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Rongping Dai
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Dinggang Shen
- School of Biomedical Engineering, Shanghai Tech University, Shanghai, China
- Shanghai United Imaging Intelligence, Shanghai, China
- Shanghai Clinical Research and Trial Center, Shanghai, China
| | - Xiaokang Yang
- MOE Key Laboratory of AI, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Minyi Guo
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Huating Li
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Weiping Jia
- Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University, Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai, China.
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Sadikin IS, Lestari YD, Victor AA. The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: a scoping review. BMC Public Health 2024; 24:177. [PMID: 38225623 PMCID: PMC10789068 DOI: 10.1186/s12889-024-17652-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION Diabetes is a serious public health problem, with low- and middle-income countries (LMICs) bearing over 80% of the burden. Diabetic retinopathy (DR) is one of the most prevalent diabetic microvascular problems, and early diagnosis through eye screening programs for people with diabetes is critical to prevent vision impairment and blindness. Community-based treatments, including non-physician cadres have been recommended to enhance DR care. METHODS The review protocol was determined and scoping review was conducted.The population, concept, and context were "cadre", "role of cadre in the management of DR", and LMICs". Data were collected from databases and searches, including grey literature. RESULTS Cadre can motivate people to attend a diabetic eye screening event when the rate of eye examinations is about six times higher than before the start of the intervention. Health education is a possible area for task sharing, and the cadre reported could also perform the task of vision testing. The cadre could be a good supporter and a good reminder for society. However, several challenges have been faced in this study and inadequate infrastructure is the foremost challenge found in this study. Other challenges encountered in the studies include poverty, lack of community awareness, trust issues, and low education levels contributing to poor health. CONCLUSION The current study highlighted significant gaps in the literature, which focus on the role of cadre as a community-based intervention in managing DR in LMICs. Further research is needed to develop evidence to support cost-effective screening services and cadre-related policy development in LMICs.
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Affiliation(s)
- Irma Suwandi Sadikin
- Residency Program in Ophthalmology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Yeni Dwi Lestari
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Andi Arus Victor
- Ophthalmology Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Szeto SK, Lai TY, Vujosevic S, Sun JK, Sadda SR, Tan G, Sivaprasad S, Wong TY, Cheung CY. Optical coherence tomography in the management of diabetic macular oedema. Prog Retin Eye Res 2024; 98:101220. [PMID: 37944588 DOI: 10.1016/j.preteyeres.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Diabetic macular oedema (DMO) is the major cause of visual impairment in people with diabetes. Optical coherence tomography (OCT) is now the most widely used modality to assess presence and severity of DMO. DMO is currently broadly classified based on the involvement to the central 1 mm of the macula into non-centre or centre involved DMO (CI-DMO) and DMO can occur with or without visual acuity (VA) loss. This classification forms the basis of management strategies of DMO. Despite years of research on quantitative and qualitative DMO related features assessed by OCT, these do not fully inform physicians of the prognosis and severity of DMO relative to visual function. Having said that, recent research on novel OCT biomarkers development and re-defined classification of DMO show better correlation with visual function and treatment response. This review summarises the current evidence of the association of OCT biomarkers in DMO management and its potential clinical importance in predicting VA and anatomical treatment response. The review also discusses some future directions in this field, such as the use of artificial intelligence to quantify and monitor OCT biomarkers and retinal fluid and identify phenotypes of DMO, and the need for standardisation and classification of OCT biomarkers to use in future clinical trials and clinical practice settings as prognostic markers and secondary treatment outcome measures in the management of DMO.
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Affiliation(s)
- Simon Kh Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Timothy Yy Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Stela Vujosevic
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Eye Clinic, IRCCS MultiMedica, Milan, Italy
| | - Jennifer K Sun
- Beetham Eye Institute, Harvard Medical School, Boston, USA
| | - SriniVas R Sadda
- Doheny Eye Institute, University of California Los Angeles, Los Angeles, USA
| | - Gavin Tan
- Singapore Eye Research Institute, SingHealth Duke-National University of Singapore, Singapore
| | - Sobha Sivaprasad
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Tien Y Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
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8
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Drinkwater JJ, Kalantary A, Turner AW. A systematic review of diabetic retinopathy screening intervals. Acta Ophthalmol 2023. [PMID: 37915115 DOI: 10.1111/aos.15788] [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: 04/27/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
The current evidence on whether annual diabetic retinopathy (DR) screening intervals can be extended was reviewed. A systematic review protocol was followed (PROSPERO ID: CRD42022359590). Original longitudinal articles that specifically assessed DR screening intervals were in English and collected data after 2000 were included. Two reviewers independently conducted the search and reviewed the articles for quality and relevant information. The heterogeneity of the data meant that a meta-analysis was not appropriate. Twelve publications were included. Studies were of good quality and many used data from DR screening programs. Studies fit into three categories; those that assessed specific DR screening intervals, those that determined optimal DR screening intervals and those that developed/assessed DR screening risk equations. For those with type 2 diabetes, extending screening intervals to 3- to 4-yearly in those with no baseline DR appeared safe. DR risk equations considered clinical factors and allocated those at lower risk of DR progression screening intervals of up to five years. Those with baseline DR or type 1 diabetes appeared to have a higher risk of progression to STDR and needed more frequent screening. DR screening intervals can be extended to 3-5 yearly in certain circumstances. These include patients with type 2 diabetes and no current DR, and those who have optimal management of other risk factors such as glucose and blood pressure.
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Affiliation(s)
- Jocelyn J Drinkwater
- Center for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Amy Kalantary
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Angus W Turner
- Center for Ophthalmology and Visual Science, The University of Western Australia, Nedlands, Western Australia, Australia
- Lions Outback Vision, Lions Eye Institute, Nedlands, Western Australia, Australia
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Guldiken YC, Malik A, Petropoulos IN, Gad H, Elgassim E, Salivon I, Ponirakis G, Alam U, Malik RA. Where Art Thou O treatment for diabetic neuropathy: the sequel. Expert Rev Neurother 2023; 23:845-851. [PMID: 37602687 DOI: 10.1080/14737175.2023.2247163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Having lived through a pandemic and witnessed how regulatory approval processes can evolve rapidly; it is lamentable how we continue to rely on symptoms/signs and nerve conduction as primary endpoints for clinical trials in DPN. AREAS COVERED Small (Aδ and C) fibers are key to the genesis of pain, regulate skin blood flow, and play an integral role in the development of diabetic foot ulceration but continue to be ignored. This article challenges the rationale for the FDA insisting on symptoms/signs and nerve conduction as primary endpoints for clinical trials in DPN. EXPERT OPINION Quantitative sensory testing, intraepidermal nerve fiber density, and especially corneal confocal microscopy remain an after-thought, demoted at best to exploratory secondary endpoints in clinical trials of diabetic neuropathy. If pharma are to be given a fighting chance to secure approval for a new therapy for diabetic neuropathy, the FDA needs to reassess the evidence rather than rely on 'opinion' for the most suitable endpoint(s) in clinical trials of diabetic neuropathy.
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Affiliation(s)
- Yigit Can Guldiken
- Department of Neurology, Kocaeli University Research and Application Hospital, İzmit/Kocaeli, Turkey
| | - Ayesha Malik
- Barts and The London School of Medicine and Dentistry - Medicine, London, UK
| | | | - Hoda Gad
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Einas Elgassim
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | - Iuliia Salivon
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
| | | | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar
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Thinggaard BS, Stokholm L, Davidsen JR, Larsen MC, Möller S, Thykjær AS, Andresen JL, Andersen N, Heegaard S, Højlund K, Kawasaki R, Laugesen C, Bek T, Grauslund J. Diabetic retinopathy is a predictor of chronic respiratory failure: A nationwide register-based cohort study. Heliyon 2023; 9:e17342. [PMID: 37426795 PMCID: PMC10329134 DOI: 10.1016/j.heliyon.2023.e17342] [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: 10/27/2022] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose Diabetic retinopathy (DR) is a hypoxic retinal disease, but so far, the association with systemic hypoxia is poorly understood. Hence, the aim of this study was to evaluate cross-sectional and longitudinal associations between DR and chronic respiratory failure (CRF) in a national cohort. Design Cross-sectional and 5-year longitudinal register-based cohort study. Methods Between 2013 and 2018, we included patients with diabetes from the Danish Registry of Diabetic Retinopathy, who were each age and sex matched with five controls without diabetes. At index date, the prevalence of CRF was compared between cases and controls, and the longitudinal relationship between DR and CRF was assessed in a five-year follow-up. Results At baseline, we identified 1,980 and 9,990 patients with CRF among 205,970 cases and 1,003,170 controls. The prevalence of CRF was higher among cases than controls (OR 1.75, 95% CI 1.65-1.86), but no difference between cases with and without DR was found.During follow-up, we identified 1,726 and 5,177 events of CRF among cases and controls, respectively. The incidence of CRF was higher among both cases with and without DR compared to controls (DR level 0: HR 1.24, 95% CI 1.16-1.33, DR level 1-4: HR 1.86, 95% CI 1.63-2.12), and higher among cases with DR compared to cases without DR (HR 1.54, 95% CI 1.38-1.72). Conclusion In this study based on nationwide data, we found an increased risk of present and incident CRF in patients with diabetes with or without DR, and we identified DR as a predictor of future CRF.
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Affiliation(s)
- Benjamin Sommer Thinggaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Lonny Stokholm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Jesper Rømhild Davidsen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- South Danish Center for Interstitial Lung Diseases (SCILS), Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Anne Suhr Thykjær
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | | | - Nis Andersen
- Organization of Danish Practicing Ophthalmologists, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Højlund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN – Open Patient Data Explorative Network, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Ryo Kawasaki
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Vision Informatics, University of Osaka, Osaka, Japan
| | - Caroline Laugesen
- Department of Ophthalmology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Toke Bek
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
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11
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Kropp M, Golubnitschaja O, Mazurakova A, Koklesova L, Sargheini N, Vo TTKS, de Clerck E, Polivka J, Potuznik P, Polivka J, Stetkarova I, Kubatka P, Thumann G. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications-risks and mitigation. EPMA J 2023; 14:21-42. [PMID: 36866156 PMCID: PMC9971534 DOI: 10.1007/s13167-023-00314-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
Proliferative diabetic retinopathy (PDR) the sequel of diabetic retinopathy (DR), a frequent complication of diabetes mellitus (DM), is the leading cause of blindness in the working-age population. The current screening process for the DR risk is not sufficiently effective such that often the disease is undetected until irreversible damage occurs. Diabetes-associated small vessel disease and neuroretinal changes create a vicious cycle resulting in the conversion of DR into PDR with characteristic ocular attributes including excessive mitochondrial and retinal cell damage, chronic inflammation, neovascularisation, and reduced visual field. PDR is considered an independent predictor of other severe diabetic complications such as ischemic stroke. A "domino effect" is highly characteristic for the cascading DM complications in which DR is an early indicator of impaired molecular and visual signaling. Mitochondrial health control is clinically relevant in DR management, and multi-omic tear fluid analysis can be instrumental for DR prognosis and PDR prediction. Altered metabolic pathways and bioenergetics, microvascular deficits and small vessel disease, chronic inflammation, and excessive tissue remodelling are in focus of this article as evidence-based targets for a predictive approach to develop diagnosis and treatment algorithms tailored to the individual for a cost-effective early prevention by implementing the paradigm shift from reactive medicine to predictive, preventive, and personalized medicine (PPPM) in primary and secondary DR care management.
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Affiliation(s)
- Martina Kropp
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Alena Mazurakova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Lenka Koklesova
- Clinic of Obstetrics and Gynecology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Nafiseh Sargheini
- Max Planck Institute for Plant Breeding Research, Carl-Von-Linne-Weg 10, 50829 Cologne, Germany
| | - Trong-Tin Kevin Steve Vo
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Eline de Clerck
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Jiri Polivka
- Department of Histology and Embryology, and Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Pavel Potuznik
- Department of Neurology, University Hospital Plzen, and Faculty of Medicine in Plzen, Charles University, 100 34 Prague, Czech Republic
| | - Jiri Polivka
- Department of Neurology, University Hospital Plzen, and Faculty of Medicine in Plzen, Charles University, 100 34 Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Kubatka
- Department of Medical Biology, Jessenius Faculty of Medicine, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Gabriele Thumann
- Division of Experimental Ophthalmology, Department of Clinical Neurosciences, University of Geneva University Hospitals, 1205 Geneva, Switzerland ,Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
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12
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Khalili Pour E, Rezaee K, Azimi H, Mirshahvalad SM, Jafari B, Fadakar K, Faghihi H, Mirshahi A, Ghassemi F, Ebrahimiadib N, Mirghorbani M, Bazvand F, Riazi-Esfahani H, Riazi Esfahani M. Automated machine learning-based classification of proliferative and non-proliferative diabetic retinopathy using optical coherence tomography angiography vascular density maps. Graefes Arch Clin Exp Ophthalmol 2023; 261:391-399. [PMID: 36050474 DOI: 10.1007/s00417-022-05818-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/07/2022] [Accepted: 08/23/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE The study aims to classify the eyes with proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) based on the optical coherence tomography angiography (OCTA) vascular density maps using a supervised machine learning algorithm. METHODS OCTA vascular density maps (at superficial capillary plexus (SCP), deep capillary plexus (DCP), and total retina (R) levels) of 148 eyes from 78 patients with diabetic retinopathy (45 PDR and 103 NPDR) was used to classify the images to NPDR and PDR groups based on a supervised machine learning algorithm known as the support vector machine (SVM) classifier optimized by a genetic evolutionary algorithm. RESULTS The implemented algorithm in three different models reached up to 85% accuracy in classifying PDR and NPDR in all three levels of vascular density maps. The deep retinal layer vascular density map demonstrated the best performance with a 90% accuracy in discriminating between PDR and NPDR. CONCLUSIONS The current study on a limited number of patients with diabetic retinopathy demonstrated that a supervised machine learning-based method known as SVM can be used to differentiate PDR and NPDR patients using OCTA vascular density maps.
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Affiliation(s)
- Elias Khalili Pour
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Khosro Rezaee
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Hossein Azimi
- Faculty of Mathematical Sciences and Computer, Kharazmi University, Tehran, Iran
| | - Seyed Mohammad Mirshahvalad
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Behzad Jafari
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Kaveh Fadakar
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Hooshang Faghihi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Ahmad Mirshahi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Fariba Ghassemi
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Masoud Mirghorbani
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Fatemeh Bazvand
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Retina Service, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, South Karegar Street, Tehran, Iran.
| | - Mohammad Riazi Esfahani
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA
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Sun XJ, Zhang GH, Guo CM, Zhou ZY, Niu YL, Wang L, Dou GR. Associations between psycho-behavioral risk factors and diabetic retinopathy: NHANES (2005-2018). Front Public Health 2022; 10:966714. [PMID: 36187629 PMCID: PMC9521717 DOI: 10.3389/fpubh.2022.966714] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Diabetes mellitus (DM) and diabetic retinopathy (DR) increase the global burden. Since their pathogenesis is complex, it is necessary to use the biopsychosocial model to discover the most effective strategies. The study is aimed to investigate the psycho-behavioral factors of DR and confirm the discrepancies from previous studies. Research design and methods The study comprised seven cycles of cross-sectional data of the National Health and Nutrition Examination Survey (NHANES) from 2005-2006 to 2017-2018. Samples of DM were selected from this complex multi-stage probability sample and divided into the non-DR and DR groups, where 4,426 samples represented 18,990,825 individuals after weighting. This study comprehensively explored the biological, social, and psychological risk factors of DR, among which the biological factors included blood pressure, blood routine, HbA1c%, blood glucose, the duration of DM, family history, comorbidities, and treatment methods. Social aspects include gender, education, income, insurance, smoking, drinking, sleep habits, and recreational activities. The Patient Health Questionnaire-9 (PHQ-9) was used to assess the psychological state. Taylor series regression was used to examine the connection between factors and DR. Results Men accounted for 55.5% of the DR group (P = 0.0174). Lymphocyte count, insulin treatment, heart failure, stroke, liver condition, and renal failure showed significant differences in DR (P < 0.05). The incidence of depression in DR was 40.5%. Mild to moderate depression [odds ratio was associated with DR [(OR) = 1.37, 95% confidence interval (CI): 1.06-1.79], but there was no statistical difference in severe depression (OR = 1.34, 95% CI: 0.83-2.17). Although ≤ 6 h of sleep was associated with DR (OR = 1.38, 95% CI: 1.01-1.88), we found no statistical differences in alcohol consumption, recreational activities, or sedentary time between the two groups in our current study (P > 0.05). Conclusions The biological risk factors of DR are significant. It showed that stroke is associated with DR, and retinal exams have the potential value as a screening tool for the brain. Besides, psycho-behavioral risk factors of DR should also be paid attention. Our study highlights that mild and moderate depression and ≤6 h of sleep are distinguishably associated with DM complicated with DR. It indicates that psycho-behavioral risk factors confer a vital influence on diabetic health care and DR.
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Affiliation(s)
- Xiao-Jia Sun
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Guo-Heng Zhang
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chang-Mei Guo
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zi-Yi Zhou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ya-Li Niu
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ling Wang
- Department of Health Statistics, Faculty of Preventive Medicine, Fourth Military Medical University, Xi'an, China,Ling Wang
| | - Guo-Rui Dou
- Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an, China,*Correspondence: Guo-Rui Dou
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14
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Grauslund J. Diabetic retinopathy screening in the emerging era of artificial intelligence. Diabetologia 2022; 65:1415-1423. [PMID: 35639120 DOI: 10.1007/s00125-022-05727-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/05/2022] [Indexed: 12/29/2022]
Abstract
Diabetic retinopathy is a frequent complication in diabetes and a leading cause of visual impairment. Regular eye screening is imperative to detect sight-threatening stages of diabetic retinopathy such as proliferative diabetic retinopathy and diabetic macular oedema in order to treat these before irreversible visual loss occurs. Screening is cost-effective and has been implemented in various countries in Europe and elsewhere. Along with optimised diabetes care, this has substantially reduced the risk of visual loss. Nevertheless, the growing number of patients with diabetes poses an increasing burden on healthcare systems and automated solutions are needed to alleviate the task of screening and improve diagnostic accuracy. Deep learning by convolutional neural networks is an optimised branch of artificial intelligence that is particularly well suited to automated image analysis. Pivotal studies have demonstrated high sensitivity and specificity for classifying advanced stages of diabetic retinopathy and identifying diabetic macular oedema in optical coherence tomography scans. Based on this, different algorithms have obtained regulatory approval for clinical use and have recently been implemented to some extent in a few countries. Handheld mobile devices are another promising option for self-monitoring, but so far they have not demonstrated comparable image quality to that of fundus photography using non-portable retinal cameras, which is the gold standard for diabetic retinopathy screening. Such technology has the potential to be integrated in telemedicine-based screening programmes, enabling self-captured retinal images to be transferred virtually to reading centres for analysis and planning of further steps. While emerging technologies have shown a lot of promise, clinical implementation has been sparse. Legal obstacles and difficulties in software integration may partly explain this, but it may also indicate that existing algorithms may not necessarily integrate well with national screening initiatives, which often differ substantially between countries.
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Affiliation(s)
- Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
- Vestfold Hospital Trust, Tønsberg, Norway.
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15
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OHGCNet: Optimal feature selection-based hybrid graph convolutional network model for joint DR-DME classification. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Zhang G, Lin JW, Wang J, Ji J, Cen LP, Chen W, Xie P, Zheng Y, Xiong Y, Wu H, Li D, Ng TK, Pang CP, Zhang M. Automated multidimensional deep learning platform for referable diabetic retinopathy detection: a multicentre, retrospective study. BMJ Open 2022; 12:e060155. [PMID: 35902186 PMCID: PMC9341185 DOI: 10.1136/bmjopen-2021-060155] [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: 12/28/2021] [Accepted: 06/20/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To develop and validate a real-world screening, guideline-based deep learning (DL) system for referable diabetic retinopathy (DR) detection. DESIGN This is a multicentre platform development study based on retrospective, cross-sectional data sets. Images were labelled by two-level certificated graders as the ground truth. According to the UK DR screening guideline, a DL model based on colour retinal images with five-dimensional classifiers, namely image quality, retinopathy, maculopathy gradability, maculopathy and photocoagulation, was developed. Referable decisions were generated by integrating the output of all classifiers and reported at the image, eye and patient level. The performance of the DL was compared with DR experts. SETTING DR screening programmes from three hospitals and the Lifeline Express Diabetic Retinopathy Screening Program in China. PARTICIPANTS 83 465 images of 39 836 eyes from 21 716 patients were annotated, of which 53 211 images were used as the development set and 30 254 images were used as the external validation set, split based on centre and period. MAIN OUTCOMES Accuracy, F1 score, sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), Cohen's unweighted κ and Gwet's AC1 were calculated to evaluate the performance of the DL algorithm. RESULTS In the external validation set, the five classifiers achieved an accuracy of 0.915-0.980, F1 score of 0.682-0.966, sensitivity of 0.917-0.978, specificity of 0.907-0.981, AUROC of 0.9639-0.9944 and AUPRC of 0.7504-0.9949. Referable DR at three levels was detected with an accuracy of 0.918-0.967, F1 score of 0.822-0.918, sensitivity of 0.970-0.971, specificity of 0.905-0.967, AUROC of 0.9848-0.9931 and AUPRC of 0.9527-0.9760. With reference to the ground truth, the DL system showed comparable performance (Cohen's κ: 0.86-0.93; Gwet's AC1: 0.89-0.94) with three DR experts (Cohen's κ: 0.89-0.96; Gwet's AC1: 0.91-0.97) in detecting referable lesions. CONCLUSIONS The automatic DL system for detection of referable DR based on the UK guideline could achieve high accuracy in multidimensional classifications. It is suitable for large-scale, real-world DR screening.
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Affiliation(s)
- Guihua Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Jian-Wei Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Ji Wang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Jie Ji
- The big data center, Shantou University Medical College, Shantou, China
| | - Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Peiwen Xie
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Yi Zheng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Yongqun Xiong
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Hanfu Wu
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Dongjie Li
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
| | - Chi Pui Pang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
- Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China
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17
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International collaboration for the development of clinical guidelines in low and middle-income countries: case study on the development of a national framework and clinical guidelines for diabetic retinopathy in Ghana. Eye (Lond) 2022; 36:12-16. [PMID: 35590050 PMCID: PMC9159026 DOI: 10.1038/s41433-022-02002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Diabetic retinopathy is a leading cause of blindness in many countries across the world. Ghana has seen a rise in diabetic retinopathy and is working on various strategies to prevent blindness. Clinical guidelines are seen as a promising strategy for improving quality and reducing cost of care. Little is known about the processes of collaborative guideline development in the African context. Methods This case study discusses the process of developing clinical guidelines for diabetic retinopathy in Ghana via a collaboration with the Kenya team that had previously developed guidelines for Kenya. Results The main lesson learnt was the ability to overcome challenges. The main output achieved was the draft national framework, guidelines and training slides on the guidelines. Conclusion Horizontal international collaboration can aid development of clinical guidelines.
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18
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Ruamviboonsuk P, Tiwari R, Sayres R, Nganthavee V, Hemarat K, Kongprayoon A, Raman R, Levinstein B, Liu Y, Schaekermann M, Lee R, Virmani S, Widner K, Chambers J, Hersch F, Peng L, Webster DR. Real-time diabetic retinopathy screening by deep learning in a multisite national screening programme: a prospective interventional cohort study. THE LANCET DIGITAL HEALTH 2022; 4:e235-e244. [DOI: 10.1016/s2589-7500(22)00017-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/17/2021] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
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19
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Choo PP, Md Din N, Azmi N, Bastion MLC. Review of the management of sight-threatening diabetic retinopathy during pregnancy. World J Diabetes 2021; 12:1386-1400. [PMID: 34630896 PMCID: PMC8472492 DOI: 10.4239/wjd.v12.i9.1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/25/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is a noncommunicable disease reaching epidemic proportions around the world. It affects younger individuals, including women of childbearing age. Diabetes can cause diabetic retinopathy (DR), which is potentially sight threatening when severe nonproliferative DR (NPDR), proliferative DR (PDR), or sight-threatening diabetic macular oedema (STDME) develops. Pregnancy is an independent risk factor for the progression of DR. Baseline DR at the onset of pregnancy is an important indicator of progression, with up to 10% of women with baseline NPDR progressing to PDR. Progression to sight-threatening DR (STDR) during pregnancy causes distress to the patient and often necessitates ocular treatment, which may have a systemic effect. Management includes prepregnancy counselling and, when possible, conventional treatment prior to pregnancy. During pregnancy, closer follow-up is required for those with a long duration of DM, poor baseline control of blood sugar and blood pressure, and worse DR, as these are risk factors for progression to STDR. Conventional treatment with anti-vascular endothelial growth factor agents for STDME can potentially lead to foetal loss. Treatment with laser photocoagulation may be preferred, and surgery under general anaesthesia should be avoided. This review provides a management plan for STDR from the perspective of practising ophthalmologists. A review of strategies for maintaining the eyesight of diabetic women with STDR with emphasis on prepregnancy counselling and planning, monitoring and safe treatment during pregnancy, and management of complications is presented.
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Affiliation(s)
- Priscilla Peixi Choo
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| | - Norshamsiah Md Din
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| | - Nooraniah Azmi
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
- Department of Ophthalmology, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
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20
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Tang F, Wang X, Ran AR, Chan CKM, Ho M, Yip W, Young AL, Lok J, Szeto S, Chan J, Yip F, Wong R, Tang Z, Yang D, Ng DS, Chen LJ, Brelén M, Chu V, Li K, Lai THT, Tan GS, Ting DSW, Huang H, Chen H, Ma JH, Tang S, Leng T, Kakavand S, Mannil SS, Chang RT, Liew G, Gopinath B, Lai TYY, Pang CP, Scanlon PH, Wong TY, Tham CC, Chen H, Heng PA, Cheung CY. A Multitask Deep-Learning System to Classify Diabetic Macular Edema for Different Optical Coherence Tomography Devices: A Multicenter Analysis. Diabetes Care 2021; 44:2078-2088. [PMID: 34315698 PMCID: PMC8740924 DOI: 10.2337/dc20-3064] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/29/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic macular edema (DME) is the primary cause of vision loss among individuals with diabetes mellitus (DM). We developed, validated, and tested a deep learning (DL) system for classifying DME using images from three common commercially available optical coherence tomography (OCT) devices. RESEARCH DESIGN AND METHODS We trained and validated two versions of a multitask convolution neural network (CNN) to classify DME (center-involved DME [CI-DME], non-CI-DME, or absence of DME) using three-dimensional (3D) volume scans and 2D B-scans, respectively. For both 3D and 2D CNNs, we used the residual network (ResNet) as the backbone. For the 3D CNN, we used a 3D version of ResNet-34 with the last fully connected layer removed as the feature extraction module. A total of 73,746 OCT images were used for training and primary validation. External testing was performed using 26,981 images across seven independent data sets from Singapore, Hong Kong, the U.S., China, and Australia. RESULTS In classifying the presence or absence of DME, the DL system achieved area under the receiver operating characteristic curves (AUROCs) of 0.937 (95% CI 0.920-0.954), 0.958 (0.930-0.977), and 0.965 (0.948-0.977) for the primary data set obtained from CIRRUS, SPECTRALIS, and Triton OCTs, respectively, in addition to AUROCs >0.906 for the external data sets. For further classification of the CI-DME and non-CI-DME subgroups, the AUROCs were 0.968 (0.940-0.995), 0.951 (0.898-0.982), and 0.975 (0.947-0.991) for the primary data set and >0.894 for the external data sets. CONCLUSIONS We demonstrated excellent performance with a DL system for the automated classification of DME, highlighting its potential as a promising second-line screening tool for patients with DM, which may potentially create a more effective triaging mechanism to eye clinics.
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Affiliation(s)
- Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xi Wang
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR
| | - An-Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | | | - Mary Ho
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Wilson Yip
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR.,Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR
| | - Jerry Lok
- Hong Kong Eye Hospital, Hong Kong SAR
| | | | | | - Fanny Yip
- Hong Kong Eye Hospital, Hong Kong SAR
| | | | - Ziqi Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Hong Kong Eye Hospital, Hong Kong SAR
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR
| | - Marten Brelén
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Victor Chu
- United Christian Hospital, Hong Kong SAR
| | - Kenneth Li
- United Christian Hospital, Hong Kong SAR
| | | | - Gavin S Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Daniel S W Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Haifan Huang
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jacey Hongjie Ma
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Shibo Tang
- Aier School of Ophthalmology, Central South University, Changsha, Hunan, China
| | - Theodore Leng
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Schahrouz Kakavand
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Suria S Mannil
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Robert T Chang
- Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, CA
| | - Gerald Liew
- Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Bamini Gopinath
- Department of Ophthalmology, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia.,Macquarie University Hearing, Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
| | - Peter H Scanlon
- Gloucestershire Retinal Research Group, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, U.K
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR.,Hong Kong Eye Hospital, Hong Kong SAR.,Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Sciences and Technology, Hong Kong SAR
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong SAR
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR
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21
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Horie S, Kukimoto N, Kamoi K, Igarashi-Yokoi T, Yoshida T, Ohno-Matsui K. Blue Widefield Images of Scanning Laser Ophthalmoscope Can Detect Retinal Ischemic Areas in Eyes With Diabetic Retinopathy. Asia Pac J Ophthalmol (Phila) 2021; 10:478-485. [PMID: 34456233 DOI: 10.1097/apo.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine whether the hyporeflective areas in the blue images obtained by widefield scanning laser ophthalmoscopy (SLO) correspond to the non-perfused areas (NPAs) in the fluorescein angiograms (FA) in eyes with diabetic retinopathy (DR). DESIGN Retrospective observational case series. METHODS Ninety patients with diabetes mellitus (DM) were studied. All had undergone multicolor widefield SLO imaging. The NPAs in the FA images and hyporeflective areas in the blue widefield SLO images were examined. The morphology of the retina was determined by optical coherence tomography. RESULTS Hyporeflective areas in the blue SLO images were found with a rate of 76.6% in eyes with proliferative DR eyes. In a comparison of the hyporeflective areas of the blue SLO images to the non-perfused areas in the FA images, the appearance and the correspondence in the locations of these two types of images were found, and the rate was highly concordant with a Cohen's kappa value of 0.675. CONCLUSIONS The high concordance between the hyporeflective areas in the widefield blue SLO and the NPAs in the FA indicates that widefield blue SLO can be used to identify ischemic retinal areas in eyes with DR without the intravenous injection of any dye.
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Affiliation(s)
- Shintaro Horie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuyuki Kukimoto
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Advanced Ophthalmic Imaging, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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22
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Cen LP, Ji J, Lin JW, Ju ST, Lin HJ, Li TP, Wang Y, Yang JF, Liu YF, Tan S, Tan L, Li D, Wang Y, Zheng D, Xiong Y, Wu H, Jiang J, Wu Z, Huang D, Shi T, Chen B, Yang J, Zhang X, Luo L, Huang C, Zhang G, Huang Y, Ng TK, Chen H, Chen W, Pang CP, Zhang M. Automatic detection of 39 fundus diseases and conditions in retinal photographs using deep neural networks. Nat Commun 2021; 12:4828. [PMID: 34376678 PMCID: PMC8355164 DOI: 10.1038/s41467-021-25138-w] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 07/22/2021] [Indexed: 02/05/2023] Open
Abstract
Retinal fundus diseases can lead to irreversible visual impairment without timely diagnoses and appropriate treatments. Single disease-based deep learning algorithms had been developed for the detection of diabetic retinopathy, age-related macular degeneration, and glaucoma. Here, we developed a deep learning platform (DLP) capable of detecting multiple common referable fundus diseases and conditions (39 classes) by using 249,620 fundus images marked with 275,543 labels from heterogenous sources. Our DLP achieved a frequency-weighted average F1 score of 0.923, sensitivity of 0.978, specificity of 0.996 and area under the receiver operating characteristic curve (AUC) of 0.9984 for multi-label classification in the primary test dataset and reached the average level of retina specialists. External multihospital test, public data test and tele-reading application also showed high efficiency for multiple retinal diseases and conditions detection. These results indicate that our DLP can be applied for retinal fundus disease triage, especially in remote areas around the world.
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Affiliation(s)
- Ling-Ping Cen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jie Ji
- Network & Information Centre, Shantou University, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
- XuanShi Med Tech (Shanghai) Company Limited, Shanghai, China
| | - Jian-Wei Lin
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Si-Tong Ju
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Hong-Jie Lin
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tai-Ping Li
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yun Wang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jian-Feng Yang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yu-Fen Liu
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Shaoying Tan
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Li Tan
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Dongjie Li
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yifan Wang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Dezhi Zheng
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yongqun Xiong
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Hanfu Wu
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jingjing Jiang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Zhenggen Wu
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Dingguo Huang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tingkun Shi
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Binyao Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jianling Yang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Xiaoling Zhang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Li Luo
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Chukai Huang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Guihua Zhang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yuqiang Huang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
- Shantou University Medical College, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Haoyu Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Weiqi Chen
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Chi Pui Pang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mingzhi Zhang
- Joint Shantou International Eye Centre of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China.
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Nazir T, Nawaz M, Rashid J, Mahum R, Masood M, Mehmood A, Ali F, Kim J, Kwon HY, Hussain A. Detection of Diabetic Eye Disease from Retinal Images Using a Deep Learning Based CenterNet Model. SENSORS 2021; 21:s21165283. [PMID: 34450729 PMCID: PMC8398326 DOI: 10.3390/s21165283] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023]
Abstract
Diabetic retinopathy (DR) is an eye disease that alters the blood vessels of a person suffering from diabetes. Diabetic macular edema (DME) occurs when DR affects the macula, which causes fluid accumulation in the macula. Efficient screening systems require experts to manually analyze images to recognize diseases. However, due to the challenging nature of the screening method and lack of trained human resources, devising effective screening-oriented treatment is an expensive task. Automated systems are trying to cope with these challenges; however, these methods do not generalize well to multiple diseases and real-world scenarios. To solve the aforementioned issues, we propose a new method comprising two main steps. The first involves dataset preparation and feature extraction and the other relates to improving a custom deep learning based CenterNet model trained for eye disease classification. Initially, we generate annotations for suspected samples to locate the precise region of interest, while the other part of the proposed solution trains the Center Net model over annotated images. Specifically, we use DenseNet-100 as a feature extraction method on which the one-stage detector, CenterNet, is employed to localize and classify the disease lesions. We evaluated our method over challenging datasets, namely, APTOS-2019 and IDRiD, and attained average accuracy of 97.93% and 98.10%, respectively. We also performed cross-dataset validation with benchmark EYEPACS and Diaretdb1 datasets. Both qualitative and quantitative results demonstrate that our proposed approach outperforms state-of-the-art methods due to more effective localization power of CenterNet, as it can easily recognize small lesions and deal with over-fitted training data. Our proposed framework is proficient in correctly locating and classifying disease lesions. In comparison to existing DR and DME classification approaches, our method can extract representative key points from low-intensity and noisy images and accurately classify them. Hence our approach can play an important role in automated detection and recognition of DR and DME lesions.
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Affiliation(s)
- Tahira Nazir
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Marriam Nawaz
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Junaid Rashid
- Department of Computer Science and Engineering, Kongju National University, Gongju 31080, Chungcheongnam-do, Korea;
- Correspondence: (J.R.); (H.-Y.K.)
| | - Rabbia Mahum
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Momina Masood
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Awais Mehmood
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Farooq Ali
- Department of Computer Science, University of Engineering and Technology Taxila, Taxila 47050, Pakistan; (T.N.); (M.N.); (R.M.); (M.M.); (A.M.); (F.A.)
| | - Jungeun Kim
- Department of Computer Science and Engineering, Kongju National University, Gongju 31080, Chungcheongnam-do, Korea;
| | - Hyuk-Yoon Kwon
- Research Center for Electrical and Information Technology, Department of Industrial Engineering, Seoul National University of Science and Technology, Seoul 01811, Korea
- Correspondence: (J.R.); (H.-Y.K.)
| | - Amir Hussain
- Centre of AI and Data Science, Edinburgh Napier University, Edinburgh EH11 4DY, UK;
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A deep learning system for detecting diabetic retinopathy across the disease spectrum. Nat Commun 2021; 12:3242. [PMID: 34050158 PMCID: PMC8163820 DOI: 10.1038/s41467-021-23458-5] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/29/2021] [Indexed: 12/11/2022] Open
Abstract
Retinal screening contributes to early detection of diabetic retinopathy and timely treatment. To facilitate the screening process, we develop a deep learning system, named DeepDR, that can detect early-to-late stages of diabetic retinopathy. DeepDR is trained for real-time image quality assessment, lesion detection and grading using 466,247 fundus images from 121,342 patients with diabetes. Evaluation is performed on a local dataset with 200,136 fundus images from 52,004 patients and three external datasets with a total of 209,322 images. The area under the receiver operating characteristic curves for detecting microaneurysms, cotton-wool spots, hard exudates and hemorrhages are 0.901, 0.941, 0.954 and 0.967, respectively. The grading of diabetic retinopathy as mild, moderate, severe and proliferative achieves area under the curves of 0.943, 0.955, 0.960 and 0.972, respectively. In external validations, the area under the curves for grading range from 0.916 to 0.970, which further supports the system is efficient for diabetic retinopathy grading.
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Li YH, Sheu WHH, Chou CC, Lin CH, Cheng YS, Wang CY, Wu CL, Lee IT. The Clinical Influence after Implementation of Convolutional Neural Network-Based Software for Diabetic Retinopathy Detection in the Primary Care Setting. Life (Basel) 2021; 11:life11030200. [PMID: 33807545 PMCID: PMC8035657 DOI: 10.3390/life11030200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Deep learning-based software is developed to assist physicians in terms of diagnosis; however, its clinical application is still under investigation. We integrated deep-learning-based software for diabetic retinopathy (DR) grading into the clinical workflow of an endocrinology department where endocrinologists grade for retinal images and evaluated the influence of its implementation. A total of 1432 images from 716 patients and 1400 images from 700 patients were collected before and after implementation, respectively. Using the grading by ophthalmologists as the reference standard, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to detect referable DR (RDR) were 0.91 (0.87-0.96), 0.90 (0.87-0.92), and 0.90 (0.87-0.93) at the image level; and 0.91 (0.81-0.97), 0.84 (0.80-0.87), and 0.87 (0.83-0.91) at the patient level. The monthly RDR rate dropped from 55.1% to 43.0% after implementation. The monthly percentage of finishing grading within the allotted time increased from 66.8% to 77.6%. There was a wide range of agreement values between the software and endocrinologists after implementation (kappa values of 0.17-0.65). In conclusion, we observed the clinical influence of deep-learning-based software on graders without the retinal subspecialty. However, the validation using images from local datasets is recommended before clinical implementation.
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Affiliation(s)
- Yu-Hsuan Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- Department of Computer Science & Information Engineering, National Taiwan University, Taipei 10617, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chien-Chih Chou
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chun-Hsien Lin
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Yuan-Shao Cheng
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chun-Yuan Wang
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-C.C.); (C.-H.L.); (Y.-S.C.); (C.-Y.W.)
| | - Chieh Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
- Department of Automatic Control Engineering, Feng Chia University, Taichung 40703, Taiwan
| | - I.-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (Y.-H.L.); (W.H.-H.S.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- College of Science, Tunghai University, Taichung 40704, Taiwan
- Correspondence:
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Grauslund J, Stokholm L, Thykjær AS, Möller S, Laugesen CS, Andresen J, Bek T, la Cour M, Heegaard S, Højlund K, Kawasaki R, Hajari J, Kyvik KO, Schielke KC, Rubin KH, Rasmussen ML. Inverse Cross-sectional and Longitudinal Relationships between Diabetic Retinopathy and Obstructive Sleep Apnea in Type 2 Diabetes. OPHTHALMOLOGY SCIENCE 2021; 1:100011. [PMID: 36246011 PMCID: PMC9559880 DOI: 10.1016/j.xops.2021.100011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 11/02/2022]
Abstract
Purpose Design Participants Methods Main Outcome Measures Results Conclusions
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Sun Y, Zou H, Li X, Xu S, Liu C. Plasma Metabolomics Reveals Metabolic Profiling For Diabetic Retinopathy and Disease Progression. Front Endocrinol (Lausanne) 2021; 12:757088. [PMID: 34777253 PMCID: PMC8589034 DOI: 10.3389/fendo.2021.757088] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/29/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUNDS Diabetic retinopathy (DR), the main retinal vascular complication of DM, is the leading cause of visual impairment and blindness among working-age people worldwide. The aim of this study was to investigate the difference of plasma metabolic profiles in patients with DR to better understand the mechanism of this disease and disease progression. METHODS We used ultrahigh-performance liquid Q-Exactive mass spectrometry and multivariate statistical analyses to conduct a comprehensive analysis of plasma metabolites in a population with DR and proliferative DR (PDR). A risk score based on the level of the selected metabolite was established and evaluated using the least absolute shrinkage and selection operator regularization logistic regression (LASSO-LR) based machine learning model. RESULTS 22 differentially expressed metabolites which belonged to different metabolic pathway were identified and confirmed to be associated with the occurrence of DR. A risk score based on the level of the selected metabolite pseudouridine was established and evaluated to strongly associated with the occurrence of DR. Four circulating plasma metabolites (pseudouridine, glutamate, leucylleucine and N-acetyltryptophan) were identified to be differentially expressed between patients with PDR and other patients, and a risk score formula based on these plasma metabolites was developed and assessed to be significantly related to PDR. CONCLUSIONS Our work highlights the possible use of the risk score assessment based on the plasma metabolites not only reveal in the early diagnosis of DR and PDR but also assist in enhancing current therapeutic strategies in the clinic.
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Affiliation(s)
- Yu Sun
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Huiling Zou
- Department of Endocrinology and Metabolism, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Xingjia Li
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing, China
| | - Shuhang Xu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu, ; Shuhang Xu,
| | - Chao Liu
- Department of Endocrinology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
- Treatment of Yingbing of State Administration of Traditional Chinese Medicine, Jiangsu Provincial Academy of Traditional Chinese Medicine, Nanjing, China
- *Correspondence: Chao Liu, ; Shuhang Xu,
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Poddar AK, Khan TA, Sweta K, Tiwary MK, Borah RR, Ali R, Sil AK, Sheeladevi S. Prevalence and causes of avoidable blindness and visual impairment, including the prevalence of diabetic retinopathy in Siwan district of Bihar, India: A population-based survey. Indian J Ophthalmol 2020; 68:375-380. [PMID: 31957732 PMCID: PMC7003600 DOI: 10.4103/ijo.ijo_1709_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The aim of this study was to estimate the prevalence and causes of visual impairment (VI) and blindness and diabetic retinopathy (DR) in Siwan district, Bihar. Methods: A population-based cross-sectional study was done from January to March 2016 using the Rapid Assessment of Avoidable Blindness 6 (RAAB 6, incorporating DR module) methodology. All individuals aged ≥50 years were examined in 57 randomly selected clusters within the district. Results: A total of 3476 individuals were enumerated and 3189 (92%) completed examination. The overall prevalence of blindness and severe VI was 2.2% (95% confidence interval (CI): 1.6–2.8) and 3.4% (95% CI: 2.6–4.3), respectively. Untreated cataract was the leading cause of blindness (73%) and severe VI (93%). The cataract surgical coverage (CSC) at <3/60 was 71.5% for eyes and 89.3% for persons in this sample and the CSC was similar between the genders. Refractive error (71%) was the primary cause of early VI. The overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4–7.2%). Prevalence of any DR, maculopathy, and sight-threatening DR was 15, 12.4, and 6%, respectively. Conclusion: To conclude, as compared to previous reports, the prevalence of blindness and DR in Siwan district of Bihar was found to be lower and the CSC was higher. However, the problem of avoidable blindness remains a major problem in this region.
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Affiliation(s)
- Ajit Kumar Poddar
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Tanwir Ahmed Khan
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | - Kumari Sweta
- Department of Ophthalmology, Akhand Jyoti Eye Hospitals, Bihar, India
| | | | - Rishi R Borah
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Rahul Ali
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Asim Kumar Sil
- Department of Ophthalmology, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
| | - Sethu Sheeladevi
- Orbis India Country Office, Vivekanand Mission Ashram, Netra Niramaya Niketan, Haldia, West Bengal, India
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Xuan Q, Ouyang Y, Wang Y, Wu L, Li H, Luo Y, Zhao X, Feng D, Qin W, Hu C, Zhou L, Liu X, Zou H, Cai C, Wu J, Jia W, Xu G. Multiplatform Metabolomics Reveals Novel Serum Metabolite Biomarkers in Diabetic Retinopathy Subjects. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:2001714. [PMID: 33240754 PMCID: PMC7675050 DOI: 10.1002/advs.202001714] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Indexed: 05/12/2023]
Abstract
Diabetic retinopathy (DR) is the main cause of vision loss or blindness in working age adults worldwide. The lack of effective diagnostic biomarkers for DR leads to unsatisfactory curative treatments. To define potential metabolite biomarkers for DR diagnosis, a multiplatform-based metabolomics study is performed. In this study, a total of 905 subjects with diabetes without DR (NDR) and with DR at different clinical stages are recruited. Multiplatform metabolomics methods are used to characterize the serum metabolic profiles and to screen and validate the DR biomarkers. Based on the criteria p < 0.05 and false-discovery rate < 0.05, 348 and 290 metabolites are significantly associated with the pathogenesis of DR and early-stage DR, respectively. The biomarker panel consisting of 12-hydroxyeicosatetraenoic acid (12-HETE) and 2-piperidone exhibited better diagnostic performance than hemoglobin A1c (HbA1c) in differentiating DR from diabetes, with AUCs of 0.946 versus 0.691 and 0.928 versus 0.648 in the discovery and validation sets, respectively. In addition, this panel showed higher sensitivity in early-stage DR detection than HbA1c. In conclusion, this multiplatform-based metabolomics study comprehensively revealed the metabolic dysregulation associated with DR onset and progression. The defined biomarker panel can be used for detection of DR and early-stage DR.
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Affiliation(s)
- Qiuhui Xuan
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
| | - Yang Ouyang
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
| | - Yanfeng Wang
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
| | - Liang Wu
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic diseases biobankShanghai JiaoTong University Affiliated Sixth People's HospitalShanghai200233China
| | - Huating Li
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic diseases biobankShanghai JiaoTong University Affiliated Sixth People's HospitalShanghai200233China
| | - Yuanyuan Luo
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
| | - Xinjie Zhao
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
| | - Disheng Feng
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
| | - Wangshu Qin
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
| | - Chunxiu Hu
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
| | - Lina Zhou
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
| | - Xinyu Liu
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
| | - Haidong Zou
- Department of OphthalmologyFirst People's Hospital of ShanghaiShanghai Jiao Tong UniversityShanghaiChina
| | - Chun Cai
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic diseases biobankShanghai JiaoTong University Affiliated Sixth People's HospitalShanghai200233China
| | - Jiarui Wu
- Key Laboratory of Systems Biology, CAS Center for Excellence in Molecular Cell Science, Institute of Biochemistry and Cell Biology, University of Chinese Academy of SciencesChinese Academy of Sciences320 Yue‐Yang RoadShanghai200031China
- Key Laboratory of Systems BiologyCAS Center for Excellence in Molecular Cell ScienceInstitute of Biochemistry and Cell BiologyUniversity of Chinese Academy of SciencesChinese Academy of Sciences320 Yue‐Yang RoadShanghai200031China
| | - Weiping Jia
- Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Endocrine and Metabolic Diseases, Metabolic diseases biobankShanghai JiaoTong University Affiliated Sixth People's HospitalShanghai200233China
- Shanghai Diabetes InstituteShanghai Key Laboratory of Diabetes MellitusShanghai Clinical Center for Endocrine and Metabolic DiseasesShanghai Jiaotong University Affiliated Sixth People's HospitalShanghai200233China
| | - Guowang Xu
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of Sciences457 Zhongshan RoadDalian116023China
- University of Chinese Academy of SciencesBeijing100049China
- CAS Key Laboratory of Separation Science for Analytical ChemistryDalian Institute of Chemical PhysicsChinese Academy of SciencesDalian116023China
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Wintergerst MW, Mishra DK, Hartmann L, Shah P, Konana VK, Sagar P, Berger M, Murali K, Holz FG, Shanmugam MP, Finger RP. Diabetic Retinopathy Screening Using Smartphone-Based Fundus Imaging in India. Ophthalmology 2020; 127:1529-1538. [DOI: 10.1016/j.ophtha.2020.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/29/2022] Open
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Kanar HS, Arsan A, Altun A, Akı SF, Hacısalihoglu A. Can subthreshold micropulse yellow laser treatment change the anti-vascular endothelial growth factor algorithm in diabetic macular edema? A randomized clinical trial. Indian J Ophthalmol 2020; 68:145-151. [PMID: 31856493 PMCID: PMC6951119 DOI: 10.4103/ijo.ijo_350_19] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the efficacy of subthreshold micropulse yellow laser (SMYL) and intravitreal aflibercept injection (IAI) combination therapy with IAI monotherapy in the treatment of diabetic macular edema (DME) and to evaluate the number of injections and SMYL sessions required. Methods This prospective study compared a group of 28 patients treated with a combination of SMYL and IAI with a group of 28 patients treated only with IAI. All patients initially received 3 monthly IAIs, and the monotherapy group was given additional injections as needed. The combination therapy patients additionally received SMYL after the loading phase. The primary outcome measures were the change in the best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to month 12; the secondary outcomes were the mean number of required injections and SMYL sessions. Results In the monotherapy group, the BCVA improved from 0.38 ± 0.10 to 0.20 ± 0.10 logMAR; in the combination group, BCVA improved from 0.40 ± 0.09 to 0.17 ± 0.06 logMAR at the end of the 12th month. The CMT was reduced from 451.28 ± 44.85 to 328.8 ± 49.69 μm in the monotherapy group and from 466.07 ± 71.79 to 312.0 ± 39.29 μm in the combination group. Improvement of the mean BCVA and reduction of the mean CMT were similar in each group. The combination group required significantly fewer injections (3.21 ± 0.41 vs 5.39 ± 1.54; P < 0.001). By month 12, 75% of patients in the monotherapy group had required additional IAIs when compared with 16% in the combination group (P < 0.001). Conclusion SMYL combination therapy demonstrated significant visual improvements in patients with DME. In the combination group, the retreatment rate and number of required injections were significantly lower compared with the IAI monotherapy group.
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Affiliation(s)
| | - Aysu Arsan
- Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Altun
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Suat Fazıl Akı
- Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Pao SI, Lin HZ, Chien KH, Tai MC, Chen JT, Lin GM. Detection of Diabetic Retinopathy Using Bichannel Convolutional Neural Network. J Ophthalmol 2020; 2020:9139713. [PMID: 32655944 PMCID: PMC7322591 DOI: 10.1155/2020/9139713] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/18/2020] [Indexed: 01/14/2023] Open
Abstract
Deep learning of fundus photograph has emerged as a practical and cost-effective technique for automatic screening and diagnosis of severer diabetic retinopathy (DR). The entropy image of luminance of fundus photograph has been demonstrated to increase the detection performance for referable DR using a convolutional neural network- (CNN-) based system. In this paper, the entropy image computed by using the green component of fundus photograph is proposed. In addition, image enhancement by unsharp masking (UM) is utilized for preprocessing before calculating the entropy images. The bichannel CNN incorporating the features of both the entropy images of the gray level and the green component preprocessed by UM is also proposed to improve the detection performance of referable DR by deep learning.
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Affiliation(s)
- Shu-I Pao
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Hong-Zin Lin
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
| | - Gen-Min Lin
- Department of Medicine, Hualien Armed Forces General Hospital, Hualien 971, Taiwan
- Department of Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei 114, Taiwan
- Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
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Al-Fawaz K, Al Rubaie K, Yasir Z, Khandekar R. Perception Among Diabetic Patients of Telescreening for Diabetic Retinopathy. Telemed J E Health 2020; 26:1455-1460. [PMID: 32522110 DOI: 10.1089/tmj.2019.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: To evaluate the satisfaction of diabetic patients and its determinants of telescreening for diabetic retinopathy (DR) in Saudi Arabia. Methods: This cross-sectional survey was conducted in December 2018 in a diabetes center of Riyadh, Saudi Arabia. Ten questions were asked by the interviewer. A 5-point Likert scale was used to grade patient responses for each question. Rasch analysis was conducted to evaluate the response of the participants. The main outcome variable was the sum of the Logit values of the responses. The Rasch score was also compared among subgroups. Results: Two hundred (n = 200) diabetic patients were interviewed. The median Rasch score of client-perceived benefit of DR telescreening was +14.6 (25% quartile +3.09, minimum; -23.2, maximum; +35.7). A positive attitude of patients regarding DR telescreening was recorded in 159 (79.5%) participants. The perception of telescreening was better in younger diabetic patients than in older diabetic patients (Friedman p < 0.001). The perception was similar in both genders (Mann-Whitney p = 0.3). Diabetic patients from Riyadh and the southern region of Saudi Arabia had significantly more positive perception than those from north and eastern regions (Freedman p < 0.001). Conclusion: Diabetic patients have positive attitude toward tele-DR screening. Their cooperation is likely to be high if large scale tele-DR screening is implemented in the Kingdom.
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Affiliation(s)
- Khalid Al-Fawaz
- Administration Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khalid Al Rubaie
- Retina Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Zia Yasir
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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García-Martín F, González Monte E, Hernández Martínez E, Bada Boch T, Bustamante Jiménez NE, Praga Terente M. When to perform renal biopsy in patients with type2 diabetes mellitus? Predictive model of non-diabetic renal disease. Nefrologia 2019; 40:180-189. [PMID: 31761446 DOI: 10.1016/j.nefro.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/20/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy (DN) is one of the most frequent complications in patients with diabetes mellitus (DM) and its diagnosis is usually established on clinical grounds. However, kidney involvement in some diabetic patients can be due to other causes, and renal biopsy might be needed to exclude them. The aim of our study was to establish the clinical and analytical data that predict DN and no-diabetic renal disease (NDRD), and to develop a predictive model (score) to confirm or dismiss DN. MATERIAL AND METHODS We conducted a transversal, observational and retrospective study, including renal biopsies performed in type2 DM patients, between 2000 and 2018. RESULTS Two hundred seven DM patients were included in our study. The mean age was 64.5±10.6 years and 74% were male. DN was found in 126 (61%) of the biopsies and NDRD in 81 (39%). Diabetic retinopathy was presented in 58% of DN patients, but only in 6% of NDRD patients (P<.001). Patients with NDRD were diagnosed of primary glomerulopathies (52%), nephroangiosclerosis (16%), inmunoallergic interstitial nephritis (15%) and vasculitis (8.5%). In the multivariate analysis, retinopathy (OR26.7; 95%CI: 6.8-104.5), chronic ischaemia of lower limbs (OR4,37; 95%CI: 1.33-14.3), insulin therapy (OR3.05; 95%CI: 1.13-8.25), time course of DM ≥10years (OR2.71; 95%CI: 1.1-6.62) and nephrotic range proteinuria (OR2.91; 95%CI: 1.2-7.1) were independent predictors for DN. Microhaematuria defined as ≥10 red blood cells per high-power field (OR0.032; 95%CI: 0.01-0.11) and overweight (OR0.21; 95%CI: 0.08-0.5) were independent predictors of NDRD. According to the predictive model based on the multivariate analysis, all patients with a score >3 had DN and 94% of cases with a score ≤1 had NDRD (score ranked from -6 to 8points). CONCLUSIONS NDRD is common in DM patients (39%), being primary glomerulonephritis the most frequent ethology. The absence of retinopathy and the presence of microhematuria are highly suggestive of NDRD. The use of our predictive model could facilitate the indication of performing a renal biopsy in DM patients.
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Affiliation(s)
- Florencio García-Martín
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España.
| | | | | | - Teresa Bada Boch
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Manuel Praga Terente
- Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Universidad Complutense, Madrid, España
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Wong TY, Sabanayagam C. The War on Diabetic Retinopathy: Where Are We Now? Asia Pac J Ophthalmol (Phila) 2019; 8:448-456. [PMID: 31789647 PMCID: PMC6903323 DOI: 10.1097/apo.0000000000000267] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Diabetic retinopathy (DR), a major cause of blindness in working-age adults, is emerging as a major public health issue worldwide, in particular in low- and middle-income countries (LMIC). Traditionally, the management of DR has been on tertiary-level treatment (eg, laser, anti-VEGF injections and surgery) in specialized settings by highly trained ophthalmologists on individual patients. To win the war on DR, a paradigm shift in strategic focus and resources must be made from such tertiary treatment toward primary and secondary prevention, which are broader, more impactful, and cost-effective for the larger population. These include improving education and awareness of risk of DR among people initially diagnosed with diabetes, promoting behavioral modifications such as physical activity and medication adherence for improving glycemic and blood pressure control, setting up systematic screening programs for DR to detect the onset or progression of the disease, and implementing cost-effective, evidence-based policies and guidelines for managing DR. Additionally, there is a need to leverage on novel technology including the application of digital big data to predict people at risk of diabetes and DR, the use of wearable devices and smart phone apps, behavioral techniques including social media for self-management of diabetes, and telemedicine-based DR screening incorporating artificial intelligence (AI) to broaden access to screening in all settings. To turn the tide on the war on DR, we must reframe DR not only as a specific condition that can be managed by ophthalmologists, but fundamentally, as a preventable condition by shifting the weight of strategies from tertiary to secondary and primary battlegrounds.
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Affiliation(s)
- Tien Y. Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS, Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS, Medical School, Singapore
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Wong T, Sabanayagam C. Strategies to Tackle the Global Burden of Diabetic Retinopathy: From Epidemiology to Artificial Intelligence. Ophthalmologica 2019; 243:9-20. [DOI: 10.1159/000502387] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
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Ting DSW, Cheung CY, Nguyen Q, Sabanayagam C, Lim G, Lim ZW, Tan GSW, Soh YQ, Schmetterer L, Wang YX, Jonas JB, Varma R, Lee ML, Hsu W, Lamoureux E, Cheng CY, Wong TY. Deep learning in estimating prevalence and systemic risk factors for diabetic retinopathy: a multi-ethnic study. NPJ Digit Med 2019; 2:24. [PMID: 31304371 PMCID: PMC6550209 DOI: 10.1038/s41746-019-0097-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 03/01/2019] [Indexed: 02/07/2023] Open
Abstract
In any community, the key to understanding the burden of a specific condition is to conduct an epidemiological study. The deep learning system (DLS) recently showed promising diagnostic performance for diabetic retinopathy (DR). This study aims to use DLS as the grading tool, instead of human assessors, to determine the prevalence and the systemic cardiovascular risk factors for DR on fundus photographs, in patients with diabetes. This is a multi-ethnic (5 races), multi-site (8 datasets from Singapore, USA, Hong Kong, China and Australia), cross-sectional study involving 18,912 patients (n = 93,293 images). We compared these results and the time taken for DR assessment by DLS versus 17 human assessors - 10 retinal specialists/ophthalmologists and 7 professional graders). The estimation of DR prevalence between DLS and human assessors is comparable for any DR, referable DR and vision-threatening DR (VTDR) (Human assessors: 15.9, 6.5% and 4.1%; DLS: 16.1%, 6.4%, 3.7%). Both assessment methods identified similar risk factors (with comparable AUCs), including younger age, longer diabetes duration, increased HbA1c and systolic blood pressure, for any DR, referable DR and VTDR (p > 0.05). The total time taken for DLS to evaluate DR from 93,293 fundus photographs was ~1 month compared to 2 years for human assessors. In conclusion, the prevalence and systemic risk factors for DR in multi-ethnic population could be determined accurately using a DLS, in significantly less time than human assessors. This study highlights the potential use of AI for future epidemiology or clinical trials for DR grading in the global communities.
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Grants
- This project received funding from National Medical Research Council (NMRC), Ministry of Health (MOH), Singapore (National Health Innovation Center, Innovation to Develop Grant (NHIC-I2D-1409022); Health Service Research Grant; SingHealth Foundation Research Grant (SHF/FG648S/2015), and the Tanoto Foundation. For Singapore Epidemiology of Eye Diseases (SEED) study, we received funding from NMRC, MOH (grants 0796/2003, IRG07nov013, IRG09nov014, STaR/0003/2008 & STaR/2013; CG/SERI/2010) and Biomedical Research Council (grants 08/1/35/19/550, 09/1/35/19/616). The Singapore Diabetic Retinopathy Program (SiDRP) received funding from the MOH, Singapore (grants AIC/RPDD/SIDRP/SERI/FY2013/0018 & AIC/HPD/FY2016/0912)
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Affiliation(s)
- Daniel S. W. Ting
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Carol Y. Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Quang Nguyen
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Gilbert Lim
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Zhan Wei Lim
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Gavin S. W. Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Yu Qiang Soh
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Department of Ophthalmology, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ya Xing Wang
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jost B. Jonas
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | - Rohit Varma
- University of Southern California Gayle and Edward Roski Eye Institute, Los Angeles, CA USA
| | - Mong Li Lee
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Wynne Hsu
- National University of Singapore, School of Computing, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Tien Yin Wong
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
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Yang QH, Zhang Y, Zhang XM, Li XR. Prevalence of diabetic retinopathy, proliferative diabetic retinopathy and non-proliferative diabetic retinopathy in Asian T2DM patients: a systematic review and Meta-analysis. Int J Ophthalmol 2019; 12:302-311. [PMID: 30809489 DOI: 10.18240/ijo.2019.02.19] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022] Open
Abstract
AIM To investigate the pooled prevalence of diabetic retinopathy (DR), proliferative DR (PDR) and nonproliferative DR (NPDR) in Asian type 2 diabetes mellitus (T2DM) patients. METHODS We performed a systematic search online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies that reported the prevalence of DR, PDR and NPDR in Asian T2DM patients. Effect size (ES) with 95% confidence interval (CI) was used to evaluate the prevalence of DR, PDR and NPDR in Asian T2DM patients, respectively. RESULTS There were 41 references and 48 995 T2DM patients involved in this study. The prevalence of DR, PDR, and NPDR was 28%, 6%, and 27% in T2DM patients, respectively; while the prevalence of PDR and NPDR in DR patients was 17% and 83%, respectively. Subgroup analysis showed that prevalence of DR in T2DM patients from Singaporean, Indian, South Korean, Malaysian, Asian, and Chinese was 33%, 42%, 16%, 35%, 21% and 25%, respectively. In T2DM patients with NPDR from Indian, South Korean, Malaysian, Asian, Chinese, higher prevalence was found than that in PDR patients (45% vs 17%, 13% vs 3%, 30% vs 5%, 23% vs 2% and 22% vs 3%), as well as in DR patients (74% vs 26%, 81% vs 19%, 86% vs 14%, 92% vs 8% and 85% vs 15%). The prevalence of PDR in T2DM from India was higher than patients from other locations of Asia, and the same results were also observed in NPDR patients. CONCLUSION In either T2DM Asian patients or DR patients, NPDR is more common than PDR. Based on our results, we should pay more attention to NPDR screening and management in T2DM patients, and we also recommend suitable interventions to prevent its progression.
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Affiliation(s)
- Qian-Hui Yang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Yan Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
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Li Z, Keel S, Liu C, He Y, Meng W, Scheetz J, Lee PY, Shaw J, Ting D, Wong TY, Taylor H, Chang R, He M. An Automated Grading System for Detection of Vision-Threatening Referable Diabetic Retinopathy on the Basis of Color Fundus Photographs. Diabetes Care 2018; 41:2509-2516. [PMID: 30275284 DOI: 10.2337/dc18-0147] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/02/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The goal of this study was to describe the development and validation of an artificial intelligence-based, deep learning algorithm (DLA) for the detection of referable diabetic retinopathy (DR). RESEARCH DESIGN AND METHODS A DLA using a convolutional neural network was developed for automated detection of vision-threatening referable DR (preproliferative DR or worse, diabetic macular edema, or both). The DLA was tested by using a set of 106,244 nonstereoscopic retinal images. A panel of ophthalmologists graded DR severity in retinal photographs included in the development and internal validation data sets (n = 71,043); a reference standard grading was assigned once three graders achieved consistent grading outcomes. For external validation, we tested our DLA using 35,201 images of 14,520 eyes (904 eyes with any DR; 401 eyes with vision-threatening referable DR) from population-based cohorts of Malays, Caucasian Australians, and Indigenous Australians. RESULTS Among the 71,043 retinal images in the training and validation data sets, 12,329 showed vision-threatening referable DR. In the internal validation data set, the area under the curve (AUC), sensitivity, and specificity of the DLA for vision-threatening referable DR were 0.989, 97.0%, and 91.4%, respectively. Testing against the independent, multiethnic data set achieved an AUC, sensitivity, and specificity of 0.955, 92.5%, and 98.5%, respectively. Among false-positive cases, 85.6% were due to a misclassification of mild or moderate DR. Undetected intraretinal microvascular abnormalities accounted for 77.3% of all false-negative cases. CONCLUSIONS This artificial intelligence-based DLA can be used with high accuracy in the detection of vision-threatening referable DR in retinal images. This technology offers potential to increase the efficiency and accessibility of DR screening programs.
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Affiliation(s)
- Zhixi Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Stuart Keel
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Chi Liu
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Yifan He
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Wei Meng
- Guangzhou Healgoo Interactive Medical Technology Co. Ltd., Guangzhou, China
| | - Jane Scheetz
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Pei Ying Lee
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Jonathan Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Daniel Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Hugh Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Robert Chang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China .,Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
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Ziemssen F, Marahrens L, Roeck D, Agostini H. Klinische Stadieneinteilung der diabetischen Retinopathie. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0417-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Szeto SKH, Wong R, Lok J, Tang F, Sun Z, Tso T, Lam TCH, Tham CC, Ng DS, Cheung CY. Non-mydriatic ultrawide field scanning laser ophthalmoscopy compared with dilated fundal examination for assessment of diabetic retinopathy and diabetic macular oedema in Chinese individuals with diabetes mellitus. Br J Ophthalmol 2018; 103:1327-1331. [PMID: 30381391 DOI: 10.1136/bjophthalmol-2018-311924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 09/19/2018] [Accepted: 10/17/2018] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate the performance of ultrawide field scanning laser ophthalmoscopy (UWF-SLO) for assessing diabetic retinopathy (DR) and diabetic macular oedema (DME) in a Chinese population, compared with clinical examination. METHODS This is a retrospective cohort study. A series of 322 eyes from 164 patients with DM were included. Each patient underwent both dilated fundal examination with DR and DME grading by retina specialist and non-mydriatic 200° UWF-SLO (Daytona, Optos, Dunfermline, UK). The severity of DR and DME from UWF-SLO images was further graded by ophthalmologists, according to both international clinical DR and DME disease severity scales and the standard 7-field Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Any DR, DME and vision-threatening DR (VTDR) were treated as endpoints for this study. RESULTS 23 out of 322 images (7.14%), including all four cases with proliferative DR on clinical examinations, were determined as ungradable. When the international scale was used for grading UWF-SLO images, the sensitivity of any DR, DME and VTDR was 67.7%, 67.4% and 72.6%, respectively; the specificity of any DR, DME and VTDR was 97.8%, 97.3% and 97.8%, respectively. The agreement with clinical grading in picking up any DR, DME and VTDR was substantial, with κ-values of 0.634, 0.694 and 0.707, respectively. The performance of UWF-SLO was shown to be lower when ETDRS scale was used for grading the images. CONCLUSION The performance of non-mydriatic UWF-SLO is comparable in identifying DR with that of clinical examination in a Chinese cohort. However, whether UWF-SLO can be considered as tool for screening DR is still undetermined.
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Affiliation(s)
- Simon K H Szeto
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Raymond Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Jerry Lok
- Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Zihan Sun
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Tiffany Tso
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Thomas C H Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Danny S Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.,Hong Kong Eye Hospital, Hong Kong Special Administrative Region, Hong Kong, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Transforming Retinal Photographs to Entropy Images in Deep Learning to Improve Automated Detection for Diabetic Retinopathy. J Ophthalmol 2018; 2018:2159702. [PMID: 30275989 PMCID: PMC6151683 DOI: 10.1155/2018/2159702] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 02/07/2023] Open
Abstract
Entropy images, representing the complexity of original fundus photographs, may strengthen the contrast between diabetic retinopathy (DR) lesions and unaffected areas. The aim of this study is to compare the detection performance for severe DR between original fundus photographs and entropy images by deep learning. A sample of 21,123 interpretable fundus photographs obtained from a publicly available data set was expanded to 33,000 images by rotating and flipping. All photographs were transformed into entropy images using block size 9 and downsized to a standard resolution of 100 × 100 pixels. The stages of DR are classified into 5 grades based on the International Clinical Diabetic Retinopathy Disease Severity Scale: Grade 0 (no DR), Grade 1 (mild nonproliferative DR), Grade 2 (moderate nonproliferative DR), Grade 3 (severe nonproliferative DR), and Grade 4 (proliferative DR). Of these 33,000 photographs, 30,000 images were randomly selected as the training set, and the remaining 3,000 images were used as the testing set. Both the original fundus photographs and the entropy images were used as the inputs of convolutional neural network (CNN), and the results of detecting referable DR (Grades 2–4) as the outputs from the two data sets were compared. The detection accuracy, sensitivity, and specificity of using the original fundus photographs data set were 81.80%, 68.36%, 89.87%, respectively, for the entropy images data set, and the figures significantly increased to 86.10%, 73.24%, and 93.81%, respectively (all p values <0.001). The entropy image quantifies the amount of information in the fundus photograph and efficiently accelerates the generating of feature maps in the CNN. The research results draw the conclusion that transformed entropy imaging of fundus photographs can increase the machinery detection accuracy, sensitivity, and specificity of referable DR for the deep learning-based system.
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Shawahna R, Shanti Y, Al Zabadi H, Sharabati M, Alawneh A, Shaqu R, Taha I, Bustami A. Prevalence and association of clinical characteristics and biochemical factors with complications of diabetes mellitus in Palestinians treated in primary healthcare practice. Diabetes Metab Syndr 2018; 12:693-704. [PMID: 29693548 DOI: 10.1016/j.dsx.2018.04.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
AIMS The current study was carried out to examine prevalence of complications related to diabetes mellitus (DM) and to investigate association between clinical variables and biochemical factors with complications of DM in patients treated in primary healthcare settings in the West Bank of Palestine. MATERIALS AND METHODS Sociodemographic, clinical, and biochemical variables were collected from 385 patients visiting 17 primary healthcare settings in the West Bank. Patients provided blood and urine samples, responded to a questionnaire interview, and were subjected to ophthalmic examination. RESULTS HbA1c levels were predicted by duration of DM (p < 0.001), HDL (p = 0.011), alkaline phosphatase (p = 0.001), blood urea (p = 0.006), and LDL (p = 0.008). Triglycerides levels were predicted by blood urea (p = 0.002), HDL (p < 0.001), and total cholesterol (p < 0.001). GOT levels were predicted by LDL (p = 0.002) and GPT (p < 0.001). GPT levels were predicted by HDL (p = 0.003) and blood urea (p = 0.025). Urine albumin were predicted by total cholesterol (p = 0.001), LDL (p = 0.005), and blood urea (p = 0.036). CD ratio was predicted by the IOP and the IOP was predicted by the CD ratio (p = 0.001). CONCLUSIONS Prevalence of complications related to DM was high among patients with DM treated in primary healthcare practice. These complications and risk factors were predicted by certain clinical characteristics and biochemical factors. Policies and programs are needed to manage these modifiable risk factors.
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Affiliation(s)
- Ramzi Shawahna
- Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine; An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine.
| | - Yousef Shanti
- An-Najah National University Hospital, Nablus, Palestine.
| | - Hamzeh Al Zabadi
- Department of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mutassem Sharabati
- Faculty of Medicine and Health Sciences, (undergraduate program), An-Najah National University, Nablus, Palestine
| | - Ammar Alawneh
- Faculty of Medicine and Health Sciences, (undergraduate program), An-Najah National University, Nablus, Palestine
| | - Rakan Shaqu
- Faculty of Medicine and Health Sciences, (undergraduate program), An-Najah National University, Nablus, Palestine
| | - Ibrahim Taha
- Faculty of Medicine and Health Sciences, (undergraduate program), An-Najah National University, Nablus, Palestine
| | - Adnan Bustami
- Faculty of Medicine and Health Sciences, (undergraduate program), An-Najah National University, Nablus, Palestine
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Wong TY, Sun J, Kawasaki R, Ruamviboonsuk P, Gupta N, Lansingh VC, Maia M, Mathenge W, Moreker S, Muqit MMK, Resnikoff S, Verdaguer J, Zhao P, Ferris F, Aiello LP, Taylor HR. Guidelines on Diabetic Eye Care: The International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. Ophthalmology 2018; 125:1608-1622. [PMID: 29776671 DOI: 10.1016/j.ophtha.2018.04.007] [Citation(s) in RCA: 381] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 12/15/2022] Open
Abstract
Diabetes mellitus (DM) is a global epidemic and affects populations in both developing and developed countries, with differing health care and resource levels. Diabetic retinopathy (DR) is a major complication of DM and a leading cause of vision loss in working middle-aged adults. Vision loss from DR can be prevented with broad-level public health strategies, but these need to be tailored to a country's and population's resource setting. Designing DR screening programs, with appropriate and timely referral to facilities with trained eye care professionals, and using cost-effective treatment for vision-threatening levels of DR can prevent vision loss. The International Council of Ophthalmology Guidelines for Diabetic Eye Care 2017 summarize and offer a comprehensive guide for DR screening, referral and follow-up schedules for DR, and appropriate management of vision-threatening DR, including diabetic macular edema (DME) and proliferative DR, for countries with high- and low- or intermediate-resource settings. The guidelines include updated evidence on screening and referral criteria, the minimum requirements for a screening vision and retinal examination, follow-up care, and management of DR and DME, including laser photocoagulation and appropriate use of intravitreal anti-vascular endothelial growth factor inhibitors and, in specific situations, intravitreal corticosteroids. Recommendations for management of DR in patients during pregnancy and with concomitant cataract also are included. The guidelines offer suggestions for monitoring outcomes and indicators of success at a population level.
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Affiliation(s)
- Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore.
| | - Jennifer Sun
- Beetham Eye Institute, Joslin Diabetes Center, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | | | - Neeru Gupta
- Ophthalmology and Vision Sciences, St. Michael's Hospital, University of Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Mauricio Maia
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wanjiku Mathenge
- Rwanda International Institute of Ophthalmology, and Dr Agarwal's Eye Hospital, Kigali, Rwanda
| | - Sunil Moreker
- Apollo, Nanavati, Seven Hills, Fortis Hiranandani, Cumballa Hill, SL Raheja, Eyeris, Conwest Jain, Bhaktivedant, MGM Hospitals, Mumbai, India
| | - Mahi M K Muqit
- Vitreoretinal Service, Moorfields Eye Hospital, NIHR Moorfields Biomedical Research Centre (BRC), London, United Kingdom
| | - Serge Resnikoff
- Brien Holden Vision Institute and SOVS, University of New South Wales, Sydney, Australia
| | - Juan Verdaguer
- Los Andes Ophthalmologic Foundation, Los Andes University, Santiago, Chile
| | - Peiquan Zhao
- Department of Ophthalmology, Xin Hua Hospital affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Frederick Ferris
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Lloyd P Aiello
- Beetham Eye Institute, Joslin Diabetes Center, and Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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45
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Tan GS, Gan A, Sabanayagam C, Tham YC, Neelam K, Mitchell P, Wang JJ, Lamoureux EL, Cheng CY, Wong TY. Ethnic Differences in the Prevalence and Risk Factors of Diabetic Retinopathy. Ophthalmology 2018; 125:529-536. [DOI: 10.1016/j.ophtha.2017.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/28/2017] [Accepted: 10/17/2017] [Indexed: 02/07/2023] Open
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46
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Chua J, Lim CXY, Wong TY, Sabanayagam C. Diabetic Retinopathy in the Asia-Pacific. Asia Pac J Ophthalmol (Phila) 2018; 7:3-16. [PMID: 29376231 DOI: 10.22608/apo.2017511] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Diabetic retinopathy (DR), the most common complication of diabetes mellitus, is the leading cause of new cases of blindness in middle-aged and elderly in the Asia-Pacific. It has been estimated that 51% of all those with blindness due to DR globally (n = 424,400) and 56% of those with visual impairment due to DR (2.1 million) come from the Asia-Pacific. Prevalence of DR among those with diabetes ranged from 10% in India to 43% in Indonesia within the Asia-Pacific. Awareness of DR among persons with diabetes ranged from 28% to 84%. Most common modifiable risk factors for DR in the Asia-Pacific were hyperglycemia, blood pressure, dyslipidemia, and obesity. Implementation of systematic screening programs for DR and advancement in telemedicine screening methods have increased patient coverage and cost-effectiveness, though there are still numerous factors impeding screening uptake in the low-middle income regions of the Asia-Pacific. Management and treatment of DR in the Asia-Pacific is mainly limited to traditional laser retinopexy, but it is suboptimal despite new clinical approaches such as use of intravitreal anti.vascular endothelial growth factor and steroids due to limited resources. Further research and data are required to structure a more cost-effective public healthcare program and more awareness-building initiatives to increase the effectiveness of DR screening programs.
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Affiliation(s)
- Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
| | - Claire Xin Ying Lim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- University College Dublin, Dublin, Ireland
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Centre for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore
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47
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Ting DSW, Cheung CYL, Lim G, Tan GSW, Quang ND, Gan A, Hamzah H, Garcia-Franco R, San Yeo IY, Lee SY, Wong EYM, Sabanayagam C, Baskaran M, Ibrahim F, Tan NC, Finkelstein EA, Lamoureux EL, Wong IY, Bressler NM, Sivaprasad S, Varma R, Jonas JB, He MG, Cheng CY, Cheung GCM, Aung T, Hsu W, Lee ML, Wong TY. Development and Validation of a Deep Learning System for Diabetic Retinopathy and Related Eye Diseases Using Retinal Images From Multiethnic Populations With Diabetes. JAMA 2017; 318:2211-2223. [PMID: 29234807 PMCID: PMC5820739 DOI: 10.1001/jama.2017.18152] [Citation(s) in RCA: 1098] [Impact Index Per Article: 156.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE A deep learning system (DLS) is a machine learning technology with potential for screening diabetic retinopathy and related eye diseases. OBJECTIVE To evaluate the performance of a DLS in detecting referable diabetic retinopathy, vision-threatening diabetic retinopathy, possible glaucoma, and age-related macular degeneration (AMD) in community and clinic-based multiethnic populations with diabetes. DESIGN, SETTING, AND PARTICIPANTS Diagnostic performance of a DLS for diabetic retinopathy and related eye diseases was evaluated using 494 661 retinal images. A DLS was trained for detecting diabetic retinopathy (using 76 370 images), possible glaucoma (125 189 images), and AMD (72 610 images), and performance of DLS was evaluated for detecting diabetic retinopathy (using 112 648 images), possible glaucoma (71 896 images), and AMD (35 948 images). Training of the DLS was completed in May 2016, and validation of the DLS was completed in May 2017 for detection of referable diabetic retinopathy (moderate nonproliferative diabetic retinopathy or worse) and vision-threatening diabetic retinopathy (severe nonproliferative diabetic retinopathy or worse) using a primary validation data set in the Singapore National Diabetic Retinopathy Screening Program and 10 multiethnic cohorts with diabetes. EXPOSURES Use of a deep learning system. MAIN OUTCOMES AND MEASURES Area under the receiver operating characteristic curve (AUC) and sensitivity and specificity of the DLS with professional graders (retinal specialists, general ophthalmologists, trained graders, or optometrists) as the reference standard. RESULTS In the primary validation dataset (n = 14 880 patients; 71 896 images; mean [SD] age, 60.2 [2.2] years; 54.6% men), the prevalence of referable diabetic retinopathy was 3.0%; vision-threatening diabetic retinopathy, 0.6%; possible glaucoma, 0.1%; and AMD, 2.5%. The AUC of the DLS for referable diabetic retinopathy was 0.936 (95% CI, 0.925-0.943), sensitivity was 90.5% (95% CI, 87.3%-93.0%), and specificity was 91.6% (95% CI, 91.0%-92.2%). For vision-threatening diabetic retinopathy, AUC was 0.958 (95% CI, 0.956-0.961), sensitivity was 100% (95% CI, 94.1%-100.0%), and specificity was 91.1% (95% CI, 90.7%-91.4%). For possible glaucoma, AUC was 0.942 (95% CI, 0.929-0.954), sensitivity was 96.4% (95% CI, 81.7%-99.9%), and specificity was 87.2% (95% CI, 86.8%-87.5%). For AMD, AUC was 0.931 (95% CI, 0.928-0.935), sensitivity was 93.2% (95% CI, 91.1%-99.8%), and specificity was 88.7% (95% CI, 88.3%-89.0%). For referable diabetic retinopathy in the 10 additional datasets, AUC range was 0.889 to 0.983 (n = 40 752 images). CONCLUSIONS AND RELEVANCE In this evaluation of retinal images from multiethnic cohorts of patients with diabetes, the DLS had high sensitivity and specificity for identifying diabetic retinopathy and related eye diseases. Further research is necessary to evaluate the applicability of the DLS in health care settings and the utility of the DLS to improve vision outcomes.
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Affiliation(s)
- Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Carol Yim-Lui Cheung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gilbert Lim
- School of Computing, National University of Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Nguyen D. Quang
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Alfred Gan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Haslina Hamzah
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | | | - Ian Yew San Yeo
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Edmund Yick Mun Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Farah Ibrahim
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ngiap Chuan Tan
- Duke-NUS Medical School, National University of Singapore, Singapore
- SingHealth Polyclinic, Singapore Health Service, Singapore
| | - Eric A. Finkelstein
- Lien Center for Palliative Care, Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore
| | - Ecosse L. Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Ian Y. Wong
- Department of Ophthalmology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Sobha Sivaprasad
- Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Rohit Varma
- University of Southern California Gayle and Edward Roski Eye Institute, Los Angeles, California
| | - Jost B. Jonas
- Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, Heidelberg, Germany
| | - Ming Guang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yatsen University, Guangzhou, China
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Gemmy Chui Ming Cheung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
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48
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AbuMustafa AM. Clinical and Biochemical Associations with Diabetic Retinopathy in Male Patients in the Gaza Strip. Front Endocrinol (Lausanne) 2017; 8:302. [PMID: 29176961 PMCID: PMC5686081 DOI: 10.3389/fendo.2017.00302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 10/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are limited data on the prevalence and risk factors for diabetic retinopathy (DR) in the Gaza Strip. OBJECTIVE To assesses clinical and biochemical associated with DR in males with type 2 diabetes mellitus (T2DM) in the Gaza Strip. METHODS One hundred and fifty males with T2DM from the Gaza Strip underwent a questionnaire interview, serum biochemical analysis, and assessment of their previous urine and blood results. RESULTS The prevalence of DR was 24.7%. The duration of diabetes and prevalence of neuropathy, nephropathy, cardiovascular disease, and recurrent infections were significantly higher among patients with DR compared with those without DR (p < 0.05). Serum urea, creatinine, glucose, cholesterol, and low-density lipoprotein cholesterol were significantly elevated, whilst eGFR and high-density lipoprotein cholesterol were significantly lower in patients with DR compared with patients without DR (p < 0.05). Urinary albumin concentration and albumin creatinine ratio (ACR) was higher in patients with DR. ACR correlated significantly with the duration of T2DM (r = 0.311, p < 0.001), glucose (r = 0.479, p < 0.001), urea (r = 0.337, p < 0.001), creatinine (r = 0.275, p = 0.001), and GFR (r = -0.275, p < 0.001). CONCLUSION These data show a high prevalence of DR in an unselected cohort of patients with T2DM and relationships to modifiable risk factors in Gaza.
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Affiliation(s)
- Ayman M. AbuMustafa
- Department of Health Research, Human Resources Development, Ministry of Health, Gaza, Palestine
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