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Tan R, Teo KYC, Husain R, Tan NC, Lee QX, Hamzah H, Wong T, Aung T, Cheng CY, Lamoureux EL, Tan CS, Wong HT, Wong TY, Tan GSW. Evaluating the outcome of screening for glaucoma using colour fundus photography-based referral criteria in a teleophthalmology screening programme for diabetic retinopathy. Br J Ophthalmol 2024; 108:933-939. [PMID: 37852739 PMCID: PMC11228193 DOI: 10.1136/bjo-2023-323339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/17/2023] [Indexed: 10/20/2023]
Abstract
AIMS To evaluate the effectiveness of glaucoma screening using glaucoma suspect (GS) referral criteria assessed on colour fundus photographs in Singapore's Integrated Diabetic Retinopathy Programme (SiDRP). METHODS A case-control study. This study included diabetic subjects who were referred from SiDRP with and without GS between January 2017 and December 2018 and reviewed at Singapore National Eye Centre. The GS referral criteria were based on the presence of a vertical cup-to-disc ratio (VCDR) of ≥0.65 and other GS features. The final glaucoma diagnosis confirmed from electronic medical records was retrospectively matched with GS status. The sensitivity, specificity and positive predictive value (PPV) of the test were evaluated. RESULTS Of 5023 patients (2625 with GS and 2398 without GS) reviewed for glaucoma, 451 (9.0%, 95% CI 8.2% to 9.8%) were confirmed as glaucoma. The average follow-up time was 21.5±10.2 months. Using our current GS referral criteria, the sensitivity, specificity and PPV were 81.6% (95% CI 77.7% to 85.1%), 50.6% (95% CI 49.2% to 52.1%) and 14.0% (95% CI 13.4% to 14.7%), respectively, resulting in 2257 false positive cases. Increasing the VCDR cut-off for referral to ≥0.80, the specificity increased to 93.9% (95% CI 93.1% to 94.5%) but the sensitivity decreased to 11.3% (95% CI 8.5% to 14.6%), with a PPV of 15.4% (95% CI 12.0% to 19.4%). CONCLUSIONS Opportunistic screening for glaucoma in a lower VCDR group could result in a high number of unnecessary referrals. If healthcare infrastructures are limited, targeting case findings on a larger VCDR group with high specificity will still be beneficial.
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Affiliation(s)
- Rose Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kelvin Yi Chong Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Save Sight Institute, Sydney, New South Wales, Australia
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
- SNEC Ocular Reading Centre, Singapore National Eye Centre, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
| | | | - Qian Xin Lee
- SNEC Ocular Reading Centre, Singapore National Eye Centre, Singapore
| | - Haslina Hamzah
- SNEC Ocular Reading Centre, Singapore National Eye Centre, Singapore
| | - Tina Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
| | - Ching Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ecosse Luc Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
| | - Colin S Tan
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
- Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore
| | - Hon-Tym Wong
- Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore
| | - Tien Y Wong
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
- Singapore National Eye Centre & Singapore Eye Research Institute, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, People's Republic of China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, People's Republic of China
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, National University of Singapore, Ophthalmology and Visual Sciences Academic Clinical Program, Singapore
- SNEC Ocular Reading Centre, Singapore National Eye Centre, Singapore
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Cao B, Zhang N, Zhang Y, Fu Y, Zhao D. Plasma cytokines for predicting diabetic retinopathy among type 2 diabetic patients via machine learning algorithms. Aging (Albany NY) 2020; 13:1972-1988. [PMID: 33323553 PMCID: PMC7880388 DOI: 10.18632/aging.202168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
AIMS This study aimed to investigate changes of plasma cytokines and to develop machine learning classifiers for predicting non-proliferative diabetic retinopathy among type 2 diabetes mellitus patients. RESULTS There were 12 plasma cytokines significantly higher in the non-proliferative diabetic retinopathy group in the pilot cohort. The validation cohort showed that angiopoietin 1, platelet-derived growth factor-BB, tissue inhibitors of metalloproteinase 2 and vascular endothelial growth factor receptor 2 were significantly higher in the NPDR group. Machine learning algorithms using the random forest yielded the best performance, with sensitivity of 92.3%, specificity of 75%, PPV of 82.8%, NPV of 88.2% and area under the curve of 0.84. CONCLUSIONS Plasma angiopoietin 1, platelet-derived growth factor-BB, and vascular endothelial growth factor receptor 2 were associated with presence of non-proliferative diabetic retinopathy and may be good biomarkers that play important roles in pathophysiology of diabetic retinopathy. MATERIALS AND METHODS In pilot cohort, 60 plasma cytokines were simultaneously measured. In validation cohort, angiopoietin 1, CXC-chemokine ligand 16, platelet-derived growth factor-BB, tissue inhibitors of metalloproteinase 1, tissue inhibitors of metalloproteinase 2, and vascular endothelial growth factor receptor 2 were validated using ELISA kits. Machine learning algorithms were developed to build a prediction model for non-proliferative diabetic retinopathy.
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Affiliation(s)
- Bin Cao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing 101149, China
| | - Ning Zhang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing 101149, China
| | - Yuanyuan Zhang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing 101149, China
| | - Ying Fu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing 101149, China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing 101149, China.,Beijing Key Laboratory of Diabetes Research and Care, Beijing 101149, China
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Yin L, Zhang D, Ren Q, Su X, Sun Z. Prevalence and risk factors of diabetic retinopathy in diabetic patients: A community based cross-sectional study. Medicine (Baltimore) 2020; 99:e19236. [PMID: 32118727 PMCID: PMC7478682 DOI: 10.1097/md.0000000000019236] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In China, there is a significant lack of awareness of diabetes and its complications. Screening of diabetic retinopathy has important for early detection, prevention, and treatment. This large, cross-sectional study aimed to characterize the demographic, physical, serological, and ocular characteristics of subjects with diabetes mellitus in Shijiazhuang, China. It also aimed to associate these characteristics with the presence of diabetic retinopathy.From May 2, 2018 to August 25, 2019, under diabetes care program, the diabetic patients (n = 1008) were subjected to standardized questionnaires to collect demographical characteristics. Also, telescreens and laboratory tests were performed for the enrolled patients. Multivariate logistic regression analysis was used to evaluate factors associated with diabetic retinopathy.Forty percent of diabetics in its population had some form of diabetic retinopathy. Diabetic retinopathic patients were likely to be elder (P = .0003), men (P = .018), hypertensive (P < .0001), and had high body mass index (P < .0001), metabolic abnormalities, and longer duration of diabetes (P < .0001). Higher intraocular pressure (P = .0008), fasting blood glucose (P < .0001), serum total cholesterol (P < .0001), serum triglyceride (P = .0006), % glycated hemoglobin (HbA1c) (P < .0001), and disc asymmetry including cup-disc ratio (P = .041) reported in patients with diabetic retinopathy. Age (P = .049), male sex (P = .048), hypertension (P = .048), duration of diabetes (P = .012), diabetic neuropathy (P = .048), diabetic nephropathy (P = .048), diabetic foot ulcer (P = .041), foot amputation (P = .042), fasting blood glucose (P = .022), serum total cholesterol (P = .028), serum triglyceride (P = .035), and HbA1c (P = .042) were associated with diabetic retinopathy.Diabetic retinopathy was the most common ocular fundus disease in diabetic patients. Also, aging, the other comorbidities, and metabolic syndrome are associated with diabetic retinopathy.Level of Evidence: III.
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Affiliation(s)
- Li Yin
- Department of Ophthalmology
| | - Delong Zhang
- The First Department of Geriatric, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
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Sapkota R, Chen Z, Zheng D, Pardhan S. The profile of sight-threatening diabetic retinopathy in patients attending a specialist eye clinic in Hangzhou, China. BMJ Open Ophthalmol 2019; 4:e000236. [PMID: 31179390 PMCID: PMC6528772 DOI: 10.1136/bmjophth-2018-000236] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background/aims To examine the profile of diabetic retinopathy, awareness and self-help in patients attending a specialist eye clinic in Hangzhou, China. Methods A total of 199 consecutive patients with diabetes (mean age = 57 years, SD = 11) attending eye clinic at the School of Medicine, Zhejiang University, Hangzhou were examined in a cross-sectional study. Clinical/demographic data were obtained from patients' records. Fundus photographs obtained from each patient were graded using Early Treatment of Diabetic Retinopathy Study (ETDRS) criteria; severe non-proliferative, proliferative retinopathy and/or macular oedema (hard exudates/thickening around fovea) were classified as sight-threatening diabetic retinopathy (STDR). Optical coherence tomography was used to confirm the diagnosis of macular oedema. Data on knowledge/awareness about diabetes and self-help/lifestyle were collected using a structured questionnaire. Results STDR was found in 80% patients of whom 18% had visual acuity of ≤counting fingers in at least one eye. Male gender, longer diabetic duration and use of insulin were significantly associated with STDR (p ≤ 0.05). Of the total, 41% patients reported that they were attending for the first time. Of all the first-time attendees, 67% had STDR. Also of all the first-time attendees, 14% were unclear whether diabetes affected their eyes. Fifty-one per cent of patients who thought their diabetes was well controlled had fasting blood sugar ≥6.5 mmol/L (p < 0.001). Of the total, 65% patients reported not doing ≥4 hours/week of physical exercise. Conclusions The majority of patients with diabetes presented to this eye clinic suffered with late-stage retinopathy. Our results advocate the need to improve diabetic diagnosis, management and awareness and to set up eye screening for diabetics in Hangzhou, China.
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Affiliation(s)
- Raju Sapkota
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dingchang Zheng
- School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Chelmsford Campus, Chelmsford, UK
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
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Lin S, Ramulu P, Lamoureux EL, Sabanayagam C. Addressing risk factors, screening, and preventative treatment for diabetic retinopathy in developing countries: a review. Clin Exp Ophthalmol 2016; 44:300-20. [DOI: 10.1111/ceo.12745] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 01/26/2016] [Accepted: 03/08/2016] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Ecosse L Lamoureux
- Singapore Eye Research Institute; Singapore
- Office of Clinical Sciences; Duke-NUS Medical School; Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute; Singapore
- Office of Clinical Sciences; Duke-NUS Medical School; Singapore
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The Prevalence and Distribution of Vitreoretinal Interface Abnormalities among Urban Community Population in China. J Ophthalmol 2015; 2015:742686. [PMID: 26759726 PMCID: PMC4674609 DOI: 10.1155/2015/742686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/23/2015] [Accepted: 11/01/2015] [Indexed: 02/08/2023] Open
Abstract
The aim of this research was to identify the prevalence and distribution of vitreoretinal interface abnormalities (VIAs) among urban community population in Shenyang, China. According to the WHO criteria, a cross-sectional study was carried out among 304 Type 2 diabetes (T2D) patients and 304 people without diabetes as control over 45 years old. The presence of VIAs was determined by standardized grading of macular optical coherence tomography (Optovue OCT; Optovue, Inc., Fremont, CA) scans and two-field fundus photographs in at least one eye. For both men and women, high prevalence of VIAs (70.79%) was observed among over 65-years-old T2D patients. Prevalence of VIAs was observed to be high among T2D patients in all age groups compared to normal subjects. Prevalence of VIAs increased with age in all subjects. Prevalence of components of VIAs was epiretinal membrane (ERM) 11.43%, posterior vitreous detachment (PVD) 17.76%, vitreomacular traction syndrome (VMT) 5.67%, macular cysts/macular edema (MC/ME) 4.61%, full-thickness macular hole (FTMH) 0.82%, and partial thickness macular hole (PTMH) 0.74% in any eye, respectively. ERM and MC/ME were more prevalent in T2D in both males and females. The results highlight the need for early detection using OCT and approaches for the prevention of VIAs of diabetes in urban community.
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Yue S, Zhang J, Wu J, Teng W, Liu L, Chen L. Use of the Monocyte-to-Lymphocyte Ratio to Predict Diabetic Retinopathy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10009-19. [PMID: 26308022 PMCID: PMC4555325 DOI: 10.3390/ijerph120810009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/13/2015] [Accepted: 08/18/2015] [Indexed: 12/21/2022]
Abstract
Background: Diabetic retinopathy (DR) is a common complication of type 2 diabetes mellitus (T2DM) and the leading cause of blindness in adults. DR pathogenesis has not been fully elucidated, but inflammation is widely accepted to play an important role. Emerging evidence suggests that the platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) are novel potential markers of inflammatory responses. The present study aimed to evaluate the associations between DR and the PLR, MLR, and NLR. Patients and Methods: We performed a case-control study involving 247 patients with T2DM. The patients were divided into three groups: 125 control subjects with T2DM, 63 diabetic subjects with non-proliferative diabetic retinopathy (NPDR), and 59 patients with proliferative diabetic retinopathy (PDR). Results: The mean PLR and NLR were significantly higher in patients with DR compared with patients without DR (p < 0.01, p = 0.02, respectively). The mean MLR in the NPDR group was higher than that of patients without DR, but there were no significant differences among the three groups (p = 0.07). Logistic regression showed that the MLR was an independent risk factor for DR (odds ratio [OR]: 54.574, 95% confidence interval [CI]: 2.708–1099.907). Based on the receiver operating characteristic (ROC) curve, use of the MLR as an indicator for DR diagnosis was projected to be 2.25, and yielded a sensitivity and specificity of 47.1% and 69.6%, respectively, with an area under the curve of 0.581 (95% CI: 0.510–0.653). Conclusions: The PLR and NLR are significantly increased in the setting of DR. After correcting for possible confounding factors, the MLR was found to be a risk factor for DR. Although the MLR may be pathophysiologically and clinically relevant in DR, its predictive ability was limited.
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Affiliation(s)
- Song Yue
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Jiahua Zhang
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Jingyang Wu
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Weiping Teng
- Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
| | - Lei Liu
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China.
| | - Lei Chen
- Department of Ophthalmology, The First Affiliated Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang 110001, China.
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Incidence Density and Risk Factors of Diabetic Retinopathy Within Type 2 Diabetes: A Five-Year Cohort Study in China (Report 1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:7899-909. [PMID: 26184262 PMCID: PMC4515698 DOI: 10.3390/ijerph120707899] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/29/2015] [Accepted: 07/07/2015] [Indexed: 11/17/2022]
Abstract
A prospective study was carried out from August 2010 to August 2014 in the community of Fengyutan (China). Six hundred and twenty two T2D subjects were collected. The incidence density of diabetic retinopathy (DR) was 1.81% person-year (95% confidence interval, CI: 1.21–2.43% person-year). After a Cox regression model analysis and adjusted confounding factors, independent predictors related to the incidence of DR including male gender (adjusted hazard ratios, aHR: 1.47, 95% CI: 1.21–1.62), with hypertension (aHR: 1.49, 95%: 1.12–1.73), duration of diabetes > 10 years (aHR: 2.28, 95%: 2.05–2.42), uncontrolled diabetes (aHR: 1.76, 95%: 1.41–2.01), total cholesterol ≥ 200 mg/dL (aHR: 1.54, 95%: 1.34–1.72) and HbA1c ≥ 7% (mmol/mol) (aHR: 2.12, 95%: 1.87–2.32). Duration of T2D revealed the significantly dose-response relationship to the onset of DR. The incidence density of DR in the Chinese community was relatively low in comparison with other studies. More attention should be paid to the T2D patients, especially of male gender, with hypertension, longer duration of diabetes, uncontrolled diabetes, total cholesterol ≥ 200mg/dL and HbA1c ≥ 7% (mmol/mol).
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Lin YT, Chen YC, Peng YT, Chen L, Liu JH, Chen FL, Tung TH. Evidence-Based Medicine of Screening of Diabetic Retinopathy among Type 2 Diabetes: A Clinical Overview. Health (London) 2015. [DOI: 10.4236/health.2015.77103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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