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Zhao M, Chandra A, Liu L, Zhang L, Xu J, Li J. Investigation of the reasons for delayed presentation in proliferative diabetic retinopathy patients. PLoS One 2024; 19:e0291280. [PMID: 38421962 PMCID: PMC10903851 DOI: 10.1371/journal.pone.0291280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
AIM To investigate reasons for delayed presentation in patients with proliferative diabetic retinopathy (PDR). METHODS A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors. RESULTS A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73-26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70-83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36-3.09, p<0.001). CONCLUSIONS This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.
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Affiliation(s)
- Meng Zhao
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospiospital, Dongcheng District, Beijing, 100730, China
| | - Aman Chandra
- Mid & South Essex NHS Foundation Trust (Southend University Hospital) Prittlewell Chase Essex SS00RY, Southend-on-Sea, United Kingdom
- Anglia Ruskin University, Cambridge, United Kingdom
| | - Lin Liu
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospiospital, Dongcheng District, Beijing, 100730, China
| | - Lin Zhang
- Endocrinology, Beijing Tongren Hospital, Capital Medical University, Dongcheng District, Beijing, 100730, China
| | - Jun Xu
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospiospital, Dongcheng District, Beijing, 100730, China
| | - Jipeng Li
- Ophthalmology, Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospiospital, Dongcheng District, Beijing, 100730, China
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Zhou J, Zhu L, Li Y. Association between the triglyceride glucose index and diabetic retinopathy in type 2 diabetes: a meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1302127. [PMID: 38130393 PMCID: PMC10733479 DOI: 10.3389/fendo.2023.1302127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023] Open
Abstract
The triglyceride-glucose (TyG) index is an accessible and reliable surrogate indicator of insulin resistance and is strongly associated with diabetes. However, its relationship with diabetic retinopathy (DR) remains controversial. This meta-analysis aimed to assess the relationship between the TyG index and the prevalence of DR. Initial studies were searched from PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) electronic databases. The retrieval time range was from the establishment of the database to June 2023. Pooled estimates were derived using a random-effects model and reported as odds ratio (OR) with 95% confidence intervals (CIs). Two researchers independently assessed the methodological quality of the included studies. The Newcastle-Ottawa Quality Scale (NOS) was utilized to assess cohort studies or case-control studies. The Agency for Healthcare Research and Quality (AHRQ) methodology checklist was applied to assess cross-sectional studies. Ten observational studies encompassing 13716 patients with type 2 diabetes were included in the meta-analysis. The results showed that a higher TyG index increased the risk of DR compared with a low TyG index (OR: 2.34, 95% CI: 1.31-4.19, P < 0.05). When the index was analyzed as a continuous variable, consistent results were observed (OR: 1.48, 95% CI: 1.12-1.97, P < 0.005). There was no significant effect on the results of the sensitivity analyses excluding one study at a time (P all < 0.05). A higher TyG index may be associated with an increased prevalence of DR in patients with type 2 diabetes. However, high-quality cohort or case-control studies are needed to further substantiate this evidence. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023432747.
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Affiliation(s)
- Jianlong Zhou
- Department of Traditional Chinese Medicine, People’s Hospital of Deyang City, Deyang, China
| | - Lv Zhu
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yadi Li
- Department of Traditional Chinese Medicine, People’s Hospital of Deyang City, Deyang, China
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Fernández-Gutiérrez DÁ, Núñez-Marrero J, Martínez-Alberto CE, Rodríguez-Álvaro M, García-Hernández AM, Brito-Brito PR. Knowledge of Diabetic Retinopathy among Primary Care Nurses Performing Fundus Photography and Agreement with Ophthalmologists on Screening. NURSING REPORTS 2023; 13:1064-1076. [PMID: 37606461 PMCID: PMC10443370 DOI: 10.3390/nursrep13030093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the complications of diabetes mellitus (DM), with macular oedema being one of the leading causes of avoidable blindness among individuals with DM worldwide. Fundus screening is the only method for early detection and treatment. High-quality training programmes for professionals performing primary care screening are essential to produce high-quality images that facilitate accurate lesion identification. This is a two-phase observational, descriptive, and cross-sectional study. The first phase analysed DR knowledge in a sample of nurses. The second phase explored agreement on DR screening between referral ophthalmologists in image assessment (gold standard) and a small group of nurses involved in the previous phase. In phase 1, the agreement rate for screening results was 90%. In phase 2, the overall raw agreement on the screening of fundus photography results between nurses and ophthalmologists was 75% (Cohen's kappa = 0.477; p < 0.001). Agreement on screening with ophthalmologists was moderate, suggesting that implementing a specific training programme for nurse-led imaging screening would help develop this competence among nurses, ensuring a good level of agreement and patient safety and adding value for users, and also for the sustainability of the healthcare system. This study was not registered.
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Affiliation(s)
- Domingo Ángel Fernández-Gutiérrez
- Nursing Department, Faculty of Healthcare Sciences, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain; (D.Á.F.-G.); (P.R.B.-B.)
- Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Spain;
| | - Janet Núñez-Marrero
- Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Spain;
| | | | - Martín Rodríguez-Álvaro
- Health Services Management Board of La Palma, The Canary Islands Health Service, 38713 Breña Alta, Spain
| | | | - Alfonso Miguel García-Hernández
- Nursing Department, Faculty of Healthcare Sciences, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain; (D.Á.F.-G.); (P.R.B.-B.)
| | - Pedro Ruymán Brito-Brito
- Nursing Department, Faculty of Healthcare Sciences, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain; (D.Á.F.-G.); (P.R.B.-B.)
- Primary Care Management Board of Tenerife, The Canary Islands Health Service, 38003 Santa Cruz de Tenerife, Spain;
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Jacoba CMP, Salongcay RP, Rageh AK, Aquino LAC, Alog GP, Saunar AV, Peto T, Silva PS. Comparisons of Handheld Retinal Imaging with Optical Coherence Tomography for the Identification of Macular Pathology in Patients with Diabetes. Ophthalmic Res 2023; 66:903-912. [PMID: 37080187 DOI: 10.1159/000530720] [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: 02/15/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
INTRODUCTION Handheld retinal imaging cameras are relatively inexpensive and highly portable devices that have the potential to significantly expand diabetic retinopathy (DR) screening, allowing a much broader population to be evaluated. However, it is essential to evaluate if these devices can accurately identify vision-threatening macular diseases if DR screening programs will rely on these instruments. Thus, the purpose of this study was to evaluate the detection of diabetic macular pathology using monoscopic macula-centered images using mydriatic handheld retinal imaging compared with spectral domain optical coherence tomography (SDOCT). METHODS Mydriatic 40°-60° macula-centered images taken with 3 handheld retinal imaging devices (Aurora [AU], SmartScope [SS], RetinaVue 700 [RV]) were compared with the Cirrus 6000 SDOCT taken during the same visit. Images were evaluated for the presence of diabetic macular edema (DME) on monoscopic fundus photographs adapted from Early Treatment Diabetic Retinopathy Study (ETDRS) definitions (no DME, noncenter-involved DME [non-ciDME], and center-involved DME [ciDME]). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for each device with SDOCT as gold standard. RESULTS Severity by ETDRS photos: no DR 33.3%, mild NPDR 20.4%, moderate 14.2%, severe 11.6%, proliferative 20.4%, and ungradable for DR 0%; no DME 83.1%, non-ciDME 4.9%, ciDME 12.0%, and ungradable for DME 0%. Gradable images by SDOCT (N = 217, 96.4%) showed no DME in 75.6%, non-ciDME in 9.8%, and ciDME in 11.1%. The ungradable rate for images (poor visualization in >50% of the macula) was AU: 0.9%, SS: 4.4%, and RV: 6.2%. For DME, sensitivity and specificity were similar across devices (0.5-0.64, 0.93-0.97). For nondiabetic macular pathology (ERM, pigment epithelial detachment, traction retinal detachment) across all devices, sensitivity was low to moderate (0.2-0.5) but highly specific (0.93-1.00). CONCLUSIONS Compared to SDOCT, handheld macular imaging attained high specificity but low sensitivity in identifying macular pathology. This suggests the importance of SDOCT evaluation for patients suspected to have DME on fundus photography, leading to more appropriate referral refinement.
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Affiliation(s)
- Cris Martin P Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Recivall P Salongcay
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Centre for Public Health, Queen's University, Belfast, UK
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Abdulrahman K Rageh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lizzie Anne C Aquino
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
| | - Glenn P Alog
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Aileen V Saunar
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
| | - Tunde Peto
- Centre for Public Health, Queen's University, Belfast, UK
| | - Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Philippine Eye Research Institute, University of the Philippines, Manila, Philippines
- Eyes and Vision Institute, The Medical City, Pasig City, Philippines
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El-Ateif S, Idri A. Single-modality and joint fusion deep learning for diabetic retinopathy diagnosis. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Gupta V, Azad SV, Vashist P, Senjam SS, Kumar A. Diabetic retinopathy screening in the public sector in India: What is needed? Indian J Ophthalmol 2022; 70:759-767. [PMID: 35225509 PMCID: PMC9114582 DOI: 10.4103/ijo.ijo_1298_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
India has been witnessing an epidemic of diabetes for several years now. A large proportion of patients with undiagnosed and poorly controlled diabetes are at great risk of developing diabetic retinopathy (DR) and irreversible blindness. The goal of DR screening is to identify people with sight-threatening DR early so that prompt treatment can be initiated, and blindness can be prevented. Systematic DR screening is essential to identify disease early, and a national effort for the same is required. We adopt a health system approach to outline the actions that need to take place for effective DR screening in the public sector in India. We discuss the role of national leadership, needs assessment, finalization of DR screening and referral pathway, trainings, strategies to improve the uptake, allocation of roles and responsibilities, public-private partnerships, quality control, and financing.
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Affiliation(s)
- Vivek Gupta
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Shorya Vardhan Azad
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Praveen Vashist
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Suraj S Senjam
- Community Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Atul Kumar
- Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Jimenez-Carmona S, Alemany-Marquez P, Alvarez-Ramos P, Mayoral E, Aguilar-Diosdado M. Validation of an Automated Screening System for Diabetic Retinopathy Operating under Real Clinical Conditions. J Clin Med 2021; 11:jcm11010014. [PMID: 35011754 PMCID: PMC8745311 DOI: 10.3390/jcm11010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background. Retinopathy is the most common microvascular complication of diabetes mellitus. It is the leading cause of blindness among working-aged people in developed countries. The use of telemedicine in the screening system has enabled the application of large-scale population-based programs for early retinopathy detection in diabetic patients. However, the need to support ophthalmologists with other trained personnel remains a barrier to broadening its implementation. Methods. Automatic diagnosis of diabetic retinopathy was carried out through the analysis of retinal photographs using the 2iRetinex software. We compared the categorical diagnoses of absence/presence of retinopathy issued by family physicians (PCP) with the same categories provided by the algorithm (ALG). The agreed diagnosis of three specialist ophthalmologists is used as the reference standard (OPH). Results. There were 653 of 3520 patients diagnosed with diabetic retinopathy (DR). Diabetic retinopathy threatening to vision (STDR) was found in 82 patients (2.3%). Diagnostic sensitivity for STDR was 94% (ALG) and 95% (PCP). No patient with proliferating or severe DR was misdiagnosed in both strategies. The k-value of the agreement between the ALG and OPH was 0.5462, while between PCP and OPH was 0.5251 (p = 0.4291). Conclusions. The diagnostic capacity of 2iRetinex operating under normal clinical conditions is comparable to screening physicians.
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Affiliation(s)
- Soledad Jimenez-Carmona
- Ophthalmology Department, Hospital Universitario Puerta del Mar, University of Cadiz, 11009 Cadiz, Spain;
- Correspondence: (S.J.-C.); (P.A.-M.)
| | - Pedro Alemany-Marquez
- Ophthalmology Department, Hospital Universitario Puerta del Mar, University of Cadiz, 11009 Cadiz, Spain;
- Correspondence: (S.J.-C.); (P.A.-M.)
| | - Pablo Alvarez-Ramos
- Ophthalmology Department, Hospital Universitario Puerta del Mar, University of Cadiz, 11009 Cadiz, Spain;
| | - Eduardo Mayoral
- Comprehensive Healthcare Plan for Diabetes, Regional Ministry of Health and Families of Andalusia, Government of Andalusia, 41020 Seville, Spain;
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