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Silva PS, Cavallerano JD, Sun JK, Tolson AM, Tolls D, Abrahamson MJ, Aiello LM, Aiello LP. Disparities Between Teleretinal Imaging Findings and Patient-Reported Diabetic Retinopathy Status and Follow-Up Eye Care Interval: A 10-Year Prospective Study. Diabetes Care 2024:dc232282. [PMID: 38457639 DOI: 10.2337/dc23-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To assess self-reported awareness of diabetic retinopathy (DR) and concordance of eye examination follow-up compared with findings from concurrent retinal images. RESEARCH DESIGN AND METHODS We conducted a prospective observational 10-year study of 26,876 consecutive patients with diabetes who underwent retinal imaging during an endocrinology visit. Awareness and concordance were evaluated using questionnaires and retinal imaging. RESULTS Awareness information and gradable images were available in 25,360 patients (94.3%). Severity of DR by imaging was as follows: no DR (n = 14,317; 56.5%), mild DR (n = 6,805; 26.8%), or vision-threatening DR (vtDR; n = 4,238; 16.7%). In the no, mild, and vtDR groups, 96.7%, 88.5%, and 54.9% of patients, respectively, reported being unaware of any prior DR. When DR was present, reporting no prior DR was associated with shorter diabetes duration, milder DR, last eye examination >1 year before, no dilation, no scheduled appointment, and less specialized provider (all P < 0.001). Among patients with vtDR, 41.2%, 58.1%, and 64.2% did not report being aware of any DR and follow-up was concordant with current DR severity in 66.7%, 41.3%, and 25.4% (P < 0.001) of patients when prior examination was performed by a retinal specialist, nonretinal ophthalmologist, or optometrist (P < 0.001), respectively. CONCLUSIONS Substantial discrepancies exist between DR presence, patient awareness, and concordance of follow-up across all DR severity levels. These discrepancies are present across all eye care provider types, with the magnitude influenced by provider type. Therefore, patient self-report should not be relied upon to reflect DR status. Modification of medical care and education models may be necessary to enhance retention of ophthalmic knowledge in patients with diabetes and ensure accurate communication between all health care providers.
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Affiliation(s)
- Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Ann M Tolson
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Martin J Abrahamson
- Adult Diabetes, Joslin Diabetes Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lloyd M Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
- Department of Ophthalmology, Harvard Medical School, Boston, MA
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Aiello LP, Jacoba CMP, Ashraf M, Cavallerano JD, Tolson AM, Tolls D, Sun JK, Silva PS. INTEGRATING MACULAR OPTICAL COHERENCE TOMOGRAPHY WITH ULTRAWIDE-FIELD IMAGING IN A DIABETIC RETINOPATHY TELEMEDICINE PROGRAM USING A SINGLE DEVICE. Retina 2023; 43:1928-1935. [PMID: 37871272 DOI: 10.1097/iae.0000000000003883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE To determine the effect of combined macular spectral-domain optical coherence tomography (SD-OCT) and ultrawide field retinal imaging (UWFI) within a telemedicine program. METHODS Comparative cohort study of consecutive patients with both UWFI and SD-OCT. Ultrawide field retinal imaging and SD-OOCT were independently evaluated for diabetic macular edema (DME) and nondiabetic macular abnormality. Sensitivity and specificity were calculated with SD-OCT as the gold standard. RESULTS Four hundred twenty-two eyes from 211 diabetic patients were evaluated. Diabetic macular edema severity by UWFI was as follows: no DME 93.4%, noncenter involved DME (nonciDME) 5.1%, ciDME 0.7%, ungradable DME 0.7%. SD-OCT was ungradable in 0.5%. Macular abnormality was identified in 34 (8.1%) eyes by UWFI and in 44 (10.4%) eyes by SD-OCT. Diabetic macular edema represented only 38.6% of referable macular abnormality identified by SD-OCT imaging. Sensitivity/specificity of UWFI compared with SD-OCT was 59%/96% for DME and 33%/99% for ciDME. Sensitivity/specificity of UWFI compared with SDOCT was 3%/98% for epiretinal membrane. CONCLUSION Addition of SD-OCT increased the identification of macular abnormality by 29.4%. More than 58.3% of the eyes believed to have any DME on UWF imaging alone were false-positives by SD-OCT. The integration of SD-OCT with UWFI markedly increased detection and reduced false-positive assessments of DME and macular abnormality in a teleophthalmology program.
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Affiliation(s)
- Lloyd Paul Aiello
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Mohamed Ashraf
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jerry D Cavallerano
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ann M Tolson
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
| | - Dorothy Tolls
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
| | - Jennifer K Sun
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Paolo S Silva
- Joslin Diabetes Center, Beetham Eye Institute, Boston, Massachusetts; and
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Jacoba CMP, Ashraf M, Cavallerano JD, Tolson AM, Tolls D, Pellegrini E, Fleming A, Sun JK, Aiello LP, Silva PS. Association of Maximizing Visible Retinal Area by Manual Eyelid Lifting With Grading of Diabetic Retinopathy Severity and Detection of Predominantly Peripheral Lesions When Using Ultra-Widefield Imaging. JAMA Ophthalmol 2022; 140:421-425. [PMID: 35201258 PMCID: PMC8874906 DOI: 10.1001/jamaophthalmol.2021.6363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Methods that increase visible retinal area (VRA; measured in millimeters squared) may improve identification of diabetic retinopathy (DR) lesions. OBJECTIVE To evaluate the association of dilation and manual eyelid lifting (MLL) with VRA on ultra-widefield imaging (UWFI) and the association of VRA with grading of DR severity and detection of predominantly peripheral lesions (PPLs). DESIGN, SETTING, AND PARTICIPANTS Retrospective, comparative case-control study at the Joslin Diabetes Center, Boston, Massachusetts. Nonmydriatic UWFI with MLL was acquired from a DR teleophthalmology program (Joslin Vision Network [JVN]). A second cohort of mydriatic UWFI was acquired at an academic retina practice (Beetham Eye Institute [BEI]) from November 6, 2017, to November 6, 2018, and with MLL thereafter until November 6, 2019. Fully automated algorithms determined VRA and hemorrhage and/or microaneurysm (HMA) counts. Predominantly peripheral lesions and HMAs were defined as present when at least 1 field had greater HMA number in the peripheral retina than within the corresponding Early Treatment Diabetic Retinopathy Study field. Participants included 3014 consecutive patients (5919 eyes) undergoing retinal imaging at JVN and BEI. EXPOSURES Dilation and MLL performed at the time of UWFI. MAIN OUTCOMES AND MEASURES Visible retinal area, DR severity, and presence of PPLs. RESULTS Of the 3014 participants, mean (SD) age was 56.1 (14.5) years, 1302 (43.2%) were female, 2450 (81.3%) were White, and mean (SD) diabetes duration was 15.9 (11.4) years. All images from 5919 eyes with UWFI were analyzed. Mean (SD) VRA was 665.1 (167.6) mm2 for all eyes (theoretical maximal VRA, 923.9 mm2), 550.8 (240.7) mm2 for nonmydriatic JVN with MLL (1418 eyes [24.0%]), 688.1 (119.9) mm2 for mydriatic BEI images (3650 eyes [61.7%]), and 757.0 (69.7) mm2 for mydriatic and MLL BEI images (851 eyes [14.4%]). Dilation increased VRA by 25% (P < .001) and MLL increased VRA an additional 10% (P < .001). Nonmydriatic MLL increased VRA by 11.0%. With MLL, HMA counts in UWFI fields increased by 41.7% (from 4.8 to 6.8; P < .001). Visible retinal area was moderately associated with increasing PPL-HMA overall and in each cohort (all, r = 0.33; BEI, r = 0.29; JVN, r = 0.36; P < .001). In JVN images, increasing VRA was associated with more PPL-HMA (quartile 1 [Q1], 23.7%; Q2, 45.8%; Q3, 60.6%; and Q4, 69.2%; P < .001). CONCLUSIONS AND RELEVANCE Using fully automated VRA and HMA detection algorithms, pupillary dilation and eyelid lifting were shown to substantially increase VRA and PLL-HMA detection. Given the importance of HMA and PPL for determining risk of DR progression, these findings emphasize the importance of maximizing VRA for optimal risk assessment in clinical trials and teleophthalmology programs.
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Affiliation(s)
- Cris Martin P. Jacoba
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Mohamed Ashraf
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jerry D. Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Ann M. Tolson
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jennifer K. Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Paolo S. Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Silva PS, Gupta A, Ajlan RS, Schlossman DK, Tolson AM, Cavallerano JD, Aiello LP. Ultrawide field scanning laser ophthalmoscopy imaging of lipemia retinalis. Acta Ophthalmol 2018; 96:e643-e646. [PMID: 28772065 DOI: 10.1111/aos.13525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/05/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the characteristic retinal features of lipemia retinalis when using ultrawide field scanning laser ophthalmoscopy. MAIN POINTS We report a case series of three subjects with ultrawide field retinal images showing cream discoloration of the fundus, light salmon-coloured posterior retinal vessels and greyish pink peripheral vasculature. On green-only imaging, many of the vessels appear light rather than typically dark. CONCLUSION Lipemia retinalis is readily apparent on ultrawide field imaging and illustrates the alterations that systemic diseases may induce in the posterior and peripheral retinal vasculature. Ultrawide field imaging highlights the disparate vascular appearance of the posterior pole and retinal periphery in this condition.
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Affiliation(s)
- Paolo S. Silva
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
- Department of Ophthalmology; Harvard Medical School; Boston MA USA
- Teleophthalmology and Image Reading Center; Philippine Eye Research Institute; National Institutes of Health; University of the Philippines; Manila Philippines
| | - Aditi Gupta
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
| | - Radwan S. Ajlan
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
| | - Deborah K. Schlossman
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
- Department of Ophthalmology; Harvard Medical School; Boston MA USA
| | - Ann M. Tolson
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
| | - Jerry D. Cavallerano
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
- Department of Ophthalmology; Harvard Medical School; Boston MA USA
| | - Lloyd Paul Aiello
- Beetham Eye Institute; Joslin Diabetes Center; Boston MA USA
- Department of Ophthalmology; Harvard Medical School; Boston MA USA
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Silva PS, Cavallerano JD, Haddad NMN, Tolls D, Thakore K, Patel B, Sehizadeh M, Tolson AM, Sun JK, Aiello LP. Comparison of Nondiabetic Retinal Findings Identified With Nonmydriatic Fundus Photography vs Ultrawide Field Imaging in an Ocular Telehealth Program. JAMA Ophthalmol 2016; 134:330-4. [PMID: 26795026 DOI: 10.1001/jamaophthalmol.2015.5605] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Ultrawide field imaging (UWFI) is increasingly being used in teleophthalmology settings. Given the greater area of the retina imaged, we evaluated the ability of UWFI vs nonmydriatic fundus photography (NMFP) to detect nondiabetic retinal findings in a teleophthalmology program. OBSERVATION We conducted a retrospective single-center comparative cohort study from January 1, 2011, to June 30, 2013, imaging 3864 and 3971 consecutive teleophthalmology patients (7728 and 7942 eyes) using NMFP and UWFI, respectively. Standard diabetic retinopathy evaluation and nondiabetic findings were compared between the 2 imaging modalities. In patients without diabetic retinopathy (2243 by NMFP and 2252 by UWFI), the rate of identification of nondiabetic findings by NMFP (451 patients [20.1%]) and UWFI (490 [21.8%]) were comparable (P = .19). Ultrawide field imaging increased the identification of choroidal nevi by 27% (406 eyes [5.3%] by NMFP vs 545 eyes [6.9%] by UWFI; P < .001) and chorioretinal atrophy or scarring by 116% (50 eyes [0.6%] by NMFP vs 101 eyes [1.3%] by UWFI; P < .001). No peripheral retinal findings were identified with NMFP, while UWFI detected 25 retinal tears (0.3%; P < .001), 54 lattice and peripheral degenerations (0.7%; P < .001), and 142 cases of vitreous detachment or floaters (1.8%; P < .001). Data analysis was performed from November 1, 2013, to May 1, 2014. CONCLUSIONS AND RELEVANCE In eyes without diabetic retinopathy, approximately 20% may have ocular findings identified on retinal imaging, which emphasizes the role of retinal imaging in patients with diabetes mellitus type 1 and type 2 regardless of the severity of retinopathy. In this cohort, UWFI increased the identification of peripheral retinal and vitreous pathologic findings.
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Affiliation(s)
- Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts3Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, University of the Philippines, M
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | | | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Komal Thakore
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Bina Patel
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts4New England College of Optometry, Boston, Massachusetts
| | - Mina Sehizadeh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Ann M Tolson
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts2Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Silva PS, Cavallerano JD, Tolson AM, Rodriguez J, Rodriguez S, Ajlan R, Tolls D, Patel B, Sehizadeh M, Thakore K, Sun JK, Aiello LP. Real-Time Ultrawide Field Image Evaluation of Retinopathy in a Diabetes Telemedicine Program. Diabetes Care 2015; 38:1643-9. [PMID: 26033507 DOI: 10.2337/dc15-0161] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 05/12/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the ability of trained nonphysician retinal imagers to perform diabetic retinopathy (DR) evaluation at the time of ultrawide field retinal (UWF) imaging in a teleophthalmology program. RESEARCH DESIGN AND METHODS Clinic patients with diabetes received Joslin Vision Network protocol retinal imaging as part of their standard medical care. Retinal imagers evaluated UWF images for referable DR at the time of image capture. Training of the imagers included 4 h of standardized didactic lectures and 12 h of guided image review. Real-time evaluations were compared with standard masked gradings performed at a centralized reading center. RESULTS A total of 3,978 eyes of 1,989 consecutive patients were imaged and evaluated. By reading center evaluation, 3,769 eyes (94.7%) were gradable for DR, 1,376 (36.5%) had DR, and 580 (15.3%) had referable DR. Compared with the reading center, real-time image evaluation had a sensitivity and specificity for identifying more than minimal DR of 0.95 (95% CI 0.94-0.97) and 0.84 (0.82-0.85), respectively, and 0.99 (0.97-1.00) and 0.76 (0.75-0.78), respectively, for detecting referable DR. Only three patients with referable DR were not identified by imager evaluation. CONCLUSIONS Point-of-care evaluation of UWF images by nonphysician imagers following standardized acquisition and evaluation protocols within an established teleophthalmology program had good sensitivity and specificity for detection of DR and for identification of referable retinal disease. With immediate image evaluation, <0.1% of patients with referable DR would be missed, reading center image grading burden would be reduced by 60%, and patient feedback would be expedited.
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Affiliation(s)
- Paolo S Silva
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA Teleophthalmology and Image Reading Center, Philippine Eye Research Institute, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Jerry D Cavallerano
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Ann M Tolson
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | | | | | - Radwan Ajlan
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Dorothy Tolls
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Bina Patel
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA New England College of Optometry, Boston, MA
| | - Mina Sehizadeh
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Komal Thakore
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA
| | - Jennifer K Sun
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA
| | - Lloyd Paul Aiello
- Beetham Eye Institute, Joslin Diabetes Center, Boston, MA Department of Ophthalmology, Harvard Medical School, Boston, MA
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Silva PS, Cavallerano JD, Tolls D, Omar A, Thakore K, Patel B, Sehizadeh M, Tolson AM, Sun JK, Aiello LM, Aiello LP. Potential efficiency benefits of nonmydriatic ultrawide field retinal imaging in an ocular telehealth diabetic retinopathy program. Diabetes Care 2014; 37:50-5. [PMID: 23939541 DOI: 10.2337/dc13-1292] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare efficiency of nonmydriatic ultrawide field retinal imaging (UWFI) and nonmydriatic fundus photography (NMFP) in a diabetic retinopathy (DR) ocular telehealth program. RESEARCH DESIGN AND METHODS Patients in this retrospective, comparative cohort study underwent NMFP and UWFI between 1 November 2011 and 1 November 2012. Images were evaluated for DR and diabetic macular edema (DME) by certified graders using a standard protocol at a centralized reading center. Identification of DR, image evaluation time, and rate of ungradable eyes were compared. RESULTS NMFP and UWFI were performed in 1,633 and 2,170 consecutive patients, respectively. No statistically significant differences were found between groups regarding age, diabetes duration, sex, ethnicity, or insulin use. The ungradable rate per patient for DR (2.9 vs. 9.9%, P < 0.0001) and DME (3.8 vs. 8.8%, P < 0.0001) was lower with UWFI than with NMFP. With UWFI, the median image evaluation time per patient was reduced from 12.8 to 9.2 min (P < 0.0001). The identification of patients with DR (38.4 vs. 33.8%) and vision-threatening DR (14.5 vs. 11.9%) was increased with UWFI versus NMFP. In a consecutive subgroup of 502 eyes of 301 patients with DR, the distribution of peripheral retinal lesions outside Early Treatment Diabetic Retinopathy Study fields suggested a more severe DR level in 9.0% (45 eyes). CONCLUSIONS In a standardized DR ocular telehealth program, nonmydriatic UWFI reduced the ungradable rate by 71% (to <3%) and reduced image evaluation time by 28%. DR was identified 17% more frequently after UWFI, and DR peripheral lesions suggested a more severe DR level in 9%. These data suggest that UWFI may improve efficiency of ocular telehealth programs evaluating DR and DME.
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Cavallerano JD, Silva PS, Tolson AM, Francis T, Tolls D, Patel B, Eagan S, Aiello LM, Aiello LP. Imager evaluation of diabetic retinopathy at the time of imaging in a telemedicine program. Diabetes Care 2012; 35:482-4. [PMID: 22238278 PMCID: PMC3322720 DOI: 10.2337/dc11-1317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program. RESEARCH DESIGN AND METHODS Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers. RESULTS Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90-1.00; specificity 0.97, 0.94-0.99). CONCLUSIONS Appropriately trained imagers can accurately identify stDR at the time of imaging.
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Abstract
Lipoprotein lipase is heterogeneous, and it was suggested that the enzyme in adipose tissue is transformed from a species of mol. wt. approx. 120000 to forms of much higher molecular weight as it is secreted from the fat-cell. This paper demonstrates that the forms of higher molecular weight are probably artifacts. Enzyme preparations were characterized by gel filtration, by density-gradient centrifugation and by affinity chromatography. The results indicate that the enzyme forms of mol. wt. greater than 120000 result from an association of the enzyme with particulate material. It is therefore necessary to reconsider schemes that have recently been proposed for the synthesis and export of lipoprotein lipase.
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