A Precise Method to Evaluate 360 Degree Measures of Optic Cup and Disc Morphology in an African American Cohort and Its Genetic Applications.

(1) Background: Vertical cup-to-disc ratio (CDR) is an important measure for evaluating damage to the optic nerve head (ONH) in glaucoma patients. However, this measure often does not fully capture the irregular cupping observed in glaucomatous nerves. We developed and evaluated a method to measure cup-to-disc ratio (CDR) at all 360 degrees of the ONH. (2) Methods: Non-physician graders from the Scheie Reading Center outlined the cup and disc on digital stereo color disc images from African American patients enrolled in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. After converting the resultant coordinates into polar representation, the CDR at each 360-degree location of the ONH was obtained. We compared grader VCDR values with clinical VCDR values, using Spearman correlation analysis, and validated significant genetic associations with clinical VCDR, using grader VCDR values. (3) Results: Graders delineated outlines of the cup contour and disc boundaries twice in each of 1815 stereo disc images. For both cases and controls, the mean CDR was highest at the horizontal bisector, particularly in the temporal region, as compared to other degree locations. There was a good correlation between grader CDR at the vertical bisector and clinical VCDR (Spearman Correlation OD: r = 0.78 [95% CI: 0.76-0.79]). An SNP in the MPDZ gene, associated with clinical VCDR in a prior genome-wide association study, showed a significant association with grader VCDR (p = 0.01) and grader CDR area ratio (p = 0.02). (4) Conclusions: The CDR of both glaucomatous and non-glaucomatous eyes varies by degree location, with the highest measurements in the temporal region of the eye. This method can be useful for capturing innate eccentric ONH morphology, tracking disease progression, and identifying genetic associations.

The English National Screening Programme for diabetic retinopathy 2003-2016.

The aim of the English NHS Diabetic Eye Screening Programme is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process. In order to achieve the delivery of evidence-based, population-based screening programmes, it was recognised that certain key components were required. It is necessary to identify the eligible population in order to deliver the programme to the maximum number of people with diabetes. The programme is delivered and supported by suitably trained, competent, and qualified, clinical and non-clinical staff who participate in recognised ongoing Continuous Professional Development and Quality Assurance schemes. There is an appropriate referral route for those with screen-positive disease for ophthalmology treatment and for assessment of the retinal status in those with poor-quality images. Appropriate assessment of control of their diabetes is also important in those who are screen positive. Audit and internal and external quality assurance schemes are embedded in the service. In England, two-field mydriatic digital photographic screening is offered annually to all people with diabetes aged 12 years and over. The programme commenced in 2003 and reached population coverage across the whole of England by 2008. Increasing uptake has been achieved and the current annual uptake of the programme in 2015-16 is 82.8% when 2.59 million people with diabetes were offered screening and 2.14 million were screened. The benefit of the programme is that, in England, diabetic retinopathy/maculopathy is no longer the leading cause of certifiable blindness in the working age group.

[Age, sex and diagnostic distribution of patients in ophthalmological medical practice in Germany]. / Die Patientenpopulation der augenärztlichen Praxen in Deutschland: Alter, Geschlecht und Diagnosen.

OBJECTIVE: The ophthalmological patient care in Germany has changed over the past decades due to demographic and diagnostic facility change and the shift from inpatient to outpatient care. METHOD: In the fourth quarter of 2010 a survey was conducted including almost 10 % of the patients of 96 ophthalmologists. The results for age, sex, main and secondary diagnosis and the main reason for the examination were examined and compared with those of surveys from 1966 and 1997. RESULTS: 15125 patients (median per doctor: 149, range: 45-376) were included in the survey. 58 % were women. The proportion of women was elevated in all decades compared to men, apart from the first age decade. The proportion of older patients (70 +) increased (1997: 25.3 %; 2010: 40.8 %) although the age distribution in Germany appears to be rather constant (1997: 11.9 %; 2010: 15.3 %). The proportion of examinations due to glaucoma, diabetes and vitreoretinal diseases increased by almost 60 % compared to 1997. CONCLUSION: Compared to the results of 1997, we observed a marked change from simple to differentiated cases in ophthalmological medical practice in Germany. The early diagnosis and therapy have to be guaranteed in the future taking into account the limited resources.