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1.
PLoS One ; 15(1): e0225300, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31917793

RESUMO

Dilated eye exams are the standard of care to detect advancing, vision threatening, but often asymptomatic retinopathy in a timely fashion, allowing for vision preserving treatments. Annual exam rates are suboptimal, especially in underserved populations. Although teleophthalmology programs tremendously improve annual exam rates in low income/under resourced settings, widespread adoption is limited. Using a mixed methods approach, three focus groups and individual interviews were conducted for patients with type 2 diabetes (N = 23) who had a teleophthalmology exam or a dilated eye exam. A survey and discussion assessed patients' perspectives and value of teleophthalmology, including willingness to pay (WTP). Financial, transportation, and motivational barriers to obtaining an annual dilated eye exam were identified. Patients greatly valued having primary care (PC) based teleophthalmology for its convenience and ability to detect disease to allow for timely treatment and would recommend such a service. Although their WTP was at least the amount of their usual copay, cost was universally cited as a concern. Having a conveniently offered PC based teleophthalmology exam was valued. Educating patients on the value and costs of having such exams may be helpful to encourage informed discussions on eye care, especially in low income, underserved populations. Our study is among the few to provide insight on the value and perceptions of teleophthalmology in US low income, urban minority populations needed to help increase uptake of this innovation. Using surveys followed by facilitated discussion allowed for richer and more varied responses.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Oftalmologia/métodos , Telemedicina , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/epidemiologia , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Exame Físico , Pobreza , Atenção Primária à Saúde , População Urbana
2.
Eur J Ophthalmol ; 30(1): 72-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30764665

RESUMO

PURPOSE: To determine whether anemia and other demographic or laboratory "risk factors" impact anti-vascular endothelial growth factor treatment in diabetic macular edema patients. METHODS: This is a retrospective, time-varying cohort study using a medical claims database to identify new diabetic macular edema patients who had received at least one intravitreal injection of anti-vascular endothelial growth factor. Exclusion occurred for having <2 years in the plan prior to diabetic macular edema diagnosis, any history of proliferative retinopathy or any treatment that is used for diabetic macular edema. Covariates of interest were demographic characteristics, laboratory values, and clinical factors such as previous anti-vascular endothelial growth factor used, number of involved eyes, year of treatment, and time since last injection. Those variables that changed with time were assessed and updated at each visit. The main outcome measure was the odds of receiving treatment at any visit. RESULTS: In total, 189 new diabetic macular edema patients with follow-up were analyzed, covering 729 visits with 543 (74.5%) receiving treatment. Univariate analysis showed that male gender (odds ratio: 0.54, 95% confidence interval: 0.32-0.91, p = 0.03), every week since last injection (odds ratio: 0.94, 95% confidence interval: 0.91-0.97, p = 0.001), and having two eyes affected (odds ratio: 2.09, 95% confidence interval: 1.10-3.97, p = 0.02) were associated with getting an injection. After multivariate analysis, only time since previous injection with every week that passed reduced the odds on having an injection at the next visit (odds ratio: 0.95, 95% confidence interval: 0.92-0.97, p < 0.001). Anemia was not associated with receiving an injection (odds ratio: 1.05, 95% confidence interval: 0.61-1.80, p = 0.86). CONCLUSION: This study used time-varying methodology to better identify which patients will likely need an injection at any one visit. While anemia was not found to impact injections, our results can aid future endeavors that may incorporate clinical visit information in developing a full prediction model to help make diabetic macular edema care more efficient.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Idoso , Anemia/complicações , Bevacizumab/uso terapêutico , Estudos de Coortes , Retinopatia Diabética/diagnóstico , Feminino , Humanos , Injeções Intravítreas , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Ranibizumab/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores , Acuidade Visual/fisiologia
3.
Eur J Ophthalmol ; 30(1): 19-25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30409042

RESUMO

PURPOSE: To investigate the effect of microalbuminuria on macular thickness in patients with type-2 diabetes mellitus with no or mild diabetic retinopathy and to investigate the relationship between macular thickness and metabolic parameters. MATERIALS AND METHODS: Fifty eight eyes of 58 patients without diabetic retinopathy (group 1) in microalbuminuria stage, 42 eyes of 42 patients with mild diabetic retinopathy (group 2) in microalbuminuria stage, and 50 eyes of 50 patients without diabetic retinopathy and microalbuminuria (group 3) were included in this study. After detailed ophthalmologic examination, all patients underwent spectral domain-optical coherence tomography measurements. Macular thickness was noted from nine different areas (fovea, four parafoveal, and four perifoveal areas) and compared between groups. The correlations between macular thickness and age, duration of diabetes mellitus, microalbuminuria, serum urea, creatinine, glycosylated hemoglobin (HbAIc), albumin, sodium (Na), and urinary Na were evaluated. RESULTS: The mean age was 53.29 ± 6.49 in group 1, 55.86 ± 6.97 in group 2, and 52.98 ± 5.66 years in group 3 (p = 0.06). The macular thickness values of superior, inferior, and nasal parafoveal areas were significantly different between groups (p = 0.001, p = 0.006, and p = 0.03, respectively). Bonferroni post test revealed that this difference originated from the difference between group 2 and 3 (p < 0.05 for all values). There were significant negative correlations between the macular thickness values of parafoveal areas and serum urea, HbA1c, albumin, microalbuminuria levels (p < 0.05 for all values). CONCLUSION: In this study, a significantly decreased parafoveal macular thickness was measured in patients with mild diabetic retinopathy and microalbuminuria compared to patients without diabetic retinopathy and microalbuminuria.


Assuntos
Albuminúria/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Retina/patologia , Adulto , Idoso , Albuminúria/sangue , Albuminúria/urina , Creatinina/urina , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/urina , Retinopatia Diabética/sangue , Retinopatia Diabética/urina , Feminino , Fóvea Central , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Sódio/urina , Tomografia de Coerência Óptica/métodos , Ureia/sangue
4.
Einstein (Sao Paulo) ; 18: eGS4913, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31531556

RESUMO

OBJECTIVE: To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. METHODS: A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. RESULTS: A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. CONCLUSION: Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Atenção Primária à Saúde/estatística & dados numéricos , Retina , Doenças Retinianas/diagnóstico , Idoso , Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/economia , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Exame Físico , Estudos Retrospectivos , Telemedicina , Acuidade Visual
5.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(10): 639-646, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184791

RESUMO

Introducción: Ciertos polimorfismos de los genes de la miosina no muscular de tipo IIA (MYH9) y de la apolipoproteína L1 (APOL1) se han asociado con la enfermedad renal crónica (ERC) en distintas poblaciones. Este estudio evaluó la asociación entre los polimorfismos rs2032487 de MYH9 y rs73885319 de APOL1 con la ERC avanzada asociada a diabetes tipo 2 en una población de Gran Canaria. Material y métodos: Los polimorfismos se genotiparon en 152 pacientes con ERC avanzada (filtrado glomerular estimado [FGe] < 30 ml/min/1,73 m2) secundaria a diabetes tipo 2, 110 pacientes con diabetes tipo 2 con evolución ≥ 20 años sin ERC avanzada (FGe ≥ 45 ml/min/1,73 m2 y ausencia de proteinuria) y 292 hemodonantes sanos de más de 50 años sin ERC ni diabetes. Resultados: La frecuencia del alelo de riesgo de rs2032487 fue de 10,7% entre pacientes con diabetes y ERC avanzada, 7,1% en aquellos con diabetes sin ERC avanzada y 6,1% en los sujetos sanos, alcanzándose diferencias significativas entre el primer y el tercer grupo (P = 0,015). El 78,5% de los sujetos con ERC avanzada eran homocigotos para el alelo protector, frente al 87,9% en los otros dos grupos (P = 0,015 y P = 0,016, respectivamente). La frecuencia del alelo de riesgo del polimorfismo rs73885319 no superó el 0,5% en ninguno de los tres grupos. Conclusiones: Estos datos sugieren que el polimorfismo rs2032487 se asocia con la ERC avanzada asociada a diabetes tipo 2 en la población de Gran Canaria


Introduction: Certain polymorphisms in the non-muscle myosin IIA (MYH9) and apolipoprotein L1 (APOL1) genes have been associated to chronic kidney disease (CKD) in different populations. This study examined the association between the MHY9 rs2032487 and APOL1 rs73885319 polymorphisms and advanced CKD related to type 2 diabetes mellitus (T2DM) in a population of Gran Canaria (Canary Islands, Spain). Patients and methods: Polymorphisms were genotyped in 152 patients with advanced CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2) secondary to T2DM, 110 patients with T2DM onset ≥ 20 years before without advanced CKD (eGFR ≥ 45 mL/min/1.73 m2 and no proteinuria), and 292 healthy blood donors over 50 years of age without CKD or diabetes. Results: The frequency of the risk allele for rs2032487 was 10.7% in patients with diabetes and advanced CKD, 7.1% in those with diabetes but without advanced CKD, and 6.1% in healthy subjects, with significant differences between the first and third groups (P = .015). Among subjects with advanced CKD, 78.5% were homozygous for the protective allele, as compared to 87.9% in the other two groups (P = .015 and P = .016 respectively). The frequency of the risk allele for the rs73885319 polymorphism did not exceed 0.5% in any of the three groups. Conclusions: These data suggest that polymorphism rs2032487 is associated to advanced CKD related to T2DM in the population of Gran Canaria


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Polimorfismo de Nucleotídeo Único , Insuficiência Renal Crônica/genética , Diabetes Mellitus Tipo 2/genética , Predisposição Genética para Doença , Insuficiência Renal Crônica/complicações , Taxa de Filtração Glomerular , Retinopatia Diabética/diagnóstico , Técnicas de Genotipagem , Razão de Chances , Análise Estatística
6.
Ophthalmic Surg Lasers Imaging Retina ; 50(10): 608-612, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671192

RESUMO

BACKGROUND AND OBJECTIVE: To analyze the examination practices and referral of patients with diabetic retinopathy (DR) by optometrists in routine clinical care. PATIENTS AND METHODS: Diabetic patient records from 2012 to 2018 were retrospectively reviewed for documentation of dilated fundus exam (DFE), imaging, follow-up appointments, and referrals. Concordance between clinical exam and coding was also analyzed. RESULTS: For 97.8% of encounters, DFE was performed, the patient was referred for DFE, or DFE was scheduled for follow-up. When DFE was performed at the initial visit, this resulted in referral of 19.8% of patients to an ophthalmologist. Imaging was obtained occasionally, with fundus photos in 2.6% and optical coherence tomography in 14.5% of encounters. Concordance of DR grading between exam and coding was 78.8%. Recommended follow-up times were incorrect based on DR severity level in 13.8% of encounters. CONCLUSION: Although DFE was performed reliably by optometrists, utilization of imaging, DR grading and coding, and appropriate follow-up periods could be improved. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:608-612.].


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico/estatística & dados numéricos , Optometria/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Técnicas de Diagnóstico Oftalmológico/normas , Feminino , Fundo de Olho , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Optometria/normas , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
7.
Invest Ophthalmol Vis Sci ; 60(14): 4711-4716, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725170

RESUMO

Purpose: Neuroretinopathy is increasingly being recognized as an independent cause of vision loss in diabetes. Visual field loss, as detected by frequency doubling technology (FDT)-based visual perimetry, is a sign of neuroretinopathy and occurs in early stages of diabetic retinopathy (DR). Here, we hypothesized that FDT visual field testing could identify patients with diabetic neuroretinopathy in the absence of clinically detectable microvascular DR. Methods: All National Health and Nutrition Examination Survey (NHANES) 2005-2008 participants receiving fundus photography and visual field screening by FDT were included in this study. Participants with self-reported glaucoma, use of glaucoma medications, or determination of glaucoma based on disk features were excluded. Visual fields were screened using FDT protocol in which participants underwent a 19-subfield suprathreshold test. Results: Patients with diabetes but no DR were more likely to have ≥1 subfield defects at 5%, 2%, and 1% probability levels than patients without diabetes (41.3% vs. 28.6%; 27.4% vs. 17.5%; 15.9% vs. 9.4%; all P < 0.0008). Multivariable regression showed that each additional glycated hemoglobin % (HbA1c) was associated with 19% greater odds of having ≥1 visual subfield defects in those with diabetes without DR (odds ratio: 1.19, 95% confidence interval: 1.07-1.33; P = 0.0020). Conclusions: Patients with diabetes have visual field defects in the absence of clinically detectable DR, suggesting neuroretinopathy precedes classical microvascular disease. These defects become more frequent with the onset of visible retinopathy and worsen as the retinopathy becomes more severe. Longitudinal studies are required to understand the pathogenesis of diabetic neuroretinopathy in relation to classic DR.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Transtornos da Visão/diagnóstico , Campos Visuais/fisiologia , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Feminino , Hemoglobina A Glicada/metabolismo , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fotografação , Transtornos da Visão/fisiopatologia , Testes de Campo Visual
8.
Ophthalmic Surg Lasers Imaging Retina ; 50(11): e274-e277, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755978

RESUMO

BACKGROUND AND OBJECTIVE: This study examines the rate of adherence to recommended ophthalmology follow-up after primary care-based telemedicine diabetic retinopathy (DR) screening. PATIENTS AND METHODS: Retrospective observational study of 5,764 insured diabetic patients undergoing telemedicine DR screening between May 2015 and April 2017 in an urban primary care setting. Patients underwent non-mydriatic fundus photography for telemedicine DR screening. The main outcome measure was the "capture rate." RESULTS: Of the patients studied, 31.7% were found to have any retinal pathology, and 20% were found to have DR. In the 11.8% percent of patients with sight-threatening retinopathy who were recommended to have a retinal examination, the capture rate was 81.9%. CONCLUSION: The authors' study demonstrated higher capture rate than has been previously reported, indicating that telemedicine DR screening in an urban, insured population may be a useful method for triaging high-risk patients without losing patients to follow-up. [Ophthalmic Surg Lasers Imaging Retina. 2019;50: e274-e277.].


Assuntos
Retinopatia Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Programas de Rastreamento/organização & administração , Telemedicina/métodos , Serviços Urbanos de Saúde/organização & administração , Adulto , Feminino , Fundo de Olho , Fidelidade a Diretrizes/normas , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação/métodos , Estudos Retrospectivos
9.
Invest Ophthalmol Vis Sci ; 60(14): 4865-4871, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31747687

RESUMO

Purpose: To evaluate the perfusion status of the retina and choriocapillaris in the area of laser scars on swept-source optical coherence tomography angiography (OCTA) images of eyes previously treated with panretinal photocoagulation (PRP). Methods: Cross-sectional exploratory analysis of swept-source OCTA images, which were retrospectively reviewed for laser scars. The appearance of the capillary networks in the area of previous laser were evaluated following a three-step grading system (normal/sparse/missing capillary network). The superficial and deep capillary plexus of the retina and the choriocapillaris were graded separately. Results: A total of 3140 laser scars in 54 eyes of 31 patients (13 female, mean age 57 ± 12 years) were included in this analysis. In the retina, 6.8% of the superficial and deep capillary network in the area evaluated appeared normal, 58% and 56% sparse, and 35% and 37% missing. Capillary dropout in the retina was not restricted to the area of prior laser treatment. The choriocapillaris decorrelation signal was either sparse (61%) or completely missing (38%) within the laser scar area. The perfusion of the choriocapillaris appeared normal in the area adjacent to laser scars. Conclusions: Capillary non-perfusion in the choriocapillaris was found within the laser scar area. Laser treatment seems to cause sustained non-perfusion of choriocapillaris in the area treated.


Assuntos
Corioide/irrigação sanguínea , Cicatriz/fisiopatologia , Retinopatia Diabética/fisiopatologia , Fotocoagulação a Laser , Vasos Retinianos/fisiologia , Idoso , Capilares/fisiologia , Cicatriz/diagnóstico , Estudos Transversais , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/cirurgia , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional/fisiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
10.
Korean J Ophthalmol ; 33(5): 399-405, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612649

RESUMO

PURPOSE: In the present study, the volume of hard exudates (HEs) was quantitatively measured using optical coherence tomography (OCT) and the agreement and correlation with area of HEs in fundus photography were analyzed. METHODS: The medical records of patients with diabetic macular edema who underwent focal laser treatment and were followed up more than 3 months were retrospectively evaluated. An automated customized program designed for measuring HE volume was used. The HEs in each OCT B-scan binary image were measured using 512 × 128 pixels, 6 mm × 6 mm OCT cube scans. The volume was measured by summing the segmented HEs in each 128 B-scan image. The area was measured in 6 mm x 6 mm fundus photography. The volume and area were measured before and 3 months after the treatment. The agreement of increase and decrease in HEs, and the correlation of volume and area of HEs were analyzed. RESULTS: A total of 35 patients (39 eyes) were included in the study. The volume was significantly reduced from 0.07978 to 0.02565 mm³ at 3 months (p < 0.001). The area was also significantly reduced from 15.35 to 8.60 mm² at 3 months (p < 0.001). The volume was decreased in 34 eyes and increased in 5 eyes. The area was decreased in 37 eyes and increased in 2 eyes. A significant correlation between volume and area was found (p < 0.001) as well as agreement between increase and decrease in volume and area. CONCLUSIONS: In the 3-dimensional quantitative volumetric analysis, the volume and area of HEs were correlated and the direction of increase and decrease was concordant. Considering the distribution of HEs in multiple layers of the retina, volumetric analysis could be considered a substitute for the analysis of HE area.


Assuntos
Retinopatia Diabética/diagnóstico , Macula Lutea/patologia , Edema Macular/diagnóstico , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Retinopatia Diabética/complicações , Exsudatos e Transudatos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Ann Saudi Med ; 39(5): 328-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31580703

RESUMO

BACKGROUND: Diabetic retinopathy (DR) is considered the fifth leading cause of visual impairment worldwide and is associated with a huge social and economic burden. OBJECTIVE: Describe the practicality of non-mydriatic funduscopic screening photography for the detection of DR among patients with type 1 and type 2 diabetes. DESIGN: Cross-sectional hospital-based study. SETTING: Diabetes center, Riyadh. PATIENTS AND METHODS: Between July and December 2017, patients with diabetes and aged ≥18 years were selected by systematic random sampling from the University Diabetes Center. Fundoscopic eye examination was performed using the TRC-NW8 non-mydriatic camera, which performs ocular coherence tomography (OCT) to detect macular edema. Using telemedicine, pictures were graded by a retinal-specialized ophthalmologist using the international clinical DR disease severity scale. Patients were classified according to the type and severity of DR. MAIN OUTCOME MEASURES: Detection and classification of DR. SAMPLE SIZE: 978 Saudi patients with diabetes. RESULTS: Of 426 (43.5%) patients with DR, 370 had nonproliferative DR and 55 had proliferative DR. Nineteen (1.9%) had macular edema. The most important risk factors for DR were longer diabetes duration and poor glycemic control. Both older age and insulin use contributed to the higher prevalence of DR and macular edema. DR was more common among type 1 patients at 55.4% compared with 49% among type 2 patients. In addition, more females had macular edema (57.1% versus 42.9% among males). Nine patients with macular edema (47.3%) had hypertension while 154 of 426 patients with DR (36.2%) had hypertension. CONCLUSION: Non-mydriatic funduscopic screening photography was practical and useful for the detection of DR in patients with type 1 and type 2 diabetes. LIMITATIONS: Conducted in a single center. CONFLICT OF INTEREST: None.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Telemedicina/métodos , Adulto , Idoso , Estudos Transversais , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Fotografação , Prevalência , Arábia Saudita/epidemiologia , Adulto Jovem
12.
Int J Med Inform ; 132: 103926, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31605882

RESUMO

BACKGROUND: Diabetic Retinopathy (DR) is considered a pathology of retinal vascular complications, which stays in the top causes of vision impairment and blindness. Therefore, precisely inspecting its progression enables the ophthalmologists to set up appropriate next-visit schedule and cost-effective treatment plans. In the literature, existing work only makes use of numerical attributes in Electronic Medical Records (EMR) for acquiring such kind of DR-oriented knowledge through conventional machine learning techniques, which require an exhaustive job of engineering most impactful risk factors. OBJECTIVE: In this paper, an approach of deep bimodal learning is introduced to leverage the performance of DR risk progression identification. METHODS: In particular, we further involve valuable clinical information of fundus photography in addition to the aforementioned systemic attributes. Accordingly, a Trilogy of Skip-connection Deep Networks, namely Tri-SDN, is proposed to exhaustively exploit underlying relationships between the baseline and follow-up information of the fundus images and EMR-based attributes. Besides that, we adopt Skip-Connection Blocks as basis components of the Tri-SDN for making the end-to-end flow of signals more efficient during feedforward and backpropagation processes. RESULTS: Through a 10-fold cross validation strategy on a private dataset of 96 diabetic mellitus patients, the proposed method attains superior performance over the conventional EMR-modality learning approach in terms of Accuracy (90.6%), Sensitivity (96.5%), Precision (88.7%), Specificity (82.1%), and Area Under Receiver Operating Characteristics (88.8%). CONCLUSIONS: The experimental results show that the proposed Tri-SDN can combine features of different modalities (i.e., fundus images and EMR-based numerical risk factors) smoothly and effectively during training and testing processes, respectively. As a consequence, with impressive performance of DR risk progression recognition, the proposed approach is able to help the ophthalmologists properly decide follow-up schedule and subsequent treatment plans.


Assuntos
Algoritmos , Retinopatia Diabética/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Fundo de Olho , Processamento de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/etiologia , Humanos , Fotografação , Curva ROC , Fatores de Risco
13.
PLoS Med ; 16(10): e1002945, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31622334

RESUMO

BACKGROUND: National guidelines in most countries set screening intervals for diabetic retinopathy (DR) that are insufficiently informed by contemporary incidence rates. This has unspecified implications for interval disease risks (IDs) of referable DR, disparities in ID between groups or individuals, time spent in referable state before screening (sojourn time), and workload. We explored the effect of various screening schedules on these outcomes and developed an open-access interactive policy tool informed by contemporary DR incidence rates. METHODS AND FINDINGS: Scottish Diabetic Retinopathy Screening Programme data from 1 January 2007 to 31 December 2016 were linked to diabetes registry data. This yielded 128,606 screening examinations in people with type 1 diabetes (T1D) and 1,384,360 examinations in people with type 2 diabetes (T2D). Among those with T1D, 47% of those without and 44% of those with referable DR were female, mean diabetes duration was 21 and 23 years, respectively, and mean age was 26 and 24 years, respectively. Among those with T2D, 44% of those without and 42% of those with referable DR were female, mean diabetes duration was 9 and 14 years, respectively, and mean age was 58 and 52 years, respectively. Individual probability of developing referable DR was estimated using a generalised linear model and was used to calculate the intervals needed to achieve various IDs across prior grade strata, or at the individual level, and the resultant workload and sojourn time. The current policy in Scotland-screening people with no or mild disease annually and moderate disease every 6 months-yielded large differences in ID by prior grade (13.2%, 3.6%, and 0.6% annually for moderate, mild, and no prior DR strata, respectively, in T1D) and diabetes type (2.4% in T1D and 0.6% in T2D overall). Maintaining these overall risks but equalising risk across prior grade strata would require extremely short intervals in those with moderate DR (1-2 months) and very long intervals in those with no prior DR (35-47 months), with little change in workload or average sojourn time. Changing to intervals of 12, 9, and 3 months in T1D and to 24, 9, and 3 months in T2D for no, mild, and moderate DR strata, respectively, would substantially reduce disparity in ID across strata and between diabetes types whilst reducing workload by 26% and increasing sojourn time by 2.3 months. Including clinical risk factor data gave a small but significant increment in prediction of referable DR beyond grade (increase in C-statistic of 0.013 in T1D and 0.016 in T2D, both p < 0.001). However, using this model to derive personalised intervals did not have substantial workload or sojourn time benefits over stratum-specific intervals. The main limitation is that the results are pertinent only to countries that share broadly similar rates of retinal disease and risk factor distributions to Scotland. CONCLUSIONS: Changing current policies could reduce disparities in ID and achieve substantial reductions in workload within the range of IDs likely to be deemed acceptable. Our tool should facilitate more rational policy setting for screening.


Assuntos
Retinopatia Diabética/diagnóstico , Programas de Rastreamento/métodos , Medição de Risco/métodos , Carga de Trabalho , Adulto , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Progressão da Doença , Feminino , Política de Saúde , Humanos , Incidência , Masculino , Oftalmologia/métodos , Probabilidade , Encaminhamento e Consulta , Estudos Retrospectivos , Escócia/epidemiologia , Resultado do Tratamento , Adulto Jovem
14.
Graefes Arch Clin Exp Ophthalmol ; 257(11): 2429-2436, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31512044

RESUMO

PURPOSE: Diabetic retinopathy (DR) is a complex eye disease associated with diabetes mellitus. It is characterized by three pathophysiological components, namely microangiopathy, neurodegeneration, and inflammation. We recently reported that intraperitoneal administration of BNN27, a novel neurosteroidal microneurotrophin, reversed the diabetes-induced neurodegeneration and inflammation in rats treated with streptozotocin (STZ), by activating the NGF TrkA and p75 receptors. The aim of the present study was to investigate the efficacy of BNN27 to protect retinal neurons when applied topically as eye drops in the same model. METHODS: The STZ rat model of DR was employed. BNN27 was administered as eye drops to diabetic Sprague-Dawley rats for 7 days, 4 weeks post-STZ (70 mg/kg) injection. Immunohistochemistry and western blot analyses were employed to examine the viability of retinal neurons in control, diabetic, and diabetic-treated animals and the involvement of the TrkA receptor and its downstream signaling ERK1/2 kinases, respectively. RESULTS: BNN27 reversed the STZ-induced attenuation of the immunoreactive brain nitric oxide synthetase (bNOS)- and tyrosine hydroxylase (TH)-expressing amacrine cells and neurofilament (NFL)-expressing ganglion cell axons in a dose-dependent manner. In addition, BNN27 activated/phosphorylated the TrkA receptor and its downstream prosurvival signaling pathway, ERK1/2 kinases. CONCLUSIONS: The results of this study provide solid evidence regarding the efficacy of BNN27 as a neuroprotectant to the diabetic retina when administered topically, and suggest that its pharmacodynamic and pharmacokinetic profiles render it a putative therapeutic for diabetic retinopathy.


Assuntos
Desidroepiandrosterona/administração & dosagem , Diabetes Mellitus Experimental , Retinopatia Diabética/tratamento farmacológico , Retina/patologia , Administração Tópica , Animais , Western Blotting , Desidroepiandrosterona/farmacocinética , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/metabolismo , Relação Dose-Resposta a Droga , Feminino , Masculino , Ratos , Ratos Sprague-Dawley , Retina/efeitos dos fármacos , Retina/metabolismo , Resultado do Tratamento
15.
Ophthalmic Res ; 62(4): 225-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31554001

RESUMO

Over the past two decades, the Diabetic Retinopathy Clinical Research Network (now known as the DRCR Retina Network) has contributed to multiple and substantial advances in the clinical care of diabetic eye disease. Network studies helped establish anti-vascular endothelial growth factor (VEGF) agents as an effective alternative to panretinal photocoagulation for eyes with proliferative diabetic retinopathy (PDR) and as first-line therapy for eyes with visual impairment for diabetic macular edema (DME), defined treatment algorithms for the use of intravitreal medications in these conditions, and provided critical data to understand how to better evaluate the diabetic eye using optical coherence tomography and other imaging modalities. Ongoing DRCR.net studies will address whether anti-VEGF therapy is effective at preventing vision-threatening complications in eyes with severe non-proliferative diabetic retinopathy, if photobiomodulation has a beneficial effect in eyes with DME, and whether initiation of DME treatment with bevacizumab and rescue with aflibercept can provide visual outcomes as good as those achieved with aflibercept alone. Future plans for the Network also include the expansion into non-diabetic eye disease in areas such as age-related macular degeneration.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Protocolos Clínicos , Retinopatia Diabética/terapia , Fotocoagulação a Laser/métodos , Retina/diagnóstico por imagem , Acuidade Visual , Retinopatia Diabética/diagnóstico , Humanos , Injeções Intravítreas , Tomografia de Coerência Óptica
16.
Int J Mol Sci ; 20(19)2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31557880

RESUMO

Diabetic retinopathy (DR), a sight-threatening neurovasculopathy, is the leading cause of irreversible blindness in the developed world. DR arises as the result of prolonged hyperglycemia and is characterized by leaky retinal vasculature, retinal ischemia, retinal inflammation, angiogenesis, and neovascularization. The number of DR patients is growing with an increase in the elderly population, and therapeutic approaches are limited, therefore, new therapies to prevent retinal injury and enhance repair are a critical unmet need. Besides vascular endothelial growth factor (VEGF)-induced vascular proliferation, several other mechanisms are important in the pathogenesis of diabetic retinopathy, including vascular inflammation. Thus, combining anti-VEGF therapy with other new therapies targeting these pathophysiological pathways of DR may further optimize treatment outcomes. Technological advancements have allowed for high-throughput proteomic studies examining biofluids such as aqueous humor, vitreous humor, tear, and serum. Many DR biomarkers have been identified, especially proteins involved in retinal inflammatory processes. This review attempts to summarize the proteomic biomarkers of DR-associated retinal inflammation identified over the last several years.


Assuntos
Retinopatia Diabética/complicações , Retinopatia Diabética/metabolismo , Proteoma , Proteômica , Retinite/etiologia , Retinite/metabolismo , Biomarcadores , Líquidos Corporais/metabolismo , Retinopatia Diabética/diagnóstico , Humanos , Processamento de Proteína Pós-Traducional , Proteômica/métodos
17.
Korean J Ophthalmol ; 33(4): 326-332, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389208

RESUMO

PURPOSE: To evaluate tear film function in patients with diabetes mellitus (DM) using tear film osmolarity (TFO) measurements compared to other tear film function tests. METHODS: DM patients without any history of ocular surface disorder but with potential effects on the tear film were enrolled in this cross-sectional study. Data including dry eye symptoms, duration of DM, stage of diabetic retinopathy and blood hemoglobin A1c levels were recorded. Tear film break-up time (TBUT) and basic tear secretion (Schirmer test) were assessed. TFO was determined using the Tearlab Osmolarity System. The outcome measures were the difference between the mean values of TBUT, basic tear secretion and TFO in both the study and control groups. RESULTS: We recruited 51 DM patients and 20 control subjects with a mean age of 51.2 (range, 21 to 70) and 48.5 (range, 24 to 70) years, respectively. A total of 27 patients (53%) and 11 controls (55%) reported dry eye symptoms (p = 0.668). The mean TBUT was 10.2 ± 4.8 seconds in the study group versus 10.5 ± 2.8 seconds in controls, which was not significantly different (p = 0.747). The mean Schirmer test score was 8.1 ± 4.3 mm in the patients versus 10.1 ± 3.0 mm in the controls (p = 0.069). The mean TFO was 294.1 ± 12.9 mosmol/L in the patients versus 291.4 ± 14.5 mosmol/L in the controls (p = 0.456). It was significantly higher in patients with poor glycemic control determined by hemoglobin A1c > 8% (p = 0.003). TFO had a positive correlation with the duration of DM (p = 0.030) but not with the stage of diabetic retinopathy (p = 0.944). However, TFO showed a significant relationship with dry eye symptoms (p = 0.001). CONCLUSIONS: TFO is impaired in patients with uncontrolled DM and is better correlated with glycemic control and dry eye symptoms than the TBUT and Schirmer tests.


Assuntos
Diabetes Mellitus/metabolismo , Retinopatia Diabética/metabolismo , Síndromes do Olho Seco/metabolismo , Lágrimas/química , Adulto , Idoso , Estudos Transversais , Retinopatia Diabética/complicações , Retinopatia Diabética/diagnóstico , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/etiologia , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Adulto Jovem
18.
Korean J Ophthalmol ; 33(4): 359-365, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31389212

RESUMO

PURPOSE: To investigate the foveal avascular zone (AVZ), superficial and deep foveal and parafoveal vessel density (VD) changes related to diabetic retinopathy. METHODS: Forty-nine type 2 diabetes mellitus (DM) and 45 healthy control subjects were included in this study. The demographic data (age and sex), disease duration, and level of glycated hemoglobin were collected. Superficial VD (%), superficial AVZ area (mm²), deep VD (%) and deep AVZ area (mm²) were evaluated via optic coherence tomography angiography. RESULTS: Superficial AVZ was 0.438 ± 0.05 mm² in the DM group, 0.246 ± 0.022 mm² in the control group (p < 0.001). Deep AVZ was 0.732 ± 0.06 mm² in the DM group, and 0.342 ± 0.022 mm² in the control group (p < 0.001). Superficial foveal VD was 29.45 ± 0.76 mm² in the DM group, and 34.86 ± 0.75 mm² in the control group (p < 0.001). Deep foveal VD was 24.85 ± 1.08 mm² in the DM group, and 33.47 ± 0.56 mm² in the control group (p < 0.001). CONCLUSIONS: In this study, we demonstrated an enlargement in the foveal AVZ along with a reduction in the vascular density of the superficial and deep capillary network in the foveal and parafoveal area using optic coherence tomography angiography in patients with nonproliferative diabetic retinopathy. This technique can be used to monitor the progression of the disease and to evaluate the response to treatment.


Assuntos
Capilares/patologia , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Angiofluoresceinografia/métodos , Fóvea Central/irrigação sanguínea , Vasos Retinianos/patologia , Tomografia de Coerência Óptica/métodos , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/etiologia , Progressão da Doença , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
BMC Health Serv Res ; 19(1): 549, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382956

RESUMO

BACKGROUND: The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians' life, the study aimed to determine the crisis' effects on patients' care-seeking behavior. Our study was the first step in paving the way of prevention strategies. METHODS: This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. RESULTS: The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven't visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. CONCLUSION: A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media.


Assuntos
Retinopatia Diabética/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Idoso , Assistência Ambulatorial , Conflitos Armados , Conscientização , Cegueira/prevenção & controle , Estudos Transversais , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Neuropatias Diabéticas/psicologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Diagnóstico Precoce , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Síria/epidemiologia
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