Diabetic retinopathy

Blindness is one of the most feared complications of diabetes and although only a small proportion of people with diabetes will become legally blind, a larger number will have significantly impaired vision affecting their daily life. They may have concerns ranging from difficulty reading the telephone directory to loss of their driving licence and hence, restricted independence. The main issues in diabetic retinopathy are identification of those at risk of visually threatening eye disease, addressing modifiable risk factors, and institution of appropriate treatment. All diabetic patients should have access to an effective screening programme. Laser photocoagulation of the retina remains the cornerstone of treatment of sight-threatening diabetic retinopathy, but over the last few years a number of new therapies have been tried and show promise in preventing visual loss from diabetic retinopathy. This chapter will discuss the epidemiology of diabetic retinopathy and the characteristic clinical features and will give an outline of practical management.

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A Clinical Study of Diabetic Retinopathy

Journal of Nepal Medical Association ◽

10.31729/jnma.638 ◽

2003 ◽

Vol 42 (148) ◽

Author(s):

KJD Karki

Keyword(s):

Diabetic Retinopathy ◽

Clinical Study ◽

High Risk ◽

Key Words ◽

Laser Treatment ◽

Proliferative Diabetic Retinopathy ◽

Laser Photocoagulation ◽

Visual Loss ◽

Diabetic Patients ◽

Vitrectomy Surgery

A clinical study of diabetic retinopathy was conducted from March- May 2002 to diagnose a patient’sdiabetic retinopathy level and identify eyes of proliferative diabetic retinopathy and maculopathy so thatthese patients could get appropriate and timely laser photocoagulation surgery and other surgical modalitiesto reduce the risk of visual loss. This study shows that out of 248 diabetic patients examined, 45.9% patientshad retinal changes. The potential candidates for panretinal and focal laser treatment were the patientswith very severe non-proliferative diabetic retinopathy (NPDR) (3.5%), early proliferative diabeticretinopathy (PDR) or high-risk PDR (3.5%), and maculopathy (8.8%).Key Words: Diabetic retinopathy, Laser photocoagulation surgery and vitrectomy Surgery.

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Prevalence of Dry Eye Disease in Type 2 Diabetic Patients and its Association with Diabetic Retinopathy

10.53350/pjmhs2115113269 ◽

2021 ◽

Vol 15 (11) ◽

pp. 3269-3272

Author(s):

Darikta Dargahi Shaikh ◽

Tehmina Imdad ◽

Safdar Ali ◽

Fayaz Ali Kalhoro ◽

Sajida Parveen Shaikh ◽

...

Keyword(s):

Type 2 Diabetes ◽

Diabetic Retinopathy ◽

Dry Eye ◽

Dry Eye Disease ◽

Eye Disease ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Department Of Ophthalmology ◽

Type 2 Diabetic

Objective: To determine the prevalence of dry eye disease in type 2 diabetic patients and its correlation with retinopathy Materials and Methods: A cross-sectional study was conducted in the Department of Ophthalmology, Chandka Medical College & Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 1st April 2021 to 30th September 2021. Consecutive 100 patients with type 2 diabetes mellitus (DM) who attended outpatient department were included as per inclusion-exclusion criteria. Results: The patients were mostly female (58%) with a female-to-male ratio of 1.38:1. Most patients (43%) were under 50, followed by 51–60. (34 %). The overall mean age was 54.26 10.06. More than half (63%) of patients had diabetes for up to 5 years. The patients had a 42 percent frequency of DES. Mild, moderate, and severe dry eye were diagnosed in 21%, 16%, and 5% of individuals. Longevity and poor diabetes control exacerbated the disease. Conclusions: Type 2 DM patients' age, but not their gender, was found to be a significant predictor of DES. Dry eye was found to be more common among diabetics with poor control of their condition. In patients with type 2 diabetes, the age, but not the gender, was substantially linked to DES. Keywords: Type 2 diabetes, Dry eye disease, Diabetic retinopathy, Meibomian gland dysfunction.

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Ophthalmic treatment of diabetic retinopathy

Diabetic Retinopathy: Screening to Treatment (Oxford Diabetes Library) ◽

10.1093/med/9780198834458.003.0019 ◽

2020 ◽

pp. 171-178

Author(s):

Ramesh R. Sivaraj ◽

Jonathan M. Gibson

Keyword(s):

Diabetic Retinopathy ◽

High Risk ◽

Group Intervention ◽

Laser Photocoagulation ◽

Interdisciplinary Approach ◽

High Risk Group ◽

Diabetic Patients ◽

Diabetic Maculopathy ◽

Operative Assessment ◽

Ophthalmic Treatment

The ophthalmic treatment of diabetic retinopathy is aimed at preserving vision and requires an interdisciplinary approach. The main treatments used for proliferative retinopathy and diabetic maculopathy include laser photocoagulation, intra-vitreal, and peri-ocular drug injections, or a combination of both. In advanced cases of diabetic retinopathy (DR), vitrectomy and retinal surgery may help preserve vision. Cataract surgery in diabetic patients is extremely successful, but overall these patients are usually considered to be at risk of more complications than the general population. Those patients with pre-existing DR at the time of surgery should be regarded as a high risk group and will require careful pre-operative assessment and post-operative review. In this group, intervention with laser photocoagulation and intra-vitreal pharmacotherapy may be necessary.

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Angiopoietin-like 4 is a potent angiogenic factor and a novel therapeutic target for patients with proliferative diabetic retinopathy

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1423765112 ◽

2015 ◽

Vol 112 (23) ◽

pp. E3030-E3039 ◽

Cited By ~ 47

Author(s):

Savalan Babapoor-Farrokhran ◽

Kathleen Jee ◽

Brooks Puchner ◽

Syed Junaid Hassan ◽

Xiaoban Xin ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Müller Cells ◽

Aqueous Fluid ◽

Angiogenic Factor ◽

Eye Disease ◽

Diabetic Patients ◽

Muller Cells ◽

Angiogenic Potential ◽

Diabetic Eye Disease

Diabetic eye disease is the most common cause of severe vision loss in the working-age population in the developed world, and proliferative diabetic retinopathy (PDR) is its most vision-threatening sequela. In PDR, retinal ischemia leads to the up-regulation of angiogenic factors that promote neovascularization. Therapies targeting vascular endothelial growth factor (VEGF) delay the development of neovascularization in some, but not all, diabetic patients, implicating additional factor(s) in PDR pathogenesis. Here we demonstrate that the angiogenic potential of aqueous fluid from PDR patients is independent of VEGF concentration, providing an opportunity to evaluate the contribution of other angiogenic factor(s) to PDR development. We identify angiopoietin-like 4 (ANGPTL4) as a potent angiogenic factor whose expression is up-regulated in hypoxic retinal Müller cells in vitro and the ischemic retina in vivo. Expression of ANGPTL4 was increased in the aqueous and vitreous of PDR patients, independent of VEGF levels, correlated with the presence of diabetic eye disease, and localized to areas of retinal neovascularization. Inhibition of ANGPTL4 expression reduced the angiogenic potential of hypoxic Müller cells; this effect was additive with inhibition of VEGF expression. An ANGPTL4 neutralizing antibody inhibited the angiogenic effect of aqueous fluid from PDR patients, including samples from patients with low VEGF levels or receiving anti-VEGF therapy. Collectively, our results suggest that targeting both ANGPTL4 and VEGF may be necessary for effective treatment or prevention of PDR and provide the foundation for studies evaluating aqueous ANGPTL4 as a biomarker to help guide individualized therapy for diabetic eye disease.

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Knowledge about Diabetic Retinopathy, Eye Check-up Practice and Associated Factors among Adult Patients with Diabetes Mellitus Attending at Debark Hospital, Northwest Ethiopia

10.21203/rs.2.16562/v5 ◽

2020 ◽

Author(s):

Abel Sinshaw Assem ◽

Mebratu Muusew Tegegne ◽

Destaye Shiferaw Alemu ◽

Asamere Tsegaw Woredekal ◽

Tsehay Kassa Tefera

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Northwest Ethiopia ◽

Good Knowledge ◽

Eye Disease ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Patients With Diabetes ◽

History Of ◽

Eye Examination

Abstract Background: Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps for timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia. The aim of this study was to assess knowledge about diabetic retinopathy, eye check-up practice and associated factors of diabetic retinopathy among adult diabetic patients at Debark hospital, Northwest Ethiopia. Methods: Institution based cross-sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant. Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47; (1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients at Debark hospital was fair (47.4%) and good eye check-up practice (eye examination at least once in the past year) was low (39.6%). Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

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A 15 Month Experience with a Primary Care-based Telemedicine Screening Program for Diabetic Retinopathy.

10.21203/rs.3.rs-29866/v2 ◽

2020 ◽

Author(s):

James Benjamin ◽

Justin Sun ◽

Devon Cohen ◽

Joseph Matz ◽

Angela Barbera ◽

...

Keyword(s):

Primary Care ◽

Diabetic Retinopathy ◽

Screening Program ◽

Primary Care Clinic ◽

University Hospital ◽

Eye Disease ◽

Diabetic Patients ◽

Close Monitoring ◽

Care Clinic ◽

Retinal Screening

Abstract Background: Using telemedicine for diabetic retinal screening is becoming popular especially amongst at-risk urban communities with poor access to care. The goal of the diabetic telemedicine project at Temple University Hospital is to improve cost-effective access to appropriate retinal care to those in need of close monitoring and/or treatment.Methods: This will be a retrospective review of 15 months of data from March 2016 to May 2017. We will investigate how many patients were screened, how interpretable the photographs were, how often the photographs generated a diagnosis of diabetic retinopathy (DR) based on the screening photo, and how many patients followed-up for an exam in the office, if indicated.Results: Six-hundred eighty-nine (689) digital retinal screening exams on 1377 eyes of diabetic patients were conducted in Temple’s primary care clinic. The majority of the photographs were read to have no retinopathy (755, 54.8%). Among all of the screening exams, 357 (51.8%) triggered a request for a referral to ophthalmology. Four-hundred forty-nine (449, 32.6%) of the photos were felt to be uninterpretable by the clinician. Referrals were meant to be requested for DR found in one or both eyes, inability to assess presence of retinopathy in one or both eyes, or for suspicion of a different ophthalmic diagnosis. Sixty-seven patients (9.7%) were suspected to have another ophthalmic condition based on other findings in the retinal photographs. Among the 34 patients that were successfully completed a referral visit to Temple ophthalmology, there was good concordance between the level of DR detected by their screening fundus photographs and visit diagnosis.Conclusions: Although a little more than half of the patients did not have diabetic eye disease, about half needed a referral to ophthalmology. However, only 9.5% of the referral-warranted exams actually received an eye exam. Mere identification of referral-warranted diabetic retinopathy or other eye disease is not enough. A successful telemedicine screening program must close the communication gap between screening and diagnosis by reviewer to provide timely follow-up by eye care specialists.

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Knowledge about diabetic retinopathy, eye check-up practice and associated factors among patients with diabetes mellitus attending Debark hospital, northwest Ethiopia

10.21203/rs.2.16562/v1 ◽

2019 ◽

Author(s):

Mebratu Muusew Tegegne ◽

Abel Sinshaw Assem ◽

Destaye Shiferaw Alemu ◽

Asamere Tsegaw Woredekal ◽

Tsehay Kassa Alemu

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Associated Factors ◽

Northwest Ethiopia ◽

Good Knowledge ◽

Eye Disease ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Patients With Diabetes ◽

History Of

Abstract Background: Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps in timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia in general and the study area in particular. Purpose: The aim of this study was to assess knowledge, eye check-up practice and associated factors of diabetic retinopathy among diabetic patients at Debark hospital, Northwest Ethiopia. Materials and Methods: Institution based cross – sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant. Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47;(1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients was fair (47.4%) in the study setting and good eye check-up practice was low (39.6%) Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

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Knowledge About Diabetic Retinopathy, Eye Check-Up Practice And Associated Factors Among Adult Patients With Diabetes Mellitus Attending At Debark Hospital, Northwest Ethiopia

10.21203/rs.2.16562/v2 ◽

2020 ◽

Author(s):

Mebratu Muusew Tegegne ◽

Abel Sinshaw Assem ◽

Destaye Shiferaw Alemu ◽

Asamere Tsegaw Woredekal ◽

Tsehay Kassa Tefera

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Northwest Ethiopia ◽

Good Knowledge ◽

Eye Disease ◽

Diabetic Patients ◽

Duration Of Diabetes ◽

Patients With Diabetes ◽

History Of ◽

Eye Examination

Abstract Background:Routine eye examination plays a vital role in detecting diabetic retinopathy in its earliest stage before the onset of blindness. Patients’ knowledge about the nature and the consequences of diabetic retinopathy and routine eye checkup helps in timely identification and early treatment. However, there is limited evidence on knowledge of patients with diabetes mellitus on diabetic retinopathy and their eye check-up practices in Ethiopia.The aim of this study was to assess knowledge, eye check-up practice and associated factors of diabetic retinopathy among adult diabetic patients at Debark hospital, Northwest Ethiopia.Methods: Institution based cross – sectional study was conducted at Debark hospital, Northwest Ethiopia, from April 20/2018- May 20/2018. A pretested interviewer administered structured questionnaire was used to collect data among 230 diabetic patients aged 18 years and above. Data were entered in to Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable and multivariable binary logistic regression analyses were done. Odds ratio with 95% confidence level was determined and variables with p–value of < 0.05 were considered as statistically significant.Result: Out of 238 sample 230 were participated, among this, 119 (51.7%) were males. The mean age of the respondents was 49 (SD ±17.6) years. One hundred nine (47.4%) participants had good knowledge and 91 (39.6%) had good eye check-up practice. Urban residence [AOR= 2.65;95% CI: 1.16-6.07)]), monthly income of 3501-8000 birr [AOR=4.54;(1.31-15.7)], type II diabetes mellitus [AOR=3.9;(1.6-9.6)], duration of diabetes (6-12 years[AOR=4.4;(1.4-13.5)]), history of eye disease [AOR=5.5;(2.3-13.0)] were associated with good knowledge. Similarly, longer duration of diabetes (13-25 years [AOR=3.77; (1.05-13.5)]) and history of eye disease [AOR=2.47; (1.09-5.62)] were associated with good eye check-up practice. Conclusion: The proportion of good knowledge about diabetic retinopathy among diabetic patients at Debark hospital was fair (47.4%) and good eye check-up practice (eye examination at least once in the past year) was low (39.6%). Longer duration of diabetes and history of eye disease were identified as positive factors for good knowledge and eye check-up practice. Knowledge and regular eye check-up practice needs to be enhanced through provision of appropriate health education.

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Ophthalmology

10.1093/med/9780198810858.003.0012 ◽

2021 ◽

pp. 515-536

Author(s):

David Yorston

Keyword(s):

Diabetic Retinopathy ◽

Hiv Infection ◽

Visual Loss ◽

Corneal Opacity ◽

Eye Disease ◽

Refractive Errors ◽

Eye Injuries ◽

Corneal Ulcers ◽

Red Eye ◽

Global Blindness

Global blindness?, Presenting features of eye disease?, Visual loss: refractive errors?, Cataract?, Corneal opacity?, Glaucoma?, Macular degeneration?, Diabetic retinopathy?, Red eye?, Injuries to the eye?, Red eye with no injury?, Conjunctivitis?, Corneal ulcers?, Uveitis?, Acute glaucoma?, Trachoma?, Xerophthalmia?, Ocular leprosy?, HIV infection and the eye?, Onchocerciasis and the eye?

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Photocoagulation for Diabetic Macular Edema

50 Studies Every Ophthalmologist Should Know ◽

10.1093/med/9780190050726.003.0029 ◽

2020 ◽

pp. 169-176

Author(s):

Alan D. Penman ◽

Kimberly W. Crowder ◽

William M. Watkins

Keyword(s):

Diabetic Retinopathy ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Laser Photocoagulation ◽

Argon Laser ◽

Diabetic Patients ◽

Nonproliferative Diabetic Retinopathy ◽

Argon Laser Photocoagulation ◽

Clinically Significant Macular Edema ◽

Clinically Significant

The Early Treatment Diabetic Retinopathy Study (ETDRS) was a randomized clinical trial involving nearly four thousand diabetic patients with early proliferative retinopathy, moderate to severe nonproliferative retinopathy, and/or diabetic macular edema in each eye. This paper (ETDRS report number 1) describes the findings in the subgroup of eyes in the ETDRS that were identified as having mild to moderate nonproliferative diabetic retinopathy and macular edema. The analysis showed that immediate focal argon laser photocoagulation of “clinically significant” diabetic macular edema substantially reduced the risk of visual loss, increased the chance of visual improvement, decreased the frequency of persistent macular edema, and caused only minor visual field losses. The authors recommended immediate focal argon laser photocoagulation for all eyes with clinically significant macular edema and mild or moderate nonproliferative diabetic retinopathy, regardless of the level of visual acuity.

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