Diabetic Retinopathy Screening in Patients with Diabetes Using a Handheld Fundus Camera: The Experience from the South-Eastern Region in Hungary

Purpose. Diabetic retinopathy (DR) is the leading cause of vision loss among active adults in industrialized countries. We aimed to investigate the prevalence of diabetes mellitus (DM), DR and its different grades, in patients with DM in the Csongrád County, South-Eastern region, Hungary. Furthermore, we aimed to detect the risk factors for developing DR and the diabetology/ophthalmology screening patterns and frequencies, as well as the effect of socioeconomic status- (SES-) related factors on the health and behavior of DM patients. Methods. A cross-sectional study was conducted on adults (>18 years) involving handheld fundus camera screening (Smartscope Pro Optomed, Finland) and image assessment using the Spectra DR software (Health Intelligence, England). Self-completed questionnaires on self-perceived health status (SPHS) and health behavior, as well as visual acuity, HbA1c level, type of DM, and attendance at healthcare services were also recorded. Results. 787 participants with fundus camera images and full self-administered questionnaires were included in the study; 46.2% of the images were unassessable. T1D and T2D were present in 13.5% and 86.5% of the participants, respectively. Among the T1D and T2D patients, 25.0% and 33.5% had DR, respectively. The SES showed significant proportion differences in the T1D group. Lower education was associated with a lower DR rate compared to non-DR (7.7% vs. 40.5%), while bad/very bad perceived financial status was associated with significantly higher DR proportion compared to non-DR (63.6% vs. 22.2%). Neither the SPHS nor the health behavior showed a significant relationship with the disease for both DM groups. Mild nonproliferative retinopathy without maculopathy (R1M0) was detected in 6% and 23% of the T1D and T2D patients having DR, respectively; R1 with maculopathy (R1M1) was present in 82% and 66% of the T1D and T2D groups, respectively. Both moderate nonproliferative retinopathy with maculopathy (R2M1) and active proliferative retinopathy with maculopathy (R3M1) were detected in 6% and 7% of the T1D and T2D patients having DR, respectively. The level of HbA1c affected the attendance at the diabetology screening ( HbA 1 c > 7 % associated with >50% of all quarter-yearly attendance in DM patients, and with 10% of the diabetology screening nonattendance). Conclusion. The prevalence of DM and DR in the studied population in Hungary followed the country trend, with a slightly higher sight-threatening DR than the previously reported national average. SES appears to affect the DR rate, in particular, for T1D. Although DR screening using handheld cameras seems to be simple and dynamic, much training and experience, as well as overcoming the issue of decreased optic clarity is needed to achieve a proper level of image assessability, and in particular, for use in future telemedicine or artificial intelligence screening programs.

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Beyond vision loss: the independent impact of diabetic retinopathy on vision-related quality of life in a Chinese Singaporean population

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313082 ◽

2018 ◽

Vol 103 (9) ◽

pp. 1314-1319 ◽

Cited By ~ 1

Author(s):

Eva K Fenwick ◽

Ryan E K Man ◽

Alfred Tau Liang Gan ◽

Neelam Kumari ◽

Charlene Wong ◽

...

Keyword(s):

Quality Of Life ◽

Diabetic Retinopathy ◽

Vision Loss ◽

Well Being ◽

Linear Regression Models ◽

Cross Sectional ◽

Significant Difference ◽

Related Quality ◽

The Impact

Background/aimsTo assess the independent impact of diabetic retinopathy (DR) on three domains of vision-related quality of life (VRQoL) in a Chinese Singapore population.MethodsThe Singapore Chinese Eye Study (n=3353; 2009–2011) was a population-based, prospective, cross-sectional study conducted at the Singapore Eye Research Institute. The study population included 292 adults with diabetes, with and without DR. DR (better eye) was categorised as presence and absence of any DR; severity of DR (no vision-threatening DR (VTDR); severe non-proliferative DR (NPDR); PDR and/or clinically significant macular oedema and VTDR). Our main outcome was VRQoL which was measured using Rasch-calibrated scores from the ‘Reading’, ‘Mobility’ and ‘Emotional’ domains of the Impact of Vision Impairment questionnaire. The relationship between DR and VRQoL was assessed using multiple linear regression models.ResultsOf the 292 individuals (mean age 61.35 ± 9.66 years; 55.8% male), 201 (68.8%), 49 (16.8%), 20 (6.8%), 22 (7.5%) and 27 (9.2%) had no DR, minimal-mild NPDR, moderate-severe NPDR, PDR and VTDR, respectively. Any DR and VTDR were independently associated with 6% and 12% worse Reading scores and 7% and 18% poorer Emotional well-being, respectively, compared with those without DR. These associations persisted after separate adjustment for visual impairment and presenting visual acuity. No significant difference was found in the Mobility domain between persons with and without DR.ConclusionsWe documented that DR, particularly VTDR, was independently associated with restrictions in Reading and Emotional well-being. Understanding factors underlying the detrimental DR-VRQoL relationship may optimise rehabilitation outcomes for individuals with DR.

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Utilization of diabetic retinopathy screening among diabetic patients at a tertiary care hospital in Kerala, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20213798 ◽

2021 ◽

Vol 8 (10) ◽

pp. 4938

Author(s):

Sona Sabitha Kumar ◽

Lathika Vasu Kamaladevi ◽

Sruthi Mankara Valsan

Keyword(s):

Diabetic Retinopathy ◽

Vision Loss ◽

Adult Population ◽

Tertiary Care ◽

Health Concern ◽

Diabetic Patients ◽

Care Hospital ◽

Screening Programs ◽

Diabetic Retinopathy Screening ◽

Retinopathy Screening

Background: Diabetes is a major public health concern that affects nearly 463 million (9.3%) of global adult population. Diabetic retinopathy, which affects around 35% of all diabetic patients, is the fifth leading cause of preventable global blindness. This study was done to determine the status of diabetic retinopathy screening and the factors that influence its uptake among diabetic patients attending a tertiary care setting in Kerala, India.Methods: 200 patients with diabetes mellitus on physician care were enrolled for a questionnaire-based survey which collected information on patient demographics, education, occupation, patient’s awareness of retinopathy, screening, diabetic blindness and their source of such knowledge.Results: 83% were aware that diabetes can result in vision loss. 61% were aware that diabetic blindness is preventable. 42% patients were aware of screening options for retinopathy. The awareness of retinopathy screening was significantly associated (p=0.0001) only with duration of diabetes.Conclusions: Awareness of diabetic retinopathy among diabetic patients in Kerala was sub optimal. Better patient education and use of mass media can increase awareness on diabetes retinopathy screening programs.

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Domestic violence against women in west of Iran: the prevalence and related factors

International Journal of Human Rights in Healthcare ◽

10.1108/ijhrh-12-2018-0080 ◽

2019 ◽

Vol 12 (5) ◽

pp. 364-372

Author(s):

Abdorrahim Afkhamzadeh ◽

Namam-Ali Azadi ◽

Shirin Ziaeei ◽

Amjad Mohamadi-Bolbanabad

Keyword(s):

Risk Factors ◽

Domestic Violence ◽

Violence Against Women ◽

Physical Violence ◽

Self Report ◽

Related Factors ◽

Cross Sectional ◽

Content Type ◽

Screening Programs ◽

Domestic Violence Against Women

Purpose The purpose of this paper is to determine the prevalence of domestic violence against women and its related factors in Sanandaj, west of Iran. Design/methodology/approach This is a cross-sectional study conducted in 2016. The sample consisted of 360 women who referred to two educational hospitals in Sanandaj. The data collection tool was a self-report questionnaire. A multivariate logistic regression was used to determine the risk factors of domestic violence against women. Findings The prevalence of “any form of violence” in the past year was 71 percent (n=245). The prevalence of emotional, sexual and physical violence was 62.2 percent (n=225), 48.7 percent (n=168) and 49.9 percent (n=172), respectively. Multivariate logistic regressions revealed that the “any form of violence” has significant association with occupation of women, economic status of family and the status of sexual satisfaction of couples. Originality/value The prevalence of domestic violence against women is high and alarming in Sanandaj, Iran. Given the relationship between experience of violence and sexual dissatisfaction, sexual education before and after marriage is recommended for couples. Also, the experience of exposure to violence in women can be included in health centers as screening programs. In this way, couples who have risk factors will receive the educational programs.

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Retinal Photography Screening Programs to Prevent Vision Loss from Diabetic Retinopathy in Rural and Urban Australia: A Review

Ophthalmic Epidemiology ◽

10.3109/09286586.2014.988875 ◽

2014 ◽

Vol 22 (1) ◽

pp. 52-59 ◽

Cited By ~ 10

Author(s):

Robyn J. Tapp ◽

Jean Svoboda ◽

Bronwyn Fredericks ◽

A. Jonathan Jackson ◽

Hugh R. Taylor

Keyword(s):

Diabetic Retinopathy ◽

Vision Loss ◽

Screening Programs ◽

Rural And Urban ◽

Retinal Photography

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Blindness Registers as Epidemiological Tools for Public Health Planning: A Case Study in Belize

Epidemiology Research International ◽

10.1155/2014/659717 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Sally L. Baxter ◽

Richard P. Wormald ◽

Joan M. Musa ◽

Daksha Patel

Keyword(s):

Public Health ◽

Diabetic Retinopathy ◽

Health Planning ◽

Population Based ◽

Service Planning ◽

Cross Sectional ◽

Screening Programs ◽

Surgical Services ◽

Public Health Planning ◽

Sectional Analysis

For public eye health programs, blindness registers can be an important tool for informing service planning. This study examines how the Belize Council for the Visually Impaired (BCVI) used its blindness register data to drive several public health interventions. Cross-sectional analysis was performed for all active registrants (n=1194) to determine the distribution of causes of registration according to age, sex, and geographical district. Cataract was the leading cause of registration (39.6%), followed by glaucoma (20.8%), diabetic retinopathy (10.2%), and childhood blindness (9.4%). The distribution of the causes of registration was fairly similar between men and women and across the various districts. However, in Stann Creek, whose population is largely of African descent, glaucoma exceeded cataract. For most causes, the majority of registrants were registered at age 50 or older. Follow-up was conducted four years later. Several interventions had been initiated, most notably bolstering cataract surgical services and creating screening programs for glaucoma and diabetic retinopathy. The register itself was also improved to maximize its utility for future use. While standardized surveys may be the most appropriate method of estimating population-based measures such as prevalence or incidence, the blindness register is still a valuable source of data for public health planning.

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Reduction of Glut1 in retinal neurons but not the RPE alleviates polyol accumulation and normalizes early characteristics of diabetic retinopathy

10.1101/2020.08.31.275230 ◽

2020 ◽

Author(s):

Nicholas C. Holoman ◽

Jacob J. Aiello ◽

Timothy D. Trobenter ◽

Matthew J. Tarchick ◽

Michael R. Kozlowski ◽

...

Keyword(s):

Oxidative Stress ◽

Diabetic Retinopathy ◽

Aldose Reductase ◽

Glucose Transporter ◽

Vision Loss ◽

Significant Proportion ◽

Diabetic Patients ◽

Retinal Neurons ◽

Anti Vegf ◽

Facilitative Glucose Transporter

AbstractHyperglycemia is a key determinant for development of diabetic retinopathy (DR). Inadequate glycemic control exacerbates retinopathy, while normalization of glucose levels delays its progression. In hyperglycemia, hexokinase is saturated and excess glucose is metabolized to sorbitol by aldose reductase via the polyol pathway. Therapies to reduce retinal polyol accumulation for the prevention of DR have been elusive due to low sorbitol dehydrogenase levels in the retina and inadequate inhibition of aldose reductase. Using systemic and conditional genetic inactivation, we targeted the primary facilitative glucose transporter in the retina, Glut1, as a preventative therapeutic in diabetic male and female mice. Unlike wildtype diabetics, diabetic Glut1+/− mice did not display elevated Glut1 levels in the retina. Furthermore, diabetic Glut1+/− mice exhibited ameliorated ERG defects, inflammation and oxidative stress, which was correlated with a significant reduction in retinal sorbitol accumulation. RPE-specific reduction of Glut1 did not prevent an increase in retinal sorbitol content or early hallmarks of DR. However, like diabetic Glut1+/− mice, reduction of Glut1 specifically in retinal neurons mitigated polyol accumulation and completely prevented retinal dysfunction and the elevation of markers for oxidative stress and inflammation associated with diabetes. These results suggest that modulation of retinal polyol accumulation via Glut1 in photoreceptors can circumvent the difficulties in regulating systemic glucose metabolism and be exploited to prevent DR.SignificanceDiabetic retinopathy (DR) affects one third of diabetic patients and is the primary cause of vision loss in adults aged 20-74. While anti-VEGF and photocoagulation treatments for the late-stage vision threatening complications can prevent vision loss, a significant proportion of patients do not respond to anti-VEGF therapies and mechanisms to stop progression of early-stage symptoms remain elusive. Glut1 is the primary facilitative glucose transporter for the retina. We determined that a moderate reduction in Glut1 levels, specifically in retinal neurons, but not the RPE, was sufficient to prevent retinal polyol accumulation and the earliest functional defects to be identified in the diabetic retina. Our study defines modulation of Glut1 in retinal neurons as a targetable molecule for prevention of DR.

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Prevalence of Metabolic Syndrome and Its Determinants in the Middle-aged and Elderly Population in A Southern Coastal Region, Iran (the PERSIAN Cohort Study): A Cross-sectional Study

Shiraz E-Medical Journal ◽

10.5812/semj.116838 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Ghazal Zoghi ◽

Azim Nejatizadeh ◽

Mehdi Shahmoradi ◽

Zahra Ghaemmaghami ◽

Masoumeh Kheirandish

Keyword(s):

Metabolic Syndrome ◽

Rural Areas ◽

Central Obesity ◽

Multiple Correspondence Analysis ◽

Smoking Status ◽

Binary Logistic Regression Analysis ◽

Related Factors ◽

Cross Sectional ◽

Screening Programs ◽

The Government

Background: Metabolic syndrome (MetS) criteria are different but interconnected cardiovascular risk factors, including dysglycemia, hypertension, abdominal obesity, and dyslipidemia. Objectives: We aimed to determine the prevalence of MetS, its components, and related factors in the south coastal area of Iran, Bandare-Kong non-communicable diseases (BKNCD). Methods: This population-based study was performed on the baseline data from participants of BKNCD, which has recruited participants from Bandare Kong city, one of the 18 distinct geographical areas included in the prospective epidemiological research studies in Iran (Persian). MetS was diagnosed based on the National Cholesterol Education Program (NCEP) criteria and the Iranian-specific cut-off for waist circumference (≥ 95 cm). The socioeconomic status (SES) was estimated by multiple correspondence analysis (MCA) based on participants’ different properties. Results: Of 3,927 participants included in this study, 2,230 (56.8%) were female. Age-standardized prevalence of MetS was 34.5%. The most common MetS component was central obesity (45.1%), followed by decreased high-density lipoprotein (42.6%), elevated fasting plasma glucose (39.9%), elevated triglyceride (37.7%), and increased blood pressure (37.5%). Besides, 84.7% of the subjects displayed at least one component of MetS. Binary logistic regression analysis revealed that women aged 65 - 70 years were at higher risk of having MetS compared to those aged 35 - 39 years (aOR = 12.37, 95% CI 7.54 - 20.30, P < 0.001). Also, living in rural areas was a risk for MetS in women (aOR = 1.55, 95% CI 1.18 - 2.03, P = 0.002). Employment and education were protective against MetS in women. Being overweight significantly increased the risk of MetS in both men and women. Obesity was more problematic for men (aOR = 16.66, 95% CI 11.65 - 23.81, P < 0.001) compared to women (aOR = 10.43, 95% CI 7.82 - 13.90, P < 0.001). Marital status, education, smoking status, and SES did not significantly predict MetS in men. Conclusions: A high prevalence of MetS was observed in this study, emphasizing central obesity, high TG, and low HDL. This calls on the government authorities to establish screening programs to identify individuals with a lower number of abnormal MetS components to prevent them from developing MetS and the resultant cardiovascular complications.

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Screening for Diabetic Retinopathy in Endocrinology Clinics by Using Handheld Cameras and Applying Artificial Intelligence Algorithms

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.856 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A419-A420

Author(s):

Zack Dvey-Aharon ◽

Petri Huhtinen

Keyword(s):

Artificial Intelligence ◽

Diabetic Retinopathy ◽

Vision Loss ◽

Ground Truth ◽

World Health ◽

Diabetic Patients ◽

Early Screening ◽

Exclusion Criteria ◽

Fundus Camera ◽

The World

Abstract According to estimations of the World Health Organization (WHO), there are almost 500M people in the world that suffer from diabetes. Projections suggest this number will surpass 700M by 2045 with global prevalence surpassing 7%. This huge population, alongside people with pre-diabetics, is prone to develop diabetic retinopathy, the leading cause of vision loss in the working age. While early screening can help prevent most cases of vision loss caused by diabetic retinopathy, the vast majority of patients are not being screened periodically as the guidelines instruct. The challenge is to find a reliable and convenient method to screen patients so that efficacy in detection of referral diabetic retinopathy is sufficient while integration with the flow of care is smooth, easy, simple, and cost-efficient. In this research, we described a screening process for more-than-mild retinopathy through the application of artificial intelligence (AI) algorithms on images obtained by a portable, handheld fundus camera. 156 patients were screened for mtmDR indication. Four images were taken per patient, two macula centered and two optic disc centered. The 624 images were taken using the Optomed Aurora fundus camera and were uploaded using Optomed Direct-Upload. Fully blinded and independently, a certified, experienced ophthalmologist (contracted by Optomed and based in Finland) reviewed each patient to determine ground truth. Indications that are different than mtmDR were also documented by the ophthalmologist to meet exclusion criteria. Data was obtained from anonymized images uploaded to the cloud-based AEYE-DS system and analysis results from the AI algorithm were promptly returned to the users. Of the 156 patients, a certified ophthalmologist determined 100% reached sufficient quality of images for grading, and 36 had existing retinal diseases that fall under exclusion criteria, thus, 77% of the participants met the participation criteria. Of the remaining 120 patients, the AEYE-DS system determined that 2 patients had at least one insufficient quality image. AEYE-DS provided readings for each of the 118 remaining patients (98.3% of all patients). These were statistically compared to the output of the ground truth arm. The patient ground truth was defined as the most severe diagnosis from the four patient images; the ophthalmologist diagnosed 54 patients as mtmDR+ (45% prevalence). Of the 54 patients with referable DR, 50 were diagnosed and of the 64 mtmDR- patients, 61 were correctly diagnosed by the AI. In summary, the results of the study in terms of sensitivity and specificity were 92.6% and 95.3%, respectively. The results indicated accurate classification of diabetic patients that required referral to the ophthalmologist and those who did not. The results also demonstrated the potential of efficient screening and easy workflow integration into points of care such as endocrinology clinics.

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Association between sociodemographic variables and awareness of diabetic retinopathy among type 2 diabetic patients

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20205473 ◽

2020 ◽

Vol 8 (1) ◽

pp. 63

Author(s):

Kasim Yasar Kannappillil Muhammedali ◽

V. Sahasranamam ◽

Saji Nair Ambika

Keyword(s):

Diabetic Retinopathy ◽

Early Detection ◽

Positive Association ◽

Demographic Variables ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Significant Positive Association ◽

Cross Sectional ◽

Screening Programs ◽

Duration Of Diabetes

Background: Early detection of diabetic retinopathy (DR) is the most important factor in reducing the blinding complications due to diabetes. Study of the various socio-demographic factors affecting awareness of DR will help us to formulate effective screening programs for early detection. Objectives of the study were to find the sociodemographic determinants associated with awareness of DR and to evaluate the association of stage of DR with awareness about diabetic retinopathy.Methods: A cross sectional study was conducted among 384 patients who had been diagnosed with diabetes mellitus in various medical camps and diabetic clinics at Thiruvananthapuram. Socio demographic variables and awareness were assessed using structured self-administered questionnaire. Dilated fundus evaluation was done and retinopathy classified. Data entered to excel sheet and analysis done using statistical software (SPSS version 20).Results: Among the 384 patients, 44.9% were diagnosed to have diabetic retinopathy. Among the diagnosed 41.6% had mild non proliferative DR (NPDR), 33.0% had moderate NPDR, 11.45% had severe NPDR. 13.4% of subjects were diagnosed to have proliferative DR. 53.1% of the subjects with diabetic retinopathy had clinically significant macular edema. There was no statistically significant association between the stage of DR to awareness. Among the socio demographic variables, significant positive association with level of awareness was obtained for duration of diabetes (OR=10.96; p=0.004)Conclusions: Duration of diabetes was significantly associated with level of awareness. There was no statistically significant association between the stage of diabetic retinopathy to awareness. This signifies the urgent need to intensify our diabetic retinopathy awareness programs.

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Diagnostic Accuracy of Direct Ophthalmoscopy and Non-Mydriatic Retinal Photography by Trained Optometrists for Screening of Diabetic Retinopathy

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i2.1015 ◽

2020 ◽

Vol 36 (2) ◽

Author(s):

Muhammad Saleh Memon ◽

Shahid Ahsan ◽

Muhammad Fahadullah ◽

Khalida Parveen ◽

Sumaira Salim ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Predictive Value ◽

Fundus Photography ◽

Slit Lamp ◽

Reference Standard ◽

Cross Sectional ◽

Fundus Camera ◽

Retinal Photography ◽

Direct Ophthalmoscopy

Purpose: To determine the reliability of direct ophthalmoscopy and Non-Mydriatic fundus photography for screening of Diabetic Retinopathy by optometrist. Study Design: Observational, cross sectional. Place and Duration of Study: Al-Ibrahim eye hospital, Karachi from October to December 2018. Material and Methods: All individuals with type 2 diabetes of≥ 40 years of age were screened for diabetic retinopathy (DR) by two trained optometrists and an ophthalmologist. First Optometrist used Non Mydriatic Fundus Camera (NMFC) and second optometrist used direct ophthalmoscopy (DO) after dilating the pupils. Final examination was done by the Ophthalmologist with slit lamp using Volk fundus lens which was considered as reference standard. Every investigator was kept unaware of the findings of others. Results: A total of 698 eyes of 349 respondents were screened. Ophthalmologist could not make decision by bio microscopy in 44 (6.3%) individuals as compared to 128 (18.3%) by 1st optometrist by NMFC and 142 (20.3%) by 2nd optometrist with DO. Diabetic retinopathy (DR) was diagnosed in 1493 (21.4%) with slit lamp, in 1172 (16.8%) with NMFC and in 1333 (19.1%) with DO. Sensitivity of NMFC was 76% and that of DO was 64.8%. Specificity of NMFC was 97.45% and that of DO was 96.63%. Positive predictive value (PPV) of NMFC was 89.33% and that of DO was 84.3% Negative predictive value (NPV) of NMFC was 93.33% and that of DO was 90.7%. Conclusion: NMFC is recommended tool for DR screening; but DO by well-trained optometrist can be reliable where neither ophthalmologist nor NMFC is available.

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