scholarly journals Validation of an Automated Screening System for Diabetic Retinopathy Operating under Real Clinical Conditions

2021 ◽  
Vol 11 (1) ◽  
pp. 14
Author(s):  
Soledad Jimenez-Carmona ◽  
Pedro Alemany-Marquez ◽  
Pablo Alvarez-Ramos ◽  
Eduardo Mayoral ◽  
Manuel Aguilar-Diosdado
Keyword(s):  
Diabetic Retinopathy ◽  
Large Scale ◽  
Developed Countries ◽  
Population Based ◽  
Diabetic Patients ◽  
Screening System ◽  
K Value ◽  
Aged People ◽  
Automated Screening ◽  
Clinical Conditions

Background: Retinopathy is the most common microvascular complication of diabetes mellitus. It is the leading cause of blindness among working-aged people in developed countries. The use of telemedicine in the screening system has enabled the application of large-scale population-based programs for early retinopathy detection in diabetic patients. However, the need to support ophthalmologists with other trained personnel remains a barrier to broadening its implementation. Methods: Automatic diagnosis of diabetic retinopathy was carried out through the analysis of retinal photographs using the 2iRetinex software. We compared the categorical diagnoses of absence/presence of retinopathy issued by family physicians (PCP) with the same categories provided by the algorithm (ALG). The agreed diagnosis of three specialist ophthalmologists is used as the reference standard (OPH). Results. There were 653 of 3520 patients diagnosed with diabetic retinopathy (DR). Diabetic retinopathy threatening to vision (STDR) was found in 82 patients (2.3%). Diagnostic sensitivity for STDR was 94% (ALG) and 95% (PCP). No patient with proliferating or severe DR was misdiagnosed in both strategies. The k-value of the agreement between the ALG and OPH was 0.5462, while between PCP and OPH was 0.5251 (p = 0.4291). Conclusions: The diagnostic capacity of 2iRetinex operating under normal clinical conditions is comparable to screening physicians.

scholarly journals The Nonmydriatic Fundus Camera in Diabetic Retinopathy Screening: A Cost-Effective Study with Evaluation for Future Large-Scale Application

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Giuseppe Scarpa ◽  
Francesca Urban ◽  
Stela Vujosevic ◽  
Michele Tessarin ◽  
Giovanni Gallo ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Early Detection ◽  
Large Scale ◽  
Screening Programme ◽  
Cost Effective ◽  
Diabetic Patients ◽  
Local Health Authority ◽  
Local Health ◽  
Fundus Camera ◽  
Diabetic Retinopathy Screening

Aims. The study aimed to present the experience of a screening programme for early detection of diabetic retinopathy (DR) using a nonmydriatic fundus camera, evaluating the feasibility in terms of validity, resources absorption, and future advantages of a potential application, in an Italian local health authority. Methods. Diabetic patients living in the town of Ponzano, Veneto Region (Northern Italy), were invited to be enrolled in the screening programme. The “no prevention strategy” with the inclusion of the estimation of blindness related costs was compared with screening costs in order to evaluate a future extensive and feasible implementation of the procedure, through a budget impact approach. Results. Out of 498 diabetic patients eligible, 80% was enrolled in the screening programme. 115 patients (34%) were referred to an ophthalmologist and 9 cases required prompt treatment for either proliferative DR or macular edema. Based on the pilot data, it emerged that an extensive use of the investigated screening programme, within the Greater Treviso area, could prevent 6 cases of blindness every year, resulting in a saving of €271,543.32 (−13.71%). Conclusions. Fundus images obtained with a nonmydriatic fundus camera could be considered an effective, cost-sparing, and feasible screening tool for the early detection of DR, preventing blindness as a result of diabetes.

Determining diabetic retinopathy screening interval based on time from no retinopathy to laser therapy

2016 ◽  
Vol 24 (4) ◽  
pp. 170-175 ◽  
Author(s):  
Daniel Hughes ◽  
Sunil Nair ◽  
John N Harvey
Keyword(s):  
Diabetic Retinopathy ◽  
Laser Therapy ◽  
Visual Outcome ◽  
Population Based ◽  
Proliferative Retinopathy ◽  
Early Years ◽  
Diabetic Patients ◽  
Community Screening ◽  
Diabetic Retinopathy Screening ◽  
Screening Interval

Objectives To determine the necessary screening interval for retinopathy in diabetic patients with no retinopathy based on time to laser therapy and to assess long-term visual outcome following screening. Methods In a population-based community screening programme in North Wales, 2917 patients were followed until death or for approximately 12 years. At screening, 2493 had no retinopathy; 424 had mostly minor degrees of non-proliferative retinopathy. Data on timing of first laser therapy and visual outcome following screening were obtained from local hospitals and ophthalmology units. Results Survival analysis showed that very few of the no retinopathy at screening group required laser therapy in the early years compared with the non-proliferative retinopathy group ( p < 0.001). After two years, <0.1% of the no retinopathy at screening group required laser therapy, and at three years 0.2% (cumulative), lower rates of treatment than have been suggested by analyses of sight-threatening retinopathy determined photographically. At follow-up (mean 7.8 ± 4.6 years), mild to moderate visual impairment in one or both eyes due to diabetic retinopathy was more common in those with retinopathy at screening (26% vs. 5%, p < 0.001), but blindness due to diabetes occurred in only 1 in 1000. Conclusions Optimum screening intervals should be determined from time to active treatment. Based on requirement for laser therapy, the screening interval for diabetic patients with no retinopathy can be extended to two to three years. Patients who attend for retinal screening and treatment who have no or non-proliferative retinopathy now have a very low risk of eventual blindness from diabetes.

scholarly journals Comparison of Efficacy and Safety of Rosuvastatin, Atorvastatin and Pravastatin among Dyslipidemic Diabetic Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Lolwa Barakat ◽  
Amin Jayyousi ◽  
Abdulbari Bener ◽  
Bilal Zuby ◽  
Mahmoud Zirie
Keyword(s):  
Renal Function ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Large Scale ◽  
Population Based ◽  
Diabetic Patients ◽  
Population Based Study ◽  
Number Of Patients ◽  
Second Year ◽  
New Onset

Objectives. To investigate the efficacy and the safety of the three most commonly prescribed statins (rosuvastatin, atorvastatin, and pravastatin) for managing dyslipidemia among diabetic patients in Qatar. Subjects and Methods. This retrospective observational population-based study included 350 consecutive diabetes patients who were diagnosed with dyslipidemia and prescribed any of the indicated statins between September 2005 and September 2009. Data was collected by review of the Pharmacy Database, the Electronic Medical Records Database (EMR viewer), and the Patient's Medical Records. Comparisons of lipid profile measurements at baseline and at first- and second-year intervals were taken. Results. Rosuvastatin (10 mg) was the most effective at reducing LDL-C (29.03%). Atorvastatin reduced LDL-C the most at a dose of 40 mg (22.8%), and pravastatin reduced LDL-C the most at a dose of 20 mg (20.3%). All three statins were safe in relation to muscular and hepatic functions. In relation to renal function, atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria (10.9%) followed by rosuvastatin (14.3%) and then pravastatin (26.6%). Conclusion. In the Qatari context, the most effective statin at reducing LDL-C was rosuvastatin 10 mg. Atorvastatin was the safest statin in relation to renal function. Future large-scale prospective studies are needed to confirm these results.

scholarly journals Association of Fenofibrate and Diabetic Retinopathy in Type 2 Diabetic Patients: A Population-Based Retrospective Cohort Study in Taiwan

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 385
Author(s):  
Ying-Chieh Lin ◽  
Yu-Ching Chen ◽  
Jorng-Tzong Horng ◽  
Jui-Ming Chen
Keyword(s):  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Laser Treatment ◽  
Population Based ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Significant Difference ◽  
Type 2 Diabetic

Background and Objectives: Fenofibrate, a PPAR-α agonist, has been demonstrated to reduce the progression of diabetic retinopathy (DR) and the need for laser treatment in a FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study. However, in the subgroup of patients without pre-existing DR, there was no significant difference in the progression of DR between the fenofibrate group and the placebo group. In this study, we aim to investigate whether fenofibrate can decrease the risk of incident DR in a population-based cohort study of type 2 diabetic patients in Taiwan. Materials and Methods: A total of 32,253 type 2 diabetic patients without previous retinopathy were retrieved from 892,419 patients in 2001–2002. They were then divided into two groups based on whether they were exposed to fenofibrate or not. The patients were followed until a diagnosis of diabetic retinopathy was made or until the year 2008. Results: With a follow-up period of 6.8 ± 1.5 years and 5.4 ± 2.6 years for 2500 fenofibrate users and 29,753 non-users, respectively, the Cox proportional hazard regression analysis revealed that the hazard ratio (HR) of new onset retinopathy was 0.57 (95% CI 0.57–0.62, p < 0.001). After adjusting for hypertension; the Charlson comorbidity index (CCI); and medications such as angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), anticoagulants, gemfibrozil, statins, and hypoglycemic agents, the adjusted HR was 0.75 (95% CI 0.68–0.82, p < 0.001). The need for laser treatment has an HR and adjusted HR of 0.59 (95% CI 0.49–0.71, p < 0.001) and 0.67 (95% CI 0.56–0.81, p < 0.001), respectively. Conclusion: Our study showed that the long-term and regular use of fenofibrate may decrease the risk of incident retinopathy and the need for laser treatment in type 2 diabetic patients. Since there are limitations associated with our study, further investigations are necessary to confirm such an association.

scholarly journals Entropy Rate Superpixel Classification for Automatic Red Lesion Detection in Fundus Images

Entropy ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 417 ◽  
Author(s):  
Roberto Romero-Oraá ◽  
Jorge Jiménez-García ◽  
María García ◽  
María I. López-Gálvez ◽  
Javier Oraá-Pérez ◽  
...  
Keyword(s):  
Large Scale ◽  
Developed Countries ◽  
Lesion Detection ◽  
Entropy Rate ◽  
Diabetic Patients ◽  
Fundus Images ◽  
Test Set ◽  
Image Appearance ◽  
Working Age ◽  
Color Fundus Images

Diabetic retinopathy (DR) is the main cause of blindness in the working-age population in developed countries. Digital color fundus images can be analyzed to detect lesions for large-scale screening. Thereby, automated systems can be helpful in the diagnosis of this disease. The aim of this study was to develop a method to automatically detect red lesions (RLs) in retinal images, including hemorrhages and microaneurysms. These signs are the earliest indicators of DR. Firstly, we performed a novel preprocessing stage to normalize the inter-image and intra-image appearance and enhance the retinal structures. Secondly, the Entropy Rate Superpixel method was used to segment the potential RL candidates. Then, we reduced superpixel candidates by combining inaccurately fragmented regions within structures. Finally, we classified the superpixels using a multilayer perceptron neural network. The used database contained 564 fundus images. The DB was randomly divided into a training set and a test set. Results on the test set were measured using two different criteria. With a pixel-based criterion, we obtained a sensitivity of 81.43% and a positive predictive value of 86.59%. Using an image-based criterion, we reached 84.04% sensitivity, 85.00% specificity and 84.45% accuracy. The algorithm was also evaluated on the DiaretDB1 database. The proposed method could help specialists in the detection of RLs in diabetic patients.

scholarly journals Retinal Complications in Diabetes Mellitus: Importance of Screening and Management

PRILOZI ◽  
2014 ◽  
Vol 35 (3) ◽  
pp. 167-173
Author(s):  
Milena Golubovik
Keyword(s):  
Diabetic Retinopathy ◽  
Systemic Risk ◽  
Vision Loss ◽  
Developed Countries ◽  
Diabetic Patients ◽  
Common Cause ◽  
Time Expenditures ◽  
Method Analysis ◽  
Retinal Complications

AbstractIntroduction: Diabetic retinal complications are the most common cause of reduced visual acuity in persons aged 25 to 75 years. However, vision loss can be prevented or delayed if the changes are seen on time.Aim: By analyzing literature data to create an algorithm for careful follow-up of diabetic patients, which would prevent progression of the changes and development of conditions leading to blindness. At the same time, this paper presents certain changes of the eye fundus and mode of their treatment.Material and method: Analysis of studies published on diabetic retinopathy and screening conducted in developed countries, with creating an algorithm for follow-up of diabetic retinal changes and their management.Conclusion: Timely detection and treatment of diabetic retinopathy with application of protocols in developed countries as well as parallel correction of systemic risk factors for progression of diabetic retinopathy will reduce the possibility of visual impairment in diabetics due to retinal complications. At the same time expenditures related to more complicated and less effective surgical procedures will be reduced along with the societal concern.

scholarly journals Diabetic Dermopathy (Shin Spots) and Diabetic Retinopathy - Are They Associated?

2020 ◽  
Vol 7 (48) ◽  
pp. 2806-2810
Author(s):  
Niya Babu ◽  
Nima Teresa Andrew ◽  
Mercy Paul ◽  
Chakkalackal Varkey Anthrayose ◽  
Anchitha Meenu Rajeev ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Retinopathy ◽  
Developed Countries ◽  
Diabetic Microangiopathy ◽  
Diabetic Patients ◽  
Keywords Diabetic Retinopathy ◽  
Duration Of Diabetes ◽  
Patients With Diabetes ◽  
The Mean ◽  
The Developed Countries

BACKGROUND Diabetes mellitus (DM) is a major cause of avoidable blindness in the developing and the developed countries. Diabetic patients have 25 times more chance of becoming blind than the non-diabetics.1 According to the WHO, the number of people in India affected with Diabetes Mellitus in the year 2000 was 31.7 million which is estimated to rise to 79.4 million by 2030, which would be higher than any other country in the world. 75 percent of all Type 2 diabetics and almost all Type 1 diabetics are expected to develop diabetic retinopathy (DR) over a period of time.2 Diabetic dermopathy or shin spots are the commonest dermatological manifestation in patients with Diabetes Mellitus. It is also known as pigmented pretibial patches, spotted leg syndrome or diabetic dermangiopathy.3 Both diabetic retinopathy and dermopathy are manifestations of diabetic microangiopathy. We wanted to study the association between diabetic retinopathy and diabetic dermopathy. METHODS 182 patients (between 40 - 70 years of age) having diabetes mellitus for at least five years were included in the study and were examined for retinal changes and skin changes. The study period was six months. RESULTS Of the 182 diabetic patients included in this study, 106 (58.2 %) had diabetic retinopathy. Shin spots were seen in 158 cases (86.8 %). 100 (94.3 %) cases with diabetic retinopathy had shin spots. The mean duration of diabetes mellitus in patients with diabetic retinopathy was 11.85 years and it was 8.16 years in those without diabetic retinopathy. The mean duration of diabetes mellitus in patients with shin spots was 14.88 years and it was 10.70 years in those without shin spots. CONCLUSIONS There is significant association between diabetic retinopathy and diabetic dermopathy. KEYWORDS Diabetic Retinopathy, Shin Spots, Diabetic Dermopathy

scholarly journals The Relationship between Estimated Glomerular Filtration Rate and Diabetic Retinopathy

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Jingyang Wu ◽  
Jin Geng ◽  
Limin Liu ◽  
Weiping Teng ◽  
Lei Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Retinopathy ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Early Stage ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
Aged People ◽  
The Relationship

Diabetic retinopathy (DR) is the leading cause of visual impairment and blindness in working-aged people. Several studies have suggested that glomerular filtration rate (GFR) was correlated with DR. This is a hospital-based study and the aim of it was to examine the relationship between the GFR and DR in patients with type 2 diabetes mellitus (T2DM). We used CKD-EPI equation to estimate GFR and SPSS 19.0 and EmpowerStats software to assess their relationship. Among the 1613 participants (aged 54.75 ± 12.19 years), 550 (34.1%) patients suffered from DR. The multivariate analysis revealed that the risk factors for DR include age (P<0.001, OR = 0.940), duration of diabetes (P<0.001, OR = 1.163), hemoglobin A1c (P=0.007, OR = 1.224), systolic blood pressure (P<0.001, OR = 1.032), diastolic blood pressure (P=0.007, OR = 0.953), high density lipoprotein cholesterol (P=0.024, OR = 3.884), and eGFR (P=0.010, OR = 0.973). Through stratified analysis and saturation effect analysis, our data suggests that eGFR of 99.4 mL/min or lower might imply the early stage of DR in diabetic patients. Thus, the evaluation of eGFR has clinical significance for the early diagnosis of DR.

scholarly journals Macular vessel density in diabetes and diabetic retinopathy with swept-source optical coherence tomography angiography

2020 ◽  
Author(s):  
Naiqiang Xie ◽  
Yan Tan ◽  
Sen Liu ◽  
Yining Xie ◽  
Shaoshuai Shuai ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Diabetic Retinopathy ◽  
Linear Regression ◽  
Large Scale ◽  
Optical Coherence Tomography Angiography ◽  
Vessel Density ◽  
Diabetic Patients ◽  
Optical Coherence ◽  
Swept Source ◽  
History Of

AbstractPurposePrevious studies on the association between macular vessel density (VD) and diabetic retinopathy had conflicting conclusions. This study assessed the alterations of macular VD, as well as other factors, in diabetic patients using swept-source optical coherence tomography angiography (SS-OCTA) in a large-scale sample from Chinese communities.MethodsPatients with type 2 diabetes without history of ocular treatment were recruited from 2017 to 2018. The average and quadrant parafoveal vessel density (PVD) were obtained with a commercial SS-OCTA device (Triton, Topcan, Japan). Univariate and multivariate linear regression was used to analyse the correlation of PVD with diabetic retinopathy (DR), diabetic macular edema (DME), HbA1c, and other factors.ResultsA total of 919 patients were included in the final statistical analysis. After adjusting for other confounding factors, the DR patients had significantly lower average PVD (β= −1.062, 95% CI = −1.424 to −0.699, P < 0.001) in comparison with those without DR. In addition, the patients with mild DR or vision-threatening diabetic retinopathy (VTDR) also had significantly lower PVD (P < 0.001 for mild DR, and P = 0.008 for VTDR) compared with those without DR. Age and HbA1c were also significantly related to PVD measurements, as shown by multivariable linear regression. Participants with DME had a significantly lower average PVD and temporal PVD than those without DME (P < 0.05).ConclusionsReduced PVD was independently associated with more severe DR, older age, higher HbA1c level, and the presence of DME. These findings provide manifest evidence to suggest that macular vessel alterations play a role in the pathogenesis of DR.

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