scholarly journals A predictive screening tool to detect diabetic retinopathy or macular edema in primary health care: construction, validation and implementation on a mobile application

PeerJ ◽  
2015 ◽  
Vol 3 ◽  
pp. e1404 ◽  
Author(s):  
Cesar Azrak ◽  
Antonio Palazón-Bru ◽  
Manuel Vicente Baeza-Díaz ◽  
David Manuel Folgado-De la Rosa ◽  
Carmen Hernández-Martínez ◽  
...  

The most described techniques used to detect diabetic retinopathy and diabetic macular edema have to be interpreted correctly, such that a person not specialized in ophthalmology, as is usually the case of a primary care physician, may experience difficulties with their interpretation; therefore we constructed, validated and implemented as a mobile app a new tool to detect diabetic retinopathy or diabetic macular edema (DRDME) using simple objective variables. We undertook a cross-sectional, observational study of a sample of 142 eyes from Spanish diabetic patients suspected of having DRDME in 2012–2013. Our outcome was DRDME and the secondary variables were: type of diabetes, gender, age, glycated hemoglobin (HbA1c), foveal thickness and visual acuity (best corrected). The sample was divided into two parts: 80% to construct the tool and 20% to validate it. A binary logistic regression model was used to predict DRDME. The resulting model was transformed into a scoring system. The area under the ROC curve (AUC) was calculated and risk groups established. The tool was validated by calculating the AUC and comparing expected events with observed events. The construction sample (n= 106) had 35 DRDME (95% CI [24.1–42.0]), and the validation sample (n= 36) had 12 DRDME (95% CI [17.9–48.7]). Factors associated with DRDME were: HbA1c (per 1%) (OR = 1.36, 95% CI [0.93–1.98],p= 0.113), foveal thickness (per 1 µm) (OR = 1.03, 95% CI [1.01–1.04],p< 0.001) and visual acuity (per unit) (OR = 0.14, 95% CI [0.00–0.16],p< 0.001). AUC for the validation: 0.90 (95% CI [0.75–1.00],p< 0.001). No significant differences were found between the expected and the observed outcomes (p= 0.422). In conclusion, we constructed and validated a simple rapid tool to determine whether a diabetic patient suspected of having DRDME really has it. This tool has been implemented on a mobile app. Further validation studies are required in the general diabetic population.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Reza Mirshahi ◽  
Hamid Riazi-Esfahani ◽  
Elias Khalili Pour ◽  
Kaveh Fadakar ◽  
Parsa Yarmohamadi ◽  
...  

AbstractThe purpose of current study was to evaluate different optical coherence tomography angiography (OCTA) metrics in eyes with diabetic retinopathy with and without diabetic macular edema (DME). In this retrospective study, macular OCTA images of eyes with non-proliferative or proliferative diabetic retinopathy were evaluated. Vascular density, vascular complexity and non-perfusion densities were compared between eyes with and without DME. One-hundred-thirty-eight eyes of 92 diabetic patients including 49 eyes with DME were included. In multivariate analysis, the presence of DME was positively associated with geometric perfusion deficit (GPD) in superficial capillary plexus (SCP), capillary non-perfusion (CNP) of SCP, and GPD in deep capillary plexus (DCP) (all P < 0.05). In eyes with DME, central foveal thickness was associated with VD ratio (SCP/DCP) (P = 0.001) and FAZ area (P = 0.001). In conclusion, in eyes with diabetic retinopathy, the presence of DME was associated with more extensive capillary non-perfusion compared to those with no macular edema.


2013 ◽  
Vol 5 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Mohammadreza Ahmadpour-Baghdadabad ◽  
Masoudreza Manaviat ◽  
Ahmad Shojaoddiny-Ardekani

Introduction: Diabetic Macular Edema (DME) is an important cause of vision loss in diabetic retinopathy. Optical Coherence Tomography (OCT) is a non-invasive modality that produces high-resolution images of retinal layers. Objective: To evaluate the prevalence of DME patterns and their association with risk factors and visual acuity. Materials and Methods: In this cross-sectional study, type 2 diabetics with macular edema referred to our center during a ten-month period underwent OCT. Patients with macular edema due to causes other than diabetes and with OCT images of improper quality were excluded from the study. Four distinct patterns were found in the OCT images. A questionnaire including age, sex, duration of diabetes, serum TG and cholesterol, HbA1c, BMI and visual acuity, as well as the findings of OCT images were filled for the subjects. Results: Eighty-six eyes from 46 patients were evaluated. The most and the least common patterns were sponge-like retinal swelling (SLRS) and posterior hyaloidal traction (PHT) found in 64.0% and 5.8% of the subjects, respectively. A sub-retinal fluid pattern was more common in males (p=0.011) and in patients with serum TG > 200mg/dl (p=0.037). There were significant associations between central foveal (r=0.45, p<0.001), nasal (r=0.35, p=0.001) and temporal (r=0.32, p=0.003) thicknesses with visual acuity. Moreover, the highest thickness (462.4±119.2μm) and also the worst visual acuity (1.0±0.5logMAR) pertained to the cystoid macular edema (CME) pattern. Conclusion: Our study showed that the most common OCT pattern of DME is the sponge-like retinal swelling, while posterior hyaloidal traction has the lowest prevalence. A higher foveal thickness and a lower visual acuity are seen in the CME pattern. Nepal J Ophthalmol 2013; 5(10): 190-194 DOI: http://dx.doi.org/10.3126/nepjoph.v5i2.8727


2020 ◽  
Vol 9 (6) ◽  
pp. 189-192
Author(s):  
Charles Masih ◽  
Kanwal Parveen ◽  
Samreen Brohi ◽  
Shehar Bano Siyal ◽  
Fatima Zia ◽  
...  

Objective: To determine the visual outcome in Diabetic Macular Edema patients after 3rd Avastin injections attending a tertiary eye care hospital. Materials and methods: This was a cross sectional study with Non probability convenient sampling technique. The study was carried out at Diabetic clinic of Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi-Pakistan. Ethical approval was taken from the institutional review board of Institute. Data collection were done retrospectively from January 2017 to June 2019. Data were retrieved for DME patients who have completed three follow-ups with Avastin injection. Inclusion Criteria were patients with age 30 to 60 years, Patient with PDR and NPDR with diabetic macular edema after 3rd injection. Data Analysis was done using SPSS version 23.0. Results: A total of 40 eyes of 40 patients were included in this study after getting information from the record sheet. Analysis were done in 30 eyes of 30 patients because 10 patients were missed their follow-up due to certain reason which were observed from record sheet. Mean age of patients was found to be 41.25±10.24.Pre-operative Avastin injection best corrected visual acuity (BCVA) was noticed by using Log MAR without glasses was 0.49 and with glasses was 0.40. Post-operative best corrected visual acuity Log MAR without glasses 0.51 and with glasses 0.42 after Avastin injection. Improvement of visual acuity was classified as Improved, worsen and Stable. There were 22 (73.33%) patients observed with improvement in visual acuity, 5 (16.66%) patients retained their vision stable and only 3 (10%) patients worsen their visual acuity after all three Avastin injections. Conclusion: The most common cause of diabetic macular edema is non-proliferative diabetic retinopathy and proliferative Diabetic Retinopathy. The Intravitreal injection play vital role, the timely treatment would improve prognosis of visual outcomes in Diabetic macular edema. So the study significantly shows the improvement in best corrected visual acuity before and after three visits.


2019 ◽  
Vol 30 (2) ◽  
pp. 315-320 ◽  
Author(s):  
Giacomo Panozzo ◽  
Giovanni Staurenghi ◽  
Giulia Dalla Mura ◽  
Diana Giannarelli ◽  
Giovanni Alessio ◽  
...  

Background:The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy.Methods:It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels.Results:A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated proliferative diabetic retinopathy, and 53 (7.5%) had laser-treated retinopathy. In the entire sample of 3657 subjects, a normal macula was present in 90.9% of cases, diabetic macular edema of any kind in 5.4%, and other maculopathies in 3.4%.Conclusion:In this large cohort study on patients undergoing cataract surgery, more than one-fourth were diabetics and more than one-fourth of these had diabetic macular edema. These high prevalences suggest the opportunity to plan an adequate preoperative assessment in all patients in order to reduce the risk of postoperative development or worsening of a sight-threatening complication such as chronic diabetic macular edema.


Author(s):  
Marlene Lindner ◽  
Behrouz Arefnia ◽  
Domagoj Ivastinovic ◽  
Harald Sourij ◽  
Ewald Lindner ◽  
...  

Abstract Objectives Periodontitis and diabetes are known to have a bidirectional relationship. Diabetic macular edema is a complication of diabetes that is strongly influenced by inflammatory pathways. However, it remains to be established whether inflammation at other locations, such as periodontitis, affects diabetic macular edema. Here, we investigated the prevalence of periodontitis in patients treated for diabetic macular edema. Materials and methods Patients with diabetic macular edema were recruited for this cross-sectional study at the Medical University of Graz. Macular edema was documented by optical coherence tomography. Periodontal status was assessed by computerized periodontal probing and panoramic X-ray imaging. Bleeding on probing, clinical attachment level, probing pocket depth, and plaque index were compared between different stages of diabetic retinopathy. Results Eighty-three eyes of 45 patients with diabetic macular edema were enrolled. Forty-four eyes (53.0%) had early stages of diabetic retinopathy (mild and moderate), and 39 eyes (47.0%) had late stages (severe and proliferative). Patients with mild or moderate DR were more likely to have more severe periodontal conditions than patients with severe or proliferative DR. Fourteen patients with mild DR (82.4%), 7 patients with moderate DR (87.5%), 4 patients with severe DR (100.0%), and 15 patients with proliferative DR (93.8%) had some degree of PD. The periodontal inflamed surface areas and the percentages of tooth sites that bled on probing were significantly higher in patients with early stages of diabetic retinopathy than in those with late stages of the disease (p < 0.05). Patients with periodontal inflamed surface areas of more than 500 mm2 required significantly more intravitreal injections in the last year than those with milder forms of periodontitis (n = 6.9 ± 3.1 versus n = 5.0 ± 3.5, p = 0.03). Conclusion In patients with diabetic macular edema, periodontitis is more prevalent in early stages of diabetic retinopathy. We suggest regular dental check-ups for diabetic patients, especially when diabetic macular edema is already present. Clinical relevance Patients with diabetic macular edema should be screened for periodontitis and vice versa, particularly early in the course of diabetes.


2021 ◽  
Vol 4 (2) ◽  
pp. 150
Author(s):  
Syntia Nusanti ◽  
Kirana Sampurna ◽  
Ari Djatikusumo ◽  
Anggun Rama Yudantha ◽  
Joedo Prihartono

Introduction :  Diabetic Retinopathy (DR) is one of the major cause of visual acuity deterioration in diabetic patients. The loss of central visual acuity in diabetic patients are mainly due to macula edema, which is found in 29% diabetic patients with the over 20 years duration of disease. The aim of this study is to evaluate and investigate the possible correlation among changes of visual acuity (VA), central macular thickness (CMT) using Spectral Domain Optical Coherence Tomography (SD-OCT). Electrophysiological responses using multifocal electroretinography (MfERG) in diabetic macular edema (DME) following intravitreal injection of bevacizumab. Methods: Single arm clinical trial. Thirty-three eyes of 33 DME patients (16 non-proliferative diabetic retinopathy and 17 non-high-risk proliferative diabetic retinopathy), receives intravitreal bevacizumab 1,25mg. All patients underwent complete ophthalmic examination including ETDRS VA testing, Sixty-one scaled hexagon MfERG and SD-OCT scan at baseline, 1-week and 1-month post-injection. Components of the first order kernel (N1, N2 and P1) in central 2o were measured. Result : MfERG showed reduced P1 amplitude (P<0.05) at 1-week after injection followed by increased P1 amplitude (P>0.05) at 1-month after treatment as compared to the baseline in all subjects. There was 19% improvement CMT and 0.2Logmar VA improvement in 1-month post-injection compared to the baseline (P<005). This study showed no serious ocular adverse effects. There was no significant correlation between changes in visual acuity with changes in CMT or other MfERG parameters. Conclusion: Intravitreal injection bevacizumab resulting in improved VA, reduction in CMT and mild improvement in the MfERG responses. Although VA changes did not correlate with reduced CMT nor with improved responses of MfERG, the combined use of SD-OCT and MfERG may be used to evaluate macular function in DME patient with worsened visual acuity post anti-VEGF injection.


Author(s):  
Kajal Seema S. ◽  
Jayalekshmi T. ◽  
Manasa S. ◽  
Prasenna M.

Background: The objective of the study was to examine the effect of long-term glycemic control, as measured by glycated hemoglobin levels (HbA1C), on the onset and progression of diabetic retinopathy (DR) and diabetic macular edema (DME) over a period of 10 years.Methods: Patients who were diagnosed to have type 2 diabetes mellitus participated in this cross-sectional observational study. Duration of onset of diabetes and the glycemic control status were analyzed. Fasting and postprandial blood sugar levels and HbA1C levels were tested for every participant. Diabetic retinopathy was graded as per the ETDRS guidelines using stereoscopic fundus photographs. In addition to the clinical evaluation, optical coherence tomography was done to confirm the presence of DME.Results: A total of 212 diabetic patients were enrolled in this study. One sixty-four patients (78.1%) had DR, out of which 71 patients (43.3%) had mild non proliferative diabetic retinopathy (NPDR), 42 patients (25.6%) had moderate NPDR, 31 patients (18.9%) had severe NPDR, and 20 (12.2%) had proliferative diabetic retinopathy (PDR). Fifty-nine patients with DR (36%) had DME. Duration of diabetes (14.62±6.18 vs 9.72±3.68 years, p<0.001), higher fasting blood glucose (176.79±59.13 vs 138.46±49.44 mg/dl, p<0.001) and higher HbA1c levels (8.21±1.38 vs 7.48±1.25 %, p=0.002) were significantly associated with DR.Conclusions: The stage of diabetic retinopathy rather than metabolic status is a strong predictive factor for the development of diabetic macular edema.


2021 ◽  
Vol 9 (4) ◽  
pp. 15-22
Author(s):  
S. Ramin ◽  
M. Ahadi ◽  
A. Ebrahimi

The purpose of this study was to investigate the therapeutic effects of 670 nm irradiation in patients with diabetic macular edema. In several studies, positive effects of red/near-infrared irradiation showed in a range of ocular diseases such as macular degeneration, macular edema, and retinitis pigmentosa. This study was conducted on forty five eyes of 26 diabetic patients with macular edema between the ages of 51 and 80.Measurement of visual acuity and slit lamp examination, funduscopy, and optical coherence tomography were performed in all subjects. None of the patients had proliferative retinopathy. We used a portable LED device (Warp 10, Quantum Devices) for treatment. Patients held this device at a distance of 3 cm from their eyes for 240 seconds for three months. Full ophthalmic examinations were repeated 1, 2, and 3 months after treatment.After 3 months, the mean visual acuity improved from 0.44 ± 0.38 log MAR to 0.27 ± 0.24 log MAR and vision increased by 1.52 ± 1.16 lines post treatment (р<0.001). The mean central macula thickness decreased from 381.49 ± 144.40 μm to 359.72 ± 128.84 μm (р=0.050). In patients with mild and moderate nonproliferative diabetic retinopathy, the mean central retinal thickness decreased 52.06 ± 67.78 μm and 39.27 ± 44.69 μm, respectively, but patients with severe type showed an increase of 34.93 ± 65.65 μm in the mean central retinal thickness (р<0.001). Also, the severity of macular edema had no effect on final outcomes (р>0.05). Photobiomodulation can positively affect diabetic macular edema, especially in patients with mild to moderate diabetic retinopathy.


2020 ◽  
Vol 8 ◽  
pp. 205031211990086
Author(s):  
Sultan H Al-Rashidi ◽  
Faris S Al-Thunayyan ◽  
Khalid A Alsuhaibani ◽  
Abdulmajeed A Alharbi ◽  
Khalid A Alharbi

Objectives: Blindness is one of the most widespread final pathways of diabetic retinopathy and its associated diabetic macular edema. The general practitioners are the first to encounter these diabetic patients. Fundoscopy is now considered as an ideal way for the diagnosis of patients with diabetic retinopathy. Therefore, this study was undertaken to know the ability and skills of general practitioners for the diagnosis and management of patients with diabetic retinopathy and diabetic macular edema. Methods: This study was conducted in all major cities in Qassim province of Saudi Arabia during January to May 2017. A validated questionnaire was used to assess the general practitioners’ knowledge and practice for the management of diabetic retinopathy and diabetic macular edema. Questions related to referrals, diagnosis, and treatment options to diabetic retinopathy and diabetic macular edema were asked to the general practitioners. Results: Of 96 general practitioners, 76 returned the questionnaire with a response rate of 79.2%. Only 26.3% general practitioners referred patients with type 1 diabetes to ophthalmologists as per guidelines set by the American Academy of Ophthalmology, whereas 74% of general practitioners showed good knowledge for referring patients with type 2 diabetes to ophthalmology clinics. Lack of knowledge was also noticed for the treatment of diabetic retinopathy, as only 36.8% of general practitioners replied positive for dilated fundus examination option, whereas 78.9% of general practitioners chose laser photocoagulation as a treatment option. Similar response from them was observed for patients with diabetic macular edema. Furthermore, data also showed years in practice of general practitioners was well correlated with their knowledge for the management of diabetic retinopathy and diabetic macular edema. Conclusion: The general practitioners included in this study showed lack of knowledge in handling patients with diabetic retinopathy and diabetic macular edema. Therefore, refresher courses are needed that highlight the acquisition of their skills in fundoscopy.


2018 ◽  
Vol 11 (4) ◽  
pp. 51-66
Author(s):  
Fedor E. Shadrichev ◽  
Nyurguyana N. Grigor'eva ◽  
Elizaveta S. Rozhdestvenskaya

Diabetic retinopathy remains one of the greatest challenges for healthcare system worldwide despite the fact that the incidence of visual acuity impairment in diabetic population has decreased due to examination quality improvement and dynamic observation of patients. Visual acuity impairment in diabetic patients is often related to diabetic macular edema. Until recently, laser photocoagulation of the retina was regarded as gold standard for diabetic macular edema treatment. Laser photocoagulation of the retina provides visual acuity stabilization rather than improvement. Since early 2000s, pharmacological approach to this severe disease has been established. As vascular endothelial growth factor (VEGF) is one of the crucial factors involved in the pathogenesis of diabetic retinal disorders, VEGF inhibitors are now recognized as a treatment of choice for diabetic macular edema. This article considers results of different clinical trials investigating anti-VEGF therapy efficacy in DME treatment.


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