Assessment of knowledge, attitude and practice of diabetic eye care among non-ophthalmic speciality doctors at a tertiary institute in India

Aim of this study was to assess the knowledge, attitude and practices (KAP) in eye care of diabetics by non-ophthalmic doctors of different specialization. The was a cross-sectional questionnaire based KAP survey among 108 non-ophthalmic diabetes mellitus treating faculties of various departments at our institute. The level of Knowledge was considered excellent if the overall average score was > 75%, similarly questionnaire focusing on attitude was considered positive if the average score was > 50% and excellent practice constituted an average score > 75%. The findings will be noted in percentages with 95% confidence interval limit. Out of the 108 subjects, 75.57% {95%CI(61%-78%)} of participants had excellent knowledge, while >87.6% {95%CI(73%-88%)} of participants had a positive attitude towards diabetic eye care, whereas there were glaring deficits in diabetic eye care practices accounting to only 45.5%{95%CI(32.8%-51.4%)} which was considered poor. Knowledge and attitude regarding diabetic eye care was excellent, there was glaring deficits in the practice of diabetic eye care by non-ophthalmic treating doctors. The deficit was probably due to busy schedule of some doctors, due to lack of uniform eye care protocols of diabetic patients, and lack of updated timely education of eye care practices among non-ophthalmic medical professionals. Hence based on the findings of our study we aim to train and educate our non-ophthalmic medical faculty regularly for adequate and better management of spectrum of diabetic eye disease.

L-type calcium channel blocker increases VEGF concentrations in retinal cells and human serum

Objective: Vascular endothelial growth factor (VEGF) plays a key role in diabetic retinopathy (DR). L-type calcium channel blockers (LTCCBs) have been widely used as antihypertensive medication (AHM), but their association with VEGF and DR is still unclear. Therefore, we explored the effect of LTCCBs compared to other AHMs on VEGF concentrations in retinal cells and human serum. Furthermore, we evaluated the association between the use of LTCCBs and the risk of severe diabetic eye disease (SDED). Research design and methods: Muller cells (MIO-M1) were cultured as per recommended protocol and treated with LTCCBs and other AHMs. VEGF secreted from cells were collected at 24 hours intervals. In an interventional study, 39 individuals received LTCCBs or other AHM for four weeks with a four-week wash-out placebo period between treatments. VEGF was measured during the medication and placebo periods. Finally, we evaluated the risk of SDED associated with LTCCB usage in 192 individuals from the FinnDiane Study in an oberservational setting. Results: In the cell cultures, medium VEGF concentration increased time-dependently after amlodipine (p<0.01) treatment, but not after losartan (p>0.01), or lisinopril (p>0.01). Amlodipine, but no other AHM, increased serum VEGF concentration (p<0.05) during the interventional clinical study. The usage of LTCCB was not associated with the risk of SDED in the observational study. Conclusions: LTCCB increases VEGF concentrations in retinal cells and human serum. However, the usage of LTCCBs does not appear to be associated with SDED in adults with type 1 diabetes.

Electroretinogram Analysis In Patients With Non-Proliferative Diabetic Retinopathy

Purpose: Non-proliferative diabetic retinopathy (NPDR) is the earliest stage of diabetic eye disease. Microscopic changes occur in the blood vessels of the eye in NPDR. The changes typically do not produce symptoms and are not visible to the naked eye. This paper aims to investigate a method for distinguishing NPDR based on Electroretinogram (ERG).Method: The ERG responses were recorded in 20 eyes from 14 patients with NPDR and 20 eyes from 20 healthy subjects as the control group. The responses of three standard stimuli were collected for both groups. Time-domain parameters, including amplitudes and implicit time, and a nonlinear criterion, were used to differentiate the groups. Results: This study showed that implicit time and amplitude of b-wave in dark-adapted 10.0 ERG and amplitude and implicit time of light-adapted flicker 30 Hz could distinguish between controls and NPDR groups. Theta values obtained for dark-adapted 10.0 ERG (p=0.0019), light-adapted 3.0 ERG (p=0.0021), and light-adapted flicker 30 Hz (p=0.0023) had significant differences between the groups. Conclusion: The proposed features have made it possible to distinguish between healthy and NPDR eyes. Choosing an appropriate method can effectively evaluate inner retinal dysfunction, especially in diabetic retinopathy.

A Fluorescent Aptasensor Based on Assembled G-Quadruplex and Thioflavin T for the Detection of Biomarker VEGF165

VEGF165, a regulator of angiogenesis, has been widely used as a serum biomarker for a number of human diseases, including cancer, rheumatoid arthritis, bronchial asthma, and diabetic eye disease. The rapid, accurate, and convenient detection of VEGF165 is a crucial step in effective healthcare monitoring, disease diagnosis, and prognosis assessment. In this study, a fluorescent aptasensor based on an assembled G-quadruplex and the signal molecule ThT was developed for VEGF165 detection. First, G-rich DNA fragments were assembled at both ends of the anti-VEGF165 aptamer, and the B-DNA form was converted into a G-quadruplex structure aptamer (G4-Apt). Then, ThT was introduced, and the G-quadruplex significantly enhanced the fluorescence intensity of the bound ThT. When VEGF165 was present, the higher affinity of the aptamer to the target protein allowed the G4-Apt/VEGF165 complex to form and release ThT, which emitted only weak fluorescence in the free state. Therefore, the aptasensor exhibited a good linear detection window from 1.56 to 25 nM VEGF165, with a limit of detection of 0.138 nM. In addition, the aptasensor was applied to detect VEGF165 in clinical serum samples, showing good accuracy, reproducibility, and stability. These results indicate that our developed fluorescent aptasensor can potentially be a reliable, convenient, and cost-effective approach for the sensitive, specific, and rapid detection of the VEGF165 biomarker.

Quantitative Imaging Biomarkers in Age-Related Macular Degeneration and Diabetic Eye Disease: A Step Closer to Precision Medicine

The management of retinal diseases relies heavily on digital imaging data, including optical coherence tomography (OCT) and fluorescein angiography (FA). Targeted feature extraction and the objective quantification of features provide important opportunities in biomarker discovery, disease burden assessment, and predicting treatment response. Additional important advantages include increased objectivity in interpretation, longitudinal tracking, and ability to incorporate computational models to create automated diagnostic and clinical decision support systems. Advances in computational technology, including deep learning and radiomics, open new doors for developing an imaging phenotype that may provide in-depth personalized disease characterization and enhance opportunities in precision medicine. In this review, we summarize current quantitative and radiomic imaging biomarkers described in the literature for age-related macular degeneration and diabetic eye disease using imaging modalities such as OCT, FA, and OCT angiography (OCTA). Various approaches used to identify and extract these biomarkers that utilize artificial intelligence and deep learning are also summarized in this review. These quantifiable biomarkers and automated approaches have unleashed new frontiers of personalized medicine where treatments are tailored, based on patient-specific longitudinally trackable biomarkers, and response monitoring can be achieved with a high degree of accuracy.

Diabetes

This chapter provides a comprehensive overview of diabetes care and management. It starts with a classification and diagnosis of diabetes, followed by sections on expert management of both Type 1 and Type 2 diabetes. Living with diabetes is then explored, from sports and exercise, travel, alcohol and recreational drug use, and special considerations such as Ramadan. Hospital inpatient management and diabetes-related emergencies are covered in detail. Diabetes and pregnancy, and paediatric and transition diabetes both have sections explaining common and rare presentations. Finally there are sections on discrete diabetic conditions, such as diabetic eye disease, nephropathy and chronic kidney disease, neuropathy, the diabetic foot, and macrovascular disease.