Diabetic Retinopathy Improved Detection Using Deep Learning

Diabetes is a disease that occurs when the body presents an uncontrolled level of glucose that is capable of damaging the retina, leading to permanent damage of the eyes or vision loss. When diabetes affects the eyes, it is known as diabetic retinopathy, which became a global medical problem among elderly people. The fundus oculi technique involves observing the eyeball to diagnose or check the pathology evolution. In this work, we implement a convolutional neural network model to process a fundus oculi image to recognize the eyeball structure and determine the presence of diabetic retinopathy. The model’s parameters are optimized using the transfer-learning methodology for mapping an image with the corresponding label. The model training and testing are performed with a dataset of medical fundus oculi images and a pathology severity scale present in the eyeball as labels. The severity scale separates the images into five classes, from a healthy eyeball to a proliferative diabetic retinopathy presence. The latter is probably a blind patient. Our proposal presented an accuracy of 97.78%, allowing for the confident prediction of diabetic retinopathy in fundus oculi images.

Diagnosis of type 3 macular neovascularization

Type 3 macular neovascularization is characterized by a complex of pathological vessels located in the sensory retina. Fundus oculi examination reveals intraretinal hemorrhages, macular edema, hard exudates and pigment epithelial detachments. Indocyanine and fluorescein angiography, OCT and angio-OCT are used for diagnosis and treatment monitoring. The treatment efficacy depends on the disease severity and the therapy applied.

Asymptomatic hypertension-mediated organ damage in patients with or without moderate to severe chronic kidney disease

Introduction Moderate or severe chronic kidney disease (CKD) is regarded as high or very high risk factor in the Systematic COronary Risk Evaluation (SCORE) system, as stated in the ESC guidelines on arterial hypertension. Assessment of cardiovascular (CV) risk should be completed evaluating hypertension-mediated organ damage (HMOD). Purpose The aim of our study was to find out differences in HMOD in patients with or without moderate to severe chronic kidney disease (CKD). Methods We enrolled 80 consecutive non-diabetic hypertensive patients, divided into two groups according to the presence of impaired renal function, evaluated by estimated glomerular filtration rate (eGFR): moderate to severe CKD group (n=26 patients, eGFR <60 mL/min/1.73 m2) and mild CKD - normal renal function group (n=54 patients, eGFR ≥60 mL/min/1.73 m2). A transthoracic echocardiogram was performed to evaluate cardiac HMOD. Small and large vessel damage was assessed by means of non-mydriatic digital fundus oculi examination in order to detect arteriolar narrowing using arteriolar-venular ratio (AVr), applanation tonometry to measure carotid-femoral pulse wave velocity (cfPWV) and carotid ultrasound to quantify intima-media tickness (IMT). Results Moderate to severe CKD patients appeared to be older (mean age 75.54±8.06 vs 63.38±9.62, p=0.001) and showed lower level of total and LDL cholesterol. Both groups showed abnormal values of cfPWV, but these were significantly higher in the presence of moderate to severe CKD (14.12±7.93 m/s vs 10.94±5.81 m/s, p=0.03). Abnormal AVr values were found in patients with higher grade of CKD, with statistically significant differences in the two groups (0.75±0.015 vs 0.81±0.06, p=0.00001). Carotid IMT resulted to be at the upper limit of normality in both groups (0.95±0.15 vs 0.90±0.18, p=0.35). With regard to echocardiography evaluation, left ventricular mass index (LVMi: 105.04±0.4 vs 96.35±1.7, p=0.06) and relative wall thickness (RWT: 0.43±0.02 vs 0.42±0.05, p=0.41) did not differ significantly in the two groups, with a mild trend for LVMi. Both groups showed abnormal diastolic dysfunction on average, but no differences emerged in the presence of more severe renal impairment (deceleration time 281.74±0.37 vs 256.30±0.54, p=0.08; E/A 0.86±0.03 vs 0.95±0.25, p=0.20; E/e' 7.89±2.93 vs 7.60±2.46, p=0.66). Conclusions Our study showed significant differences in HMOD in presence of moderate to severe renal impairment. Moderate to severe CKD seemed to be associated to vascular damage (hypertensive retinopathy and arterial stiffness), while no significant differences in echocardiographic markers of cardiac remodeling were found, suggesting that systemic vascular damage is more closely linked to CKD than cardiac damage. Therefore, the use of fundus oculi examination and PWV should always be considered to properly assess the target organ damage in hypertensive patients with CKD. Funding Acknowledgement Type of funding source: None

Posterior Scleritis: About A Case

Posterior scleritis is a rare and often unknown condition that can simulate many conditions including intraocular tumor or orbital pathology. We report the case of a 44-year-old patient with left eye pain and redness followed by a significant decrease in visual acuity. Clinical examination showed papillary hyperemia, chorioretinal folds at the posterior pole, venous tortuosity, and absence of hyalitis or vasculitis in the fundus oculi associated angiography retinal. Orbital-cerebral MRI and B ultrasound allowed the diagnosis of posterior scleritis

A Case of Fundus Oculi Albinoticus Diagnosed as Angelman Syndrome by Genetic Testing

Purpose: To report a case of fundus oculi albinoticus diagnosed as Angelman syndrome (AS) via genetic testing. Case Report: This study reports on a 4-year-old boy. Since he had been having respiratory disturbance since birth, he underwent a complete physical examination to investigate the cause. The results indicated that he had various brain congenital abnormalities, such as a thin corpus callosum, as well as hydronephrosis, an atrial septal defect, and skin similar to patients with fundus oculi albinoticus. Examination revealed bilateral fundus oculi albinoticus, mild iridic hypopigmentation, optic atrophy, and poor visual tracking. Genetic testing revealed a deletion in the Prader-Willi syndrome/AS region on chromosome 15, and together with the results of methylation analysis, his condition was diagnosed as AS. Follow-up examinations revealed no change in the fundus oculi albinoticus and optic atrophy, nor did they indicate poor visual tracking. Conclusions: When fundus oculi albinoticus and optic atrophy are observed in patients with multiple malformations, AS should be considered as a differential diagnosis.

Microretina: An “Open Source” Tool for Retinal Images Analysis

Several are the instrumental tests currently available in the diagnosis of retinal diseases. Their outputs are typically images of anatomical portions of the eye. However, these are useful to highlight only few aspects of the characteristic lesions of the occurring pathology. For this reason, the clinician needs to have tools able to perform comparative analysis of the different diagnostic images by using procedures of integration of the different clinical information contained in each of them. In this paper, we will describe a new medical software tool (MicroRetina) tailored for the comparative analysis of images of the fundus oculi, acquired during diagnostic tests that make use of different medical instruments. The developed software is an open system able to manage images acquired by different instruments and it will be able to give a helpful support to one of the existing problem in performing diagnosis by using images of the fundus oculi. In particular, it will allow the clinician to perform in real time the comparative analysis of the different clinical findings allowing him to have further diagnostic information not otherwise available by the analysis of the single images only.

Scotopic Microperimetry in the Early Diagnosis of Age-Related Macular Degeneration: Preliminary Study

Background. Recent clinical studies have shown that, in some degenerative retinal diseases, like age-related macular degeneration (AMD), the sensitivity of the rods decreases more rapidly than the sensitivity of the cones. The aim of this study was to evaluate if there is a correlation between the presence of hard drusen at the macular level and the rod damage responsible for the reduction in scotopic retinal sensitivity in subjects at risk for AMD.Methods. The authors selected 24 subjects (14 men and 10 women) with an average age of 67.25 ± 5.7 years. Macular hard drusen were present in 50% of the subjects at thefundus oculiexam. The researchers evaluated the retinal sensitivity to light in mesopic and scotopic conditions of each subject with an MP-1 scotopic microperimeter (MP-1S).Results. In subjects with hard drusen in thefundus oculiexamination, there was a statistically significant reduction in scotopic retinal sensitivity, while the mesopic retinal sensitivity was not compromised.Conclusion. This study revealed how the presence of hard drusen at the macular level is associated with a reduction in scotopic retinal sensitivity compared to a control group of healthy subjects. Retinal functionality in a scotopic setting examined with MP-1S could be useful in early diagnosis of AMD.