Svanevaughn5997
To study the relationship between the severity of myopia and the severity of diabetic retinopathy (DR) in individuals with type 1 or type 2 diabetes mellitus (DM).
This retrospective study was conducted using data from electronic medical records from a multicentric eyecare network located in various geographic regions of India. Individuals with type 1 or type 2 DM were classified according to their refractive status. Severe nonproliferative DR (NPDR), PDR, or presence of clinically significant macular edema (CSME) with any type of DR was considered as vision-threatening diabetic retinopathy (VTDR).
A total of 472 individuals with type-1 DM (mean age 41 ± 10 years) and 9341 individuals with type-2 DM (52 ± 9 years) were enrolled. Individuals with a hyperopic refractive error had a significant positive association with the diagnosis of VTDR (odds ratio (OR) 1.26; 95%CI 1.04-1.51, P = 0.01) and moderate nonproliferative DR (OR 1.27; 95%CI 1.02-1.59, P = 0.03) in type-2 DM; however, no significant association was found in type-1 DM. After adjusting for age, gender, anisometropia, and duration of diabetes, the presence of high myopia (< - 6 D) reduced the risk of VTDR in type 2 DM (OR 0.18; 95% CI 0.04-0.77, P = 0.02), but no association was found in type 1 DM. Mild and moderate myopia had no significant association with any forms of DR in both type-1 and type-2 DM.
Hyperopic refractive error was found to increase the risk of VTDR in persons with type 2 DM. High-myopic refractive error is protective for VTDR in type 2 DM, but not in type-1 DM.
Hyperopic refractive error was found to increase the risk of VTDR in persons with type 2 DM. High-myopic refractive error is protective for VTDR in type 2 DM, but not in type-1 DM.
To determine the prevalence of presbyopia and its association with elevated glycemic levels in subjects ≥40 years of age in the South Indian population of Chennai.
This was a retrospective study. Subjects were included from the Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular genetics Study (SN-DREAMS 1). Demographic data, detailed medical and ocular history, comprehensive eye examination, and biochemical investigations were performed. Glycosylated hemoglobin results were categorized as controls (4%-5.6%), prediabetic (5.7%-6.4%), and diabetic (≥6.5%) groups. The given presbyopic correction was divided into two groups as within and outside donders limit. Prevalence rates and mean values were determined and compared among the three glycemic groups. The Student t test, the Chi-square test, and multivariate logistic regression analyses were performed.
The overall prevalence of presbyopia from our previously conducted SN-DREAMS 1 population of 1414 patients was 79.77% (95% CI 0.775-0.818). In total, 1128 participants were included for our current secondary analysis with a mean age of 54.40 years (range 40-83). The number of subjects within and outside donders limit was 1044 (92.55%) and 84 (7.44%), respectively. In each age group (40-49, 50-59, ≥60) regardless of being within or outside donders limits, an increasing trend in the prevalence of presbyopia was noted based on increasing glycemic levels.
Our study demonstrated a high prevalence of presbyopia in the South Indian population of Chennai. Findings show that the prevalence of presbyopia in different age groups increases with worsening diabetes status.
Our study demonstrated a high prevalence of presbyopia in the South Indian population of Chennai. Findings show that the prevalence of presbyopia in different age groups increases with worsening diabetes status.
Diabetic retinopathy (DR) is a potentially sight-threatening complication of diabetes mellitus. The majority of cases are in older adults. This study aims to evaluate modifiable and nonmodifiable protective factors against DR in a geriatric Indian population.
This retrospective observational study uses data from a multitiered ophthalmology network to evaluate several demographic and clinical variables against diabetic retinopathy and visual acuity.
Our data show that high myopia, the female sex, and no cataract surgery are associated with lower prevalence of DR (OR = 0.21, 0.65, and 0.76, respectively; P < 0.001). We also found that among those with DR, people categorized as payers, retirees, and those living in urban or metropolitan areas have better visual acuity (OR = 0.65, 0.65, 0.83, and 0.73, respectively; P < 0.001). Among those with DR, females, presence of cataracts, and no cataract surgery had lower associations with sight-threatening DR (STDR) (OR = 0.68, 0.37, and 0.76, respectively; P < 0.001). Prevalence of DR decreased in older age groups while controlling for DM duration.
It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.
It is probable that high myopia, the female sex, and better glycemic control are protective against DR and STDR in our study cohort of adults over 60 years of age. It is possible that occupations involving manual labor, delayed cataract surgery, and living past the age of 70 are also protective against DR.
There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screening for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment.
We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM.
The prevalence of DR in 44,599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR.
In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.
In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.
The aim of the study was to analyse the reliability of an offline artificial intelligence (AI) algorithm for community screening of diabetic retinopathy.
A total of 1378 patients with diabetes visiting public dispensaries under the administration of the Municipal Corporation of Greater Mumbai between August 2018 and September 2019 were enrolled for the study. Fundus images were captured by non-specialist operators using a smartphone-based camera covering the posterior pole, including the disc and macula, and the nasal and temporal fields. The offline AI algorithm on the smartphone marked the images as referable diabetic retinopathy (RDR) or non-RDR, which were then compared against the grading by two vitreoretinal surgeons to derive upon the sensitivity and specificity of the algorithm.
Out of 1378 patients, gradable fundus images were obtained and analysed for 1294 patients. AZD0095 price The sensitivity and specificity of diagnosing RDR were 100% (95% CI 94.72-100.00%) and 89.55% (95% CI 87.76-91.16%), respectively; the same values for any diabetic retinopathy (DR) were 89.13% (95% CI 82.71-93.79%) and 94.43% (95% CI 91.89-94.74%), respectively, with no false-negative results.
The robustness of the offline AI algorithm was established in this study making it a reliable tool for community-based DR screening.
The robustness of the offline AI algorithm was established in this study making it a reliable tool for community-based DR screening.
To assess the use of smartphone-based direct ophthalmoscope photography for screening of diabetic retinopathy (DR) in known diabetic patients walking into a general practitioner's clinic and referring them to a vitreoretinal specialist for further evaluation and management if required.
The study included 94 eyes of 47 walk-in patients in a general practitioner's OPD who were known to have type 2 diabetes mellitus and were already on treatment for the same.
The study included 47 patients with diabetes with a mean age of 56.2 ± 9.4 years. The Cohen's kappa values revealed that the diagnosis related to the DR status made using a camera was in substantial agreement with the clinical diagnosis (Kappa value 0.770). The Cohen's kappa values revealed that the diagnosis related to the DME made using a camera was in moderate agreement with the clinical diagnosis (Kappa value 0.410). The agreement between the findings of the camera and clinical diagnosis was statistically significant (P < 0.05).
Direct ophthalmoscope-based smartphone imaging can be a useful tool in the OPD of a general practitioner. These images can be assessed for retinopathy, and patients can be referred to a vitreoretinal specialist for further evaluation and management if needed. Hence, the burden of vision loss due to complications of DR in the rural sector can be abridged.
Direct ophthalmoscope-based smartphone imaging can be a useful tool in the OPD of a general practitioner. These images can be assessed for retinopathy, and patients can be referred to a vitreoretinal specialist for further evaluation and management if needed. Hence, the burden of vision loss due to complications of DR in the rural sector can be abridged.
To assess the perceptions of physicians about diabetic retinopathy (DR) screening, barriers to DR screening, and change in management protocol of Diabetes Mellitus (DM) patients with DR.
A cross-sectional descriptive study was conducted using a standard predesigned and pretested structured questionnaire through online mode in the month of April 2021 to assess the criteria used for referral of diabetic patients for DR screening, barriers to DR screening, and the management plan among physicians after the patient has been diagnosed with DR.
In total, 100 physicians participated in the study. Physicians responded that criteria used for referral for DR screening according to duration was <5 years (n = 0), 5-10 years (n = 60), >10 years (n = 10), and irrespective of the duration (n = 30). According to severity, well-controlled DM without (n = 30) and with other system involvement (n = 50) and uncontrolled DM without (20) and with other system involvement (n = 50) and irrespective of the severity of disease (n = 30) was reported. Physicians (n = 40) responded that patients who were diagnosed with DR belonged to the Type 1 DM category rather than Type 2 DM (P < 0.05). With regard to the barriers and challenges faced in ensuring DR screening, the following themes emerged no ocular symptoms, lack of compliance, time constraint for the patient, and lack of motivation.
We found that the preferred practice pattern of physicians regarding referral for DR screening was dependent on the duration of the disease (mostly 5-10 years of the disease) and severity (when other systems were involved). Noncompliance with advice was the major barrier to DR screening.
We found that the preferred practice pattern of physicians regarding referral for DR screening was dependent on the duration of the disease (mostly 5-10 years of the disease) and severity (when other systems were involved). Noncompliance with advice was the major barrier to DR screening.
