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Jost B Jonas - One of the best experts on this subject based on the ideXlab platform.

  • incidence and progression of Diabetic Retinopathy a systematic review
    The Lancet Diabetes & Endocrinology, 2019
    Co-Authors: Charumathi Sabanayagam, Riswana Banu, Miao Li Chee, Ryan Lee, Ya Xing Wang, Gavin Tan, Jost B Jonas, Ecosse L Lamoureux, Chingyu Cheng
    Abstract:

    Summary Diabetic Retinopathy is a leading cause of vision impairment and blindness. We systematically reviewed studies published from Jan 1, 1980, to Jan 7, 2018, assessed the methodological quality, and described variations in incidence of Diabetic Retinopathy by region with a focus on population-based studies that were conducted after 2000 (n=8, including two unpublished studies). Of these eight studies, five were from Asia, and one each from the North America, Caribbean, and sub-Saharan Africa. The annual incidence of Diabetic Retinopathy ranged from 2·2% to 12·7% and progression from 3·4% to 12·3%. Progression to proliferative Diabetic Retinopathy was higher in individuals with mild disease compared with those with no disease at baseline. Our Review suggests that more high-quality population-based studies capturing data on the incidence and progression of Diabetic Retinopathy with stratification by age and sex are needed to consolidate the evidence base. Our data is useful for conceptualisation and development of major public health strategies such as screening programmes for Diabetic Retinopathy.

  • subfoveal choroidal thickness in diabetes and Diabetic Retinopathy
    Ophthalmology, 2013
    Co-Authors: Jie Xu, Ya Xing Wang, Jost B Jonas, Liang Xu, Kui Fang Du, Lei Shao, Chang Xi Chen, Jin Qiong Zhou
    Abstract:

    Purpose To examine subfoveal choroidal thickness (SFCT) in patients with diabetes mellitus and patients with Diabetic Retinopathy. Design Population-based, cross-sectional study. Participants The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range, 50–93 years). Methods A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (OCT) with enhanced depth imaging for measurement of SFCT and fundus photography for the assessment of Diabetic Retinopathy. Main Outcome Measures Subfoveal choroidal thickness. Results Fasting blood samples, fundus photographs, and choroidal OCT images were available for 2041 subjects (58.8%), with 246 subjects (12.1±0.7%) fulfilling the diagnosis of diabetes mellitus and 23 subjects having Diabetic Retinopathy. Mean SFCT did not differ significantly between patients with diabetes mellitus and nonDiabetic subjects (266±108 vs. 261±103 μm; P  = 0.43) nor between patients with Diabetic Retinopathy and subjects without Retinopathy (249±86 vs. 262±104 μm; P  = 0.56). After adjustment for age, sex, axial length, lens thickness, anterior chamber depth, corneal curvature radius, and best-corrected visual acuity, SFCT was associated with a higher glycosylated hemoglobin (HbA1c) value ( P P  = 0.001; B, 21.3; 95% CI, 9.12–33.5) but not with presence of Diabetic Retinopathy ( P  = 0.61) or stage of Diabetic Retinopathy ( P  = 0.14). As a corollary, after adjusting for age, region of habitation, body mass index, systolic and diastolic blood pressure, and level of education, diabetes mellitus was associated with a thicker SFCT ( P P  = 0.61) nor stage of Diabetic Retinopathy ( P  = 0.09) were associated significantly with SFCT after adjusting for body mass index, diastolic and systolic blood pressure, and level of education and after adjusting for blood glucose concentrations, HbA1c value, diagnosis of diabetes mellitus, and systolic and diastolic blood pressure, respectively. Conclusions Patients with diabetes mellitus had a slightly, but statistically significantly, thicker subfoveal choroid, whereas presence and stage of Diabetic Retinopathy were not associated additionally with an abnormal SFCT. Whereas diabetes mellitus as a systemic disease leads to a slight thickening of the choroid, Diabetic Retinopathy as an ocular disorder was not associated with choroidal thickness abnormalities after adjusting for the presence of diabetes mellitus. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Rajiv Raman - One of the best experts on this subject based on the ideXlab platform.

  • prevalence and risk factors for Diabetic Retinopathy in rural india sankara nethralaya Diabetic Retinopathy epidemiology and molecular genetic study iii sn dreams iii report no 2
    BMJ open diabetes research & care, 2014
    Co-Authors: Rajiv Raman, Swakshyar Saumya Pal, Vaitheeswaran Kulothungan, Suganeswari Ganesan, Tarun Sharma
    Abstract:

    Objective The study was aimed at estimating the prevalence of type 2 diabetes mellitus and Diabetic Retinopathy in a rural population of South India. Design A population-based cross-sectional study. Participants 13 079 participants were enumerated. Methods A multistage cluster sampling method was used. All eligible participants underwent comprehensive eye examination. The fundi of all patients were photographed using 45°, four-field stereoscopic digital photography, and an additional 30° seven-field stereo digital pairs were taken for participants with Diabetic Retinopathy. The diagnosis of Diabetic Retinopathy was based on Klein9s classification. Main outcome measures Prevalence of diabetes mellitus and Diabetic Retinopathy and associated risk factors. Results The prevalence of diabetes in the rural Indian population was 10.4% (95% CI 10.39% to 10.42%); the prevalence of Diabetic Retinopathy, among patients with diabetes mellitus, was 10.3% (95% CI 8.53% to 11.97%). Statistically significant variables, on multivariate analysis, associated with increased risk of Diabetic Retinopathy were: gender (men at greater risk; OR 1.52; 95% CI 1.01 to 2.29), use of insulin (OR 3.59; 95% CI 1.41 to 9.14), longer duration of diabetes (15 years; OR 6.01; 95% CI 2.63 to 13.75), systolic hypertension (OR 2.14; 95% CI 1.20 to 3.82), and participants with poor glycemic control (OR 3.37; 95% CI 2.13 to 5.34). Conclusions Nearly 1 of 10 individuals in rural South India, above the age of 40 years, showed evidence of type 2 diabetes mellitus. Likewise, among participants with diabetes, the prevalence of Diabetic Retinopathy was around 10%; the strongest predictor being the duration of diabetes.

  • association of obesity with Diabetic Retinopathy sankara nethralaya Diabetic Retinopathy epidemiology and molecular genetics study sn dreams report no 8
    Acta Diabetologica, 2010
    Co-Authors: Rajiv Raman, Padmaja Kumari Rani, Perumal Gnanamoorthy, Rachapalle Reddi Sudhir, Govindasamy Kumaramanikavel, A Tarun E Sharma
    Abstract:

    The aim of the study was to report the prevalence of obesity indices in individuals with diabetes and find out their association with Diabetic Retinopathy in the urban Indian population. Subjects (n = 1,414) were recruited from Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular Genetics Study (SN-DREAMS-I), a cross-sectional study between 2003 and 2006. Anthropometric measurements were carried out, and all patients’ fundi were photographed using 45° four-field stereoscopic digital photography. The diagnosis of Diabetic Retinopathy was based on the modified Klein classification. Generalized obesity and abdominal obesity were defined using WHO Asia Pacific guidelines with the BMI (body mass index) cutoff as ≥23 kg/m2, WC (waist circumference) cutoffs as ≥90 cm in men and ≥80 cm in women and WHO guidelines using WHR (waist-to-hip ratio) cutoffs as ≥0.90 for men and ≥0.85 for women. Prevalence of obesity defined by BMI and WC was more in women compared to men, and that defined by WHR was more in men compared to women (P < 0.001). The prevalence of isolated generalized obesity, isolated abdominal obesity and combined obesity were 5.4, 10.1 and 58% in men and 4.5, 10.8 and 74.4% in women, respectively. The prevalence of any Diabetic Retinopathy and sight-threatening Diabetic Retinopathy was more in the isolated abdominal obesity group (26.35 and 6.08%, respectively) than in other subgroups. On logistic regression analysis, isolated abdominal obesity (OR 2.02, 95% CI: 1.06–3.86) and increased WHR in women (OR 1.48 95% CI: 1.10–2.38) were associated with Diabetic Retinopathy; BMI ≥ 23 (OR 0.66, 95% CI: 0.48–0.90) and combined obesity (OR 0.72, 95% CI: 0.53–0.99) had a protective role for any Diabetic Retinopathy in the overall group. In the urban south Indian population, isolated abdominal obesity and higher WHR in women were associated with Diabetic Retinopathy, but not with the severity of Diabetic Retinopathy.

  • prevalence of Diabetic Retinopathy in india sankara nethralaya Diabetic Retinopathy epidemiology and molecular genetics study report 2
    Ophthalmology, 2009
    Co-Authors: Rajiv Raman, Padmaja Kumari Rani, Sudhir Reddi Rachepalle, Perumal Gnanamoorthy, Satagopan Uthra, Govindasamy Kumaramanickavel, Tarun Sharma
    Abstract:

    Objective The aim of the study was to estimate the prevalence of Diabetic Retinopathy in an urban Indian population older than 40 years. Design A population-based cross-sectional study. Participants Five thousand nine hundred ninety-nine subjects residing in Chennai, India, were enumerated. Methods A multistage random sampling, based on socioeconomic criteria, was followed. Identified subjects with diabetes mellitus (based on the World Health Organization criteria) underwent detailed examination at the base hospital. The fundi of all patients were photographed using 45°, 4-field stereoscopic digital photography. The diagnosis of Diabetic Retinopathy was based on Klein's classification of the Early Treatment Diabetic Retinopathy Study scale. Main Outcome Measures These included age- and gender-adjusted prevalence of diabetes and Diabetic Retinopathy, and correlation of prevalence with history-based risk factors. Results The age- and gender - adjusted prevalence rate of diabetes in an urban Chennai population was 28.2% (95% confidence interval [CI], 27.0–29.3), and the prevalence of Diabetic Retinopathy in general population was 3.5% (95% CI, 3.49–3.54). The prevalence of Diabetic Retinopathy in the population with diabetes mellitus was 18.0% (95% CI, 16.0–20.1). History-based variables that were significantly associated with increased risk of Diabetic Retinopathy included gender (men at greater risk; odds ratio [OR], 1.41; 95% CI, 1.04–1.91); use of insulin (OR, 3.52; 95% CI, 2.05–6.02); longer duration of diabetes (>15 years; OR, 6.43; 95% CI, 3.18–12.90); and subjects with known diabetes mellitus (OR, 2.98; 95% CI, 1.72–5.17). Differences in the socioeconomic status did not influence the occurrence of Diabetic Retinopathy. Conclusions The prevalence of Diabetic Retinopathy was 18% in an urban population with diabetes mellitus in India. The duration of diabetes is the strongest predictor for Diabetic Retinopathy. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Ronald Klein - One of the best experts on this subject based on the ideXlab platform.

  • serum lipids and proliferative Diabetic Retinopathy and macular edema in persons with long term type 1 diabetes mellitus the wisconsin epidemiologic study of Diabetic Retinopathy
    JAMA Ophthalmology, 2015
    Co-Authors: Barbara E. K. Klein, Chelsea E Myers, Kerri P Howard, Ronald Klein
    Abstract:

    Importance Total serum and high-density lipoprotein cholesterol have been considered risk factors for severe vascular outcomes in persons with type 1 diabetes mellitus. Objective To examine the long-term relationships between these 2 serum lipids and the incidence and prevalence of proliferative Diabetic Retinopathy and macular edema. Design, Setting, and Participants Nine-hundred three persons with younger-onset type 1 diabetes mellitus who participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Exposures Serum total and high-density cholesterol and history of statin use during the course of 5 visits spanning approximately 30 years (April 10, 1984, to February 13, 2014). Main Outcomes and Measures Prevalence and incidence of proliferative Diabetic Retinopathy and macular edema. Results A modest association was found for higher levels of high-density lipoprotein cholesterol and decreased prevalence of proliferative Diabetic Retinopathy (odds ratio per 10 mg/dL, 0.87; 95% CI, 0.82-0.93), adjusting for duration of diabetes mellitus, glycosylated hemoglobin A 1c , statin use, and end-stage renal disease. While adjusting for covariates, no associations of serum total or high-density lipoprotein cholesterol and incident proliferative Diabetic Retinopathy or macular edema, nor of statin use with decreased incidence of proliferative Diabetic Retinopathy or macular edema, were identified. Conclusions and Relevance In the course of long-duration diabetes mellitus during a time of changing medical care, there appeared to be little effect of serum lipids or statins on the incidence of proliferative Diabetic Retinopathy and macular edema.

  • prevalence of Diabetic Retinopathy in the united states 2005 2008
    JAMA, 2010
    Co-Authors: Xinzhi Zhang, Barbara E. K. Klein, Jinan B Saaddine, Chiufang Chou, Mary Frances Cotch, Yiling J Cheng, Linda S Geiss, Edward W Gregg, Ann L Albright, Ronald Klein
    Abstract:

    Context The prevalence of diabetes in the United States has increased. People with diabetes are at risk for Diabetic Retinopathy. No recent national population-based estimate of the prevalence and severity of Diabetic Retinopathy exists. Objectives To describe the prevalence and risk factors of Diabetic Retinopathy among US adults with diabetes aged 40 years and older. Design, Setting, and Participants Analysis of a cross-sectional, nationally representative sample of the National Health and Nutrition Examination Survey 2005-2008 (N = 1006). Diabetes was defined as a self-report of a previous diagnosis of the disease (excluding gestational diabetes mellitus) or glycated hemoglobin A1c of 6.5% or greater. Two fundus photographs were taken of each eye with a digital nonmydriatic camera and were graded using the Airlie House classification scheme and the Early Treatment Diabetic Retinopathy Study severity scale. Prevalence estimates were weighted to represent the civilian, noninstitutionalized US population aged 40 years and older. Main Outcome Measurements Diabetic Retinopathy and vision-threatening Diabetic Retinopathy. Results The estimated prevalence of Diabetic Retinopathy and vision-threatening Diabetic Retinopathy was 28.5% (95% confidence interval [CI], 24.9%-32.5%) and 4.4% (95% CI, 3.5%-5.7%) among US adults with diabetes, respectively. Diabetic Retinopathy was slightly more prevalent among men than women with diabetes (31.6%; 95% CI, 26.8%-36.8%; vs 25.7%; 95% CI, 21.7%-30.1%; P = .04). Non-Hispanic black individuals had a higher crude prevalence than non-Hispanic white individuals of Diabetic Retinopathy (38.8%; 95% CI, 31.9%-46.1%; vs 26.4%; 95% CI, 21.4%-32.2%; P = .01) and vision-threatening Diabetic Retinopathy (9.3%; 95% CI, 5.9%-14.4%; vs 3.2%; 95% CI, 2.0%-5.1%; P = .01). Male sex was independently associated with the presence of Diabetic Retinopathy (odds ratio [OR], 2.07; 95% CI, 1.39-3.10), as well as higher hemoglobin A1c level (OR, 1.45; 95% CI, 1.20-1.75), longer duration of diabetes (OR, 1.06 per year duration; 95% CI, 1.03-1.10), insulin use (OR, 3.23; 95% CI, 1.99-5.26), and higher systolic blood pressure (OR, 1.03 per mm Hg; 95% CI, 1.02-1.03). Conclusion In a nationally representative sample of US adults with diabetes aged 40 years and older, the prevalence of Diabetic Retinopathy and vision-threatening Diabetic Retinopathy was high, especially among Non-Hispanic black individuals.

  • familial aggregation of severity of Diabetic Retinopathy in mexican americans from starr county texas
    Diabetes Care, 2005
    Co-Authors: Michael D Hallman, Ronald Klein, Barbara E. K. Klein, Charles J Huber, Victor H Gonzalez, Craig L Hanis
    Abstract:

    OBJECTIVE —Diabetic Retinopathy is a major cause of blindness. To determine whether Retinopathy itself or only its severity aggregates in families, we examined the occurrence and severity of Diabetic Retinopathy in Mexican-American siblings with type 2 diabetes. RESEARCH DESIGN AND METHODS —Using stereoscopic fundus photography of seven standard fields, we measured Retinopathy in 656 type 2 Diabetic patients from 282 Mexican-American families from Starr County, Texas. Retinopathy severity was scored using the Early Treatment of Diabetic Retinopathy Study system and classified as no Retinopathy, early nonproliferative Diabetic Retinopathy (NPDR-E), moderate-to-severe nonproliferative Diabetic Retinopathy (NPDR-S), or proliferative Diabetic Retinopathy (PDR). RESULTS —Of 249 siblings of randomly selected probands with Retinopathy, 169 (67.9%) had Retinopathy, compared with 95 of 125 siblings of unaffected probands (76.0%; P = 0.11). Proband Retinopathy class was associated ( P = 0.03) with sibling Retinopathy class, with significant odds ratios (ORs) for NPDR-E versus no Retinopathy (OR 0.57 [95% CI 0.35–0.93]) and PDR versus NPDR-E (2.02 [1.13–3.63]); the contrast of NPDR-S versus NPDR-E approached significance (1.78 [0.99–3.20]). With the more severe classes (PDR and NPDR-S) combined in one group and the less severe ones (none and NPDR-E) in another, more severe proband Retinopathy was associated with more severe sibling Retinopathy (1.72 [1.03–2.88]). CONCLUSIONS —More severe Diabetic Retinopathy showed evidence of familial aggregation, but the occurrence of Diabetic Retinopathy per se did not. The factors involved in the onset of Diabetic Retinopathy may differ from those involved in its progression to more severe forms.

  • proposed international clinical Diabetic Retinopathy and Diabetic macular edema disease severity scales
    Ophthalmology, 2003
    Co-Authors: Charles P Wilkinson, Frederick L Ferris, Ronald Klein, Matthew D. Davis, Paul P Lee, Carldavid Agardh, Diana G Dills, Anselm Kampik, R Pararajasegaram, Juan T Verdaguer
    Abstract:

    PURPOSE: To develop consensus regarding clinical disease severity classification systems for Diabetic Retinopathy and Diabetic macular edema that can be used around the world, and to improve communication and coordination of care among physicians who care for patients with diabetes. DESIGN: Report regarding the development of clinical Diabetic Retinopathy disease severity scales. PARTICIPANTS: A group of 31 individuals from 16 countries, representing comprehensive ophthalmology, retina subspecialties, endocrinology, and epidemiology. METHODS: An initial clinical classification system, based on the Early Treatment Diabetic Retinopathy Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy publications, was circulated to the group in advance of a workshop. Each member reviewed this using e-mail, and a modified Delphi system was used to stratify responses. At a later workshop, separate systems for Diabetic Retinopathy and macular edema were developed. These were then reevaluated by group members, and the modified Delphi system was again used to measure degrees of agreement. MAIN OUTCOME MEASURES: Consensus regarding specific classification systems was achieved. RESULTS: A five-stage disease severity classification for Diabetic Retinopathy includes three stages of low risk, a fourth stage of severe nonproliferative Retinopathy, and a fifth stage of proliferative Retinopathy. Diabetic macular edema is classified as apparently present or apparently absent. If training and equipment allow the screener to make a valid decision, macular edema is further categorized as a function of its distance from the central macula. CONCLUSIONS: There seems to be a genuine need for consistent international clinical classification systems for Diabetic Retinopathy and Diabetic macular edema that are supported with solid evidence. The proposed clinical classification systems provide a means of appropriately categorizing Diabetic Retinopathy and macular edema. It is hoped that these systems will be valuable in improving both screening of individuals with diabetes and communication and discussion among individuals caring for these patients.

  • epidemiology of proliferative Diabetic Retinopathy
    Diabetes Care, 1992
    Co-Authors: Ronald Klein, Barbara E. K. Klein, Scot E. Moss
    Abstract:

    OBJECTIVE This review examines recent epidemiological data about the prevalence and incidence of and risk factors for proliferative Diabetic Retinopathy. In addition, the relation of proliferative Retinopathy to other systemic complications associated with diabetes is reviewed. RESEARCH DESIGN AND METHODS The data come mostly from the baseline and 4-yr follow-up examinations of a large population-based study, the WESDR, which involved 996 younger-onset insulin-dependent people whose diabetes was diagnosed at RESULTS The major finding is that proliferative Retinopathy is a prevalent complication (23% in the WESDR younger-onset group, 10% in the WESDR older-onset group that takes insulin, and 3% in the group that does not take insulin). Hyperglycemia, longer duration of diabetes, and more severe Retinopathy at baseline were associated with an increased 4-yr risk of developing proliferative Retinopathy. However, higher blood pressure at baseline was associated only with the development of proliferative Retinopathy in the younger-onset group. The presence of proliferative Diabetic Retinopathy was associated with an increased 4-yr risk of loss of vision, cardiovascular disease, Diabetic nephropathy, and mortality. In the WESDR, a significant number of Diabetic people with proliferative Retinopathy at risk for vision loss were not under the care of an ophthalmologist or had not undergone panretinal photocoagulation. CONCLUSIONS These data suggest that hyperglycemia and, possibly, high blood pressure are related to proliferative Retinopathy. They also suggest that once proliferative Diabetic Retinopathy is detected, people should have a medical evaluation, because it is a strong indicator for the presence and development of systemic disease. These data also indicate that Diabetic patients and their physicians should be aware of the need for routine ophthalmological examinations to detect and treat proliferative Retinopathy.

Tien Yin Wong - One of the best experts on this subject based on the ideXlab platform.

  • Artificial intelligence for Diabetic Retinopathy screening, prediction and management.
    Current opinion in ophthalmology, 2020
    Co-Authors: Dinesh Visva Gunasekeran, Daniel Shu Wei Ting, Gavin S Tan, Tien Yin Wong
    Abstract:

    Purpose of review Diabetic Retinopathy is the most common specific complication of diabetes mellitus. Traditional care for patients with diabetes and Diabetic Retinopathy is fragmented, uncoordinated and delivered in a piecemeal nature, often in the most expensive and high-resource tertiary settings. Transformative new models incorporating digital technology are needed to address these gaps in clinical care. Recent findings Artificial intelligence and telehealth may improve access, financial sustainability and coverage of Diabetic Retinopathy screening programs. They enable risk stratifying patients based on individual risk of vision-threatening Diabetic Retinopathy including Diabetic macular edema (DME), and predicting which patients with DME best respond to antivascular endothelial growth factor therapy. Summary Progress in artificial intelligence and tele-ophthalmology for Diabetic Retinopathy screening, including artificial intelligence applications in 'real-world settings' and cost-effectiveness studies are summarized. Furthermore, the initial research on the use of artificial intelligence models for Diabetic Retinopathy risk stratification and management of DME are outlined along with potential future directions. Finally, the need for artificial intelligence adoption within ophthalmology in response to coronavirus disease 2019 is discussed. Digital health solutions such as artificial intelligence and telehealth can facilitate the integration of community, primary and specialist eye care services, optimize the flow of patients within healthcare networks, and improve the efficiency of Diabetic Retinopathy management.

  • traditional and novel risk factors of Diabetic Retinopathy and research challenges
    Current Medicinal Chemistry, 2013
    Co-Authors: Gavin S Tan, Kamran M Ikram, Tien Yin Wong
    Abstract:

    Diabetic Retinopathy affects one-third of people with diabetes and is the most frequent cause of blindness in working aged adults. Although Diabetic Retinopathy blindness appears to have fallen in the developed world, the rapidly increasing number of persons with diabetes worldwide has resulted in a continuous increase in the global burden of this disease. The major risk factors for Diabetic Retinopathy include duration of diabetes, hyperglycemia, and hypertension, but this is accountable for only a small amount of the variation in the risk of Diabetic Retinopathy. Research into new markers for Retinopathy including genetics, blood biomarkers and retinal imaging will further improve our understanding of the risk factors and pathogenesis of Diabetic Retinopathy.

  • serum apolipoprotein ai and b are stronger biomarkers of Diabetic Retinopathy than traditional lipids
    Diabetes Care, 2011
    Co-Authors: Muhammad Bayu Sasongko, Tien Yin Wong, Thanh T Nguyen, Ryo Kawasaki, Alicia J Jenkins, Jonathan E Shaw, Jie Jin Wang
    Abstract:

    OBJECTIVE To describe and compare the associations of serum lipoproteins and apolipoproteins with Diabetic Retinopathy. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 224 Diabetic patients (85 type 1 and 139 type 2) from a diabetes clinic. Diabetic Retinopathy was graded from fundus photographs according to the Airlie House Classification system and categorized into mild, moderate, and vision-threatening Diabetic Retinopathy (VTDR). Serum traditional lipids (total, LDL, non–HDL, and HDL cholesterol and triglycerides) and apolipoprotein AI (apoAI), apolipoprotein B (apoB), and the apoB-to-apoAI ratio were assessed. RESULTS Diabetic Retinopathy was present in 133 (59.4%) individuals. After adjustment for age, sex, diabetes duration, A1C, systolic blood pressure, and diabetes medications, the HDL cholesterol level was inversely associated with Diabetic Retinopathy (odds ratio 0.39 [95% CI 0.16–0.94], highest versus lowest quartile; P trend = 0.017). The ApoAI level was inversely associated with Diabetic Retinopathy (per SD increase, 0.76 [95% CI 0.59–0.98]), whereas apoB (per SD increase, 1.31 [1.02–1.68]) and the apoB-to-apoAI ratio (per SD increase, 1.48 [1.13–1.95]) were positively associated with Diabetic Retinopathy. Results were similar for mild to moderate Diabetic Retinopathy and VTDR. Traditional lipid levels improved the area under the receiver operating curve by 1.8%, whereas apolipoproteins improved the area by 8.2%. CONCLUSIONS ApoAI and apoB and the apoB-to-apoAI ratio were significantly and independently associated with Diabetic Retinopathy and Diabetic Retinopathy severity and improved the ability to discriminate Diabetic Retinopathy by 8%. Serum apolipoprotein levels may therefore be stronger biomarkers of Diabetic Retinopathy than traditional lipid measures.

  • lack of knowledge of glycosylated hemoglobin in patients with Diabetic Retinopathy
    Diabetes Research and Clinical Practice, 2008
    Co-Authors: Shiqi Wang, Tien Yin Wong, Gabriella Tikellis, Nathan D Wong, Jie Jin Wang
    Abstract:

    We surveyed 220 patients with Diabetic Retinopathy attending a tertiary eye hospital in Australia, and found that knowledge of HbA1c, and the proportion achieving target level of <7%, remained low in patients with Diabetic Retinopathy. These data re-emphasize the gap between clinical guidelines and actual management of patients with diabetes.

Jennifer R Evans - One of the best experts on this subject based on the ideXlab platform.

  • laser photocoagulation for proliferative Diabetic Retinopathy
    Cochrane Database of Systematic Reviews, 2014
    Co-Authors: Jennifer R Evans, Manuele Michelessi, Gianni Virgili
    Abstract:

    Background Diabetic Retinopathy is a complication of diabetes in which high blood sugar levels damage the blood vessels in the retina. Sometimes new blood vessels grow in the retina, and these can have harmful effects; this is known as proliferative Diabetic Retinopathy. Laser photocoagulation is an intervention that is commonly used to treat Diabetic Retinopathy, in which light energy is applied to the retina with the aim of stopping the growth and development of new blood vessels, and thereby preserving vision. Objectives To assess the effects of laser photocoagulation for Diabetic Retinopathy compared to no treatment or deferred treatment. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2014), EMBASE (January 1980 to June 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 June 2014. Selection criteria We included randomised controlled trials (RCTs) where people (or eyes) with Diabetic Retinopathy were randomly allocated to laser photocoagulation or no treatment or deferred treatment. We excluded trials of lasers that are no longer in routine use. Our primary outcome was the proportion of people who lost 15 or more letters (3 lines) of best-corrected visual acuity (BCVA) as measured on a logMAR chart at 12 months. We also looked at longer-term follow-up of the primary outcome at two to five years. Secondary outcomes included mean best corrected distance visual acuity, severe visual loss, mean near visual acuity, progression of Diabetic Retinopathy, quality of life, pain, loss of driving licence, vitreous haemorrhage and retinal detachment. Data collection and analysis We used standard methods as expected by the Cochrane Collaboration. Two review authors selected studies and extracted data. Main results We identified a large number of trials of laser photocoagulation of Diabetic Retinopathy (n = 83) but only five of these studies were eligible for inclusion in the review, i.e. they compared laser photocoagulation with currently available lasers to no (or deferred) treatment. Three studies were conducted in the USA, one study in the UK and one study in Japan. A total of 4786 people (9503 eyes) were included in these studies. The majority of participants in four of these trials were people with proliferative Diabetic Retinopathy; one trial recruited mainly people with non-proliferative Retinopathy. Four of the studies evaluated panretinal photocoagulation with argon laser and one study investigated selective photocoagulation of non-perfusion areas. Three studies compared laser treatment to no treatment and two studies compared laser treatment to deferred laser treatment. All studies were at risk of performance bias because the treatment and control were different and no study attempted to produce a sham treatment. Three studies were considered to be at risk of attrition bias. At 12 months there was little difference between eyes that received laser photocoagulation and those allocated to no treatment (or deferred treatment), in terms of loss of 15 or more letters of visual acuity (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.89 to 1.11; 8926 eyes; 2 RCTs, low quality evidence). Longer term follow-up did not show a consistent pattern, but one study found a 20% reduction in risk of loss of 15 or more letters of visual acuity at five years with laser treatment. Treatment with laser reduced the risk of severe visual loss by over 50% at 12 months (RR 0.46, 95% CI 0.24 to 0.86; 9276 eyes; 4 RCTs, moderate quality evidence). There was a beneficial effect on progression of Diabetic Retinopathy with treated eyes experiencing a 50% reduction in risk of progression of Diabetic Retinopathy (RR 0.49, 95% CI 0.37 to 0.64; 8331 eyes; 4 RCTs, low quality evidence) and a similar reduction in risk of vitreous haemorrhage (RR 0.56, 95% CI 0.37 to 0.85; 224 eyes; 2 RCTs, low quality evidence). None of the studies reported near visual acuity or patient-relevant outcomes such as quality of life, pain, loss of driving licence or adverse effects such as retinal detachment. We did not plan any subgroup analyses, but there was a difference in baseline risk in participants with non-proliferative Retinopathy compared to those with proliferative Retinopathy. With the small number of included studies we could not do a formal subgroup analysis comparing effect in proliferative and non-proliferative Retinopathy. Authors' conclusions This review provides evidence that laser photocoagulation is beneficial in treating proliferative Diabetic Retinopathy. We judged the evidence to be moderate or low, depending on the outcome. This is partly related to reporting of trials conducted many years ago, after which panretinal photocoagulation has become the mainstay of treatment of proliferative Diabetic Retinopathy. Future Cochrane Reviews on variations in the laser treatment protocol are planned. Future research on laser photocoagulation should investigate the combination of laser photocoagulation with newer treatments such as anti-vascular endothelial growth factors (anti-VEGFs).

  • prevalence of Diabetic Retinopathy in various ethnic groups a worldwide perspective
    Survey of Ophthalmology, 2012
    Co-Authors: Sobha Sivaprasad, Bhaskar Gupta, Roxanne Crosbynwaobi, Jennifer R Evans
    Abstract:

    The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic Retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of Diabetic Retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for Diabetic Retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of Diabetic Retinopathy, sight-threatening Diabetic Retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of Diabetic Retinopathy—such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia—ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems,geneticsusceptibility,andepigenetics.Therates ofnonproliferativeDiabeticRetinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening Diabetic Retinopathy substantially improve the long- term Diabetic Retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of Diabetic Retinopathy aroundtheworldandhighlighttheneedtoreinforceethnicity-basedscreeningandtreatmentthresholds

  • prevalence of Diabetic Retinopathy in various ethnic groups a worldwide perspective
    Survey of Ophthalmology, 2012
    Co-Authors: Sobha Sivaprasad, Bhaskar Gupta, Roxanne Crosbynwaobi, Jennifer R Evans
    Abstract:

    The alarming rise in diabetes prevalence is a global public health and economic problem. Diabetic Retinopathy is the most common complication of diabetes and the leading cause of blindness among working-age populations in the Western world. Screening and prompt treatment of Diabetic Retinopathy are not top priorities in many regions of the world, because the impacts of other causes of preventable blindness remain an issue. Ethnicity is a complex, independent risk factor for Diabetic Retinopathy. Observations from white populations cannot be extrapolated fully to other ethnic groups. The prevalence of Diabetic Retinopathy, sight-threatening Diabetic Retinopathy, and clinically significant macular edema are higher in people of South Asian, African, Latin American, and indigenous tribal descent compared to the white population. Although all ethnic groups are susceptible to the established risk factors of Diabetic Retinopathy-such as length of exposure and severity of hyperglycemia, hypertension, and hyperlipidemia-ethnic-specific risk factors also may influence these rates. Such risk factors may include differential susceptibility to conventional risk factors, insulin resistance, differences in anthropometric measurements, truncal obesity, urbanization, variations in access to healthcare systems, genetic susceptibility, and epigenetics. The rates of nonproliferative Diabetic Retinopathy appear to be declining in the United States, supporting the observation that better medical management of diabetes and prompt treatment of sight-threatening Diabetic Retinopathy substantially improve the long-term Diabetic Retinopathy incidence; studies from other parts of the world are limited and do not mirror this finding, however. We examine the ethnicity and region-based prevalence of Diabetic Retinopathy around the world and highlight the need to reinforce ethnicity-based screening and treatment thresholds in Diabetic Retinopathy.