Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting.

Introduction: Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This study examined the extent of patients' adherence to postscreening recommendations.

Predicting optical coherence tomography-derived diabetic macular edema grades from fundus photographs using deep learning.

Center-involved diabetic macular edema (ci-DME) is a major cause of vision loss. Although the gold standard for diagnosis involves 3D imaging, 2D imaging by fundus photography is usually used in screening settings, resulting in high false-positive and false-negative calls. To address this, we train a deep learning model to predict ci-DME from fundus photographs, with an ROC-AUC of 0.

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management.

Background: Novel telemedicine platforms have expanded access to critical retinal screening into primary care settings. This increased access has contributed to improved retinal screening uptake for diabetic patients, particularly those treated in Federally Qualified Health Centers ('safety net' clinics). The aim of this study was to understand how the implementation of telemedical screening for diabetic retinopathy within primary care settings is improving the delivery of critical preventative services, while also introducing changes into clinic workflows and creating additional tasks and responsibilities within resource-constrained clinics.

Diabetic Retinopathy and the Cascade into Vision Loss.

Vision loss from diabetic retinopathy should be unnecessary for patients with access to diabetic retinopathy screening, yet it still occurs at high rates and in varied contexts. Precisely because vision loss is only one of many late-stage complications of diabetes, interfering with the management of diabetes and making self-care more difficult, Vision Threatening Diabetic Retinopathy (VTDR) is considered a "high stakes" diagnosis. Our mixed-methods research addressed the contexts of care and treatment seeking in a sample of people with VTDR using safety-net clinic services and eye specialist referrals.

Can Commercially Available Handheld Retinal Cameras Effectively Screen Diabetic Retinopathy?

Organizations that care for people with diabetes have increasingly adopted telemedicine-based diabetic retinopathy screening (TMDRS) as a way to increase adherence to recommended retinal exams. Recently, handheld retinal cameras have emerged as a low-cost, lightweight alternative to traditional bulky tabletop retinal cameras. Few published clinical trials have been performed on handheld retinal cameras.

A Revised Approach for the Detection of Sight-Threatening Diabetic Macular Edema.

Importance: Diabetic macular edema is one of the leading causes of vision loss among working-age adults in the United States. Telemedicine screening programs and epidemiological studies rely on monoscopic fundus photography for the detection of clinically significant macular edema (CSME). Improving the accuracy of detecting CSME from monoscopic images could be valuable while recognizing the limitations of such detection in an era of optical coherence tomography detection of diabetic macular edema.

Improving Accuracy of Grading and Referral of Diabetic Macular Edema Using Location and Extent of Hard Exudates in Retinal Photography.

Background: Hard exudates (HE) are used as a surrogate marker for sight-threatening diabetic macular edema (DME) in most telemedicine-based screening programs in the world. This study investigates whether proximity of HE to the center of the macula, and extent of HE are associated with greater clinically significant macular edema (CSME) severity. A novel method for associating optical coherence tomography (OCT) scans with CSME was developed.

Utility of hard exudates for the screening of macular edema.

Purpose: The purpose of this study was to determine whether hard exudates (HEs) within one disc diameter of the foveola is an acceptable criterion for the referral of diabetic patients suspected of clinically significant macular edema (CSME) in a screening setting.

Methods: One hundred forty-three adults diagnosed as having diabetes mellitus were imaged using a nonmydriatic digital fundus camera at the Alameda County Medical Center in Oakland, CA. Nonstereo fundus images were graded independently for the presence of HE near the center of the macula by two graders according to the EyePACS grading protocol.

EyePACS: an adaptable telemedicine system for diabetic retinopathy screening.

Background: Annual retinal screening of patients with diabetes is the standard clinical practice to prevent visual impairment and blindness from diabetic retinopathy. Telemedicine-based diabetic retinopathy screening (DRS) in primary care settings can effectively detect sight-threatening retinopathy and significantly increase compliance with annual retinal exams. EyePACS is a license-free Web-based DRS system designed to simplify the process of image capture, transmission, and review.

A screening approach to the surveillance of patients with diabetes for the presence of vision-threatening retinopathy.

Objective: To provide scientifically based screening rules for the primary care setting designed to identify, through evaluation of a prescribed and limited portion of the posterior fundus, those patients with diabetes who have retinopathy severe enough to need referral to eye care specialists.

Design: Retrospective analysis of the Early Treatment Diabetic Retinopathy Study (ETDRS) photographic data base.

Participants: The fundus photographic grading data from 3711 patients with diabetes enrolled in the ETDRS.

Impaired color vision associated with diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report No. 15.

Purpose: To report color vision abnormalities associated with diabetic retinopathy.

Methods: Color vision function was measured at baseline in 2,701 patients enrolled in the Early Treatment Diabetic Retinopathy Study, a randomized trial investigating photocoagulation and aspirin in the treatment of diabetic retinopathy. Hue discrimination was measured by the Farnsworth-Munsell 100-Hue test, and errors in color vision were reported as the square root of the total 100-Hue (SQRT 100-Hue) score.

Barriers to compliance with screening guidelines for diabetic retinopathy.

Objective: To identify barriers to compliance with guidelines for diabetic retinopathy screening.

Methods: The population studied included 4410 adults, aged 31 to 64, enrolled in an Independent Practice Association (IPA) plan in Upstate New York, who were diagnosed with diabetes, and their Primary Care Physicians (408 PCPs). Claims data were used to calculate variables characterizing patients and their PCPs.

Brachydactyly-short stature-hypertension (Bilginturan) syndrome: report on two families.

We report on two families with autosomal dominant brachydactyly of hands and feet and hypertension. All affected members of the first family had proportionate short stature. However, the propositus and the affected relatives in the second family were only short compared to unaffected relatives.

Ferromagnetic hyperthermia: functional and histopathologic effects on normal rabbit ocular tissue.

Ferromagnetic (FM) hyperthermia has previously been evaluated in a rabbit tumour model of ocular melanoma. To study the effect of focal heating in normal rabbit eyes, FM seeds were implanted into a 14-mm episcleral plaque an heated to operating temperatures of 48 or 58 degrees C. Thermal induction was performed by placing rabbits in a uniform, oscillating (11 kHz) magnetic field operating at 1200 W and as H-field strength of 265 A/m.

Macular heterotopia in proliferative diabetic retinopathy.

Macular heterotopia secondary to proliferative diabetic retinopathy has been previously reported in clinical cases. To our knowledge, we present the first clinicopathologic case of macular heterotopia in a young patient with proliferative diabetic retinopathy. The significant pathologic findings included dense fibrovascular tissue on the disc to correspond with nasal tractional retinal detachment, a superonasally displaced fovea, and an area of stripped and recoiled internal limiting membrane overlying a retinal fold.

Paraneoplastic retinopathy associated with antiretinal bipolar cell antibodies in cutaneous malignant melanoma.

Purpose: It has been shown previously that the sera, from patients with visual paraneoplastic syndrome associated with lung cancer, contain immunoglobulins that are reactive with the tumor and with photoreceptor and large retinal ganglion cells. The purpose of this study is to determine the retinal cell population that reacts with immunoglobulins in the sera of patients with melanoma-associated retinopathy.

Methods: Clinical and electrophysiologic studies were used to determine the locus responsible for the visual defect in each patient.

Lens-corrected visual field sensitivity and diabetes.

Purpose: To examine whether peripheral S-cone system and achromatic sensitivity was reduced in patients with diabetes compared to normal controls.

Methods: Perimetric measurements were obtained to study peripheral S-cone system and achromatic sensitivity in patients with diabetes and normal controls. Measures of individual lens absorption of short-wavelength light were used to correct visual field sensitivity values for attenuation of test light due to lens absorption.

Methodologic dependence of electroretinogram oscillatory potential amplitudes.

The International Society for Clinical Electrophysiology of Vision (ISCEV) protocol for eliciting oscillatory potentials uses a considerably lower flash intensity and a different preconditioning stimulus than the only oscillatory potential protocol used to predict progression of diabetic retinopathy. To determine if the ISCEV protocol will be useful in predicting progression of diabetic retinopathy, summed oscillatory potential amplitudes were measured by both protocols in a population of diabetics. Summed oscillatory potential amplitudes measured by the ISCEV protocol, although smaller, are highly correlated with the summed oscillatory potential amplitudes measured with the higher-intensity flash.

Characterization of the electroretinographic scotopic B-wave amplitude in diabetic and normal subjects.

The intensity-response function of the scotopic b-wave of the electroretinogram may be a useful device for monitoring patients with retinal disease. Three models were evaluated that describe this function in 152 patients with diabetic retinopathy of varying severity and in 40 nondiabetic comparison subjects. The models considered were the Naka-Rushton equation fit to all 21 data points collected, the Naka-Rushton equation fit to the data points below the "second limb" of the function, and a log-linear fit only to data at the nine lowest intensities.

Lenses of diabetic patients "yellow" at an accelerated rate similar to older normals.

The authors used a psychophysical method to measure lens transmission of young, type I diabetic patients and normal controls. The results from normal controls agreed with previously published reports of decreasing lens transmission with age, and those from diabetic subjects suggested that lenses of young, type I diabetic patients age or "yellow" at an accelerated rate that was similar to that of normal controls over the age of 60 yr. The rate of accelerated lens density that occurs per year with the duration of diabetes is similar to the rate of accelerated lens density that occurs per year with patient age over 60 yr.