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Telemedicine-based diabetic retinopathy screening programs: an evaluation of utility and cost-effectiveness
摘要： Diabetes is the main cause of blindness among working age adults, although treatment is highly effective in preventing vision loss. Eye examinations are recommended on a yearly basis for most patients for timely detection of retinal disease. Telemedicine-based diabetic retinopathy screening (TMDRS) programs have been developed to identify patients with sight-threatening diabetic eye disease because patients are often noncompliant with recommended live eye examinations. This article reviews the cost-effectiveness of the various forms of TMDRS. A review of relevant articles, mostly published since 2008, shows that societal benefits generally outweigh the costs of TMDRS. However, advances in technology to improve efficacy, lower costs, and broaden screening to other sight-threatening conditions, such as glaucoma and refractive error, are necessary to improve the sustainability of TMDRS within health care organizations. Patient satisfaction with these telemedicine programs is generally high. New models of shared care with primary care providers and staff are emerging to improve patient engagement and follow-up care when individuals are found to have sight-threatening eye disease. TMDRS programs are growing and provide valuable clinical benefit. The cost-utility is currently well proven in locations with limited access to regular eye care services, such as rural areas, poor communities, and prison systems; however, improvements over time are necessary for these programs to be cost-effective in mainstream medical settings in the future.
关键词： telemedicine,retinopathy,retinal imaging,diabetes
更新于2025-09-09 09:28:46
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Clinical Analysis of Newly Diagnosed Diabetes Mellitus Patients by Abnormal Fundus Examination
摘要： Purpose: To investigate the clinical analysis of newly diagnosed diabetes mellitus (NDM) patients with abnormal fundus examination at the first visit. Methods: This retrospective study utilized the first visit medical records of 15 patients (30 eyes) who were diagnosed with NDM from February 2011 to October 2016. Results: Patients were divided into 3 groups: 1) diabetic retinopathy group including proliferative diabetic retinopathy (PDR) (3) and severe non-proliferative diabetic retinopathy (NPDR) (1); 2) retinal vascular disease group including central retinal vein occlusion (CRVO) (1), branch retinal vein occlusion (1), vitreous hemorrhage with CRVO (1) and macular edema (1); and 3) other retinal disease group including vitreous hemorrhage due to choroidal neovascular rupture (1), exudative age-related macular degeneration (3), central serous chorioretinopathy (2), and macular hole (1). All 3 PDR patients had latent autoimmune diabetes in adults (type 1.5 diabetes). The remaining 12 patients had type 2 diabetes. Three patients showed mild NPDR in the opposite eye and the other 9 patients did not have diabetic retinopathy in the opposite eye. Onset age, HbA1C and proteinuria were significantly different between the diabetic retinopathy group and the other retinal disease group (p = 0.006, p = 0.012 and p = 0.006, Mann-Whitney test). Conclusions: In patients with various retinal diseases, early detection of NDM could be achieved by performing fundoscopic imaging and systemic examination as well as basic ophthalmologic examination. In addition, patients with diabetic retinopathy should be treated promptly through ophthalmology and internal medicine consultation. For the retinal vascular disease and other retinal disease groups, not only treatment for ophthalmic diseases, but also education about diabetes treatment are important.
关键词： Latent autoimmune diabetes in adults,Newly diagnosed diabetes mellitus,Diabetic retinopathy,HbA1C
更新于2025-09-09 09:28:46
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Efficacy of Primary Intravitreal Ranibizumab Injection for Treatment of Type 1 Retinopathy of Prematurity
摘要： ??: ???????? ?? ???? ????? ????? ???? ?? ? ???? ??? ??? ???. ??? ??: 2013? 1? 1??? 2016? 1? 1??? 1? ???????? ? ??? ????? ????? ???? ??? ???? ???? ? ??? ????. 1?, ??? ??? ??? ?? ????? ???? ?????, ?? ?? ???? ??? 9?? ??? ??? ?????? ???. ???? ?? ???? ?????? ??? ??? ?????? ?????. ??: 21?(39?)? ?? ? ??? 9?(16?), ??? 12?(23?)?? ?????. ?? ?? ?? ?? 2.1 ± 1.5? ?? ????? ????? ???? ?????. ?? ?? 18.2 ± 9.1? ??? plus ??? ?????. 1??? ???????? ?????? ???????? ??????, 4??? ???????? ?????? ????? ????? ???? ?????. ? 87.1% (34/39)? ??? ? ??? ???????? ???????? ???? ?? ?? ???? ?? ????? ?????. ????? ????? ???? ??? ???? ???? ???? ???. ??: ???????? ?? ???? ????? ????? ???? ??? ?????? ?? ???? ???? ?????. ??? ?? ?? ???????? ???? ?? ??? ?? ??? ????? ??? ??? ????, ??? ???? ??? ?? ?? ??? ??? ??? ????.
关键词： Intravitreal injection,Type 1,Retinopathy of prematurity,Ranibizumab
更新于2025-09-09 09:28:46
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Exporting Diabetic Retinopathy Images from VA VistA Imaging for Research
摘要： The US Department of Veterans Affairs has been acquiring store and forward digital diabetic retinopathy surveillance retinal fundus images for remote reading since 2007. There are 900+ retinal cameras at 756 acquisition sites. These images are manually read remotely at 134 sites. A total of 2.1 million studies have been performed in the teleretinal imaging program. The human workload for reading images is rapidly growing. It would be ideal to develop an automated computer algorithm that detects multiple eye diseases as this would help standardize interpretations and improve efficiency of the image readers. Deep learning algorithms for detection of diabetic retinopathy in retinal fundus photographs have been developed and there are needs for additional image data to validate this work. To further this research, the Atlanta VA Health Care System (VAHCS) has extracted 112,000 DICOM diabetic retinopathy surveillance images (13,000 studies) that can be subsequently used for the validation of automated algorithms. An extensive amount of associated clinical information was added to the DICOM header of each exported image to facilitate correlation of the image with the patient’s medical condition. The clinical information was saved as a JSON object and stored in a single Unlimited Text (VR = UT) DICOM data element. This paper describes the methodology used for this project and the results of applying this methodology.
关键词： VistA,Image retrieval for research,DICOM,Retinal imaging,JSON,Diabetic retinopathy
更新于2025-09-09 09:28:46
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[IEEE 2018 International Conference on Soft-computing and Network Security (ICSNS) - Coimbatore, India (2018.2.14-2018.2.16)] 2018 International Conference on Soft-computing and Network Security (ICSNS) - Severity level detection of diabetic retinopathy using ELM classifier
摘要： An eye disease which destroys the normal vision ability of diabetic patients is known as diabetic retinopathy. Early diagnosis of this disease is necessary because, it is severe in the later stages. The presence exudates, micro aneurysms(MAs) and hemorrhages are the first clinical symptoms of this disease. Exudates are red dots formed by swelling of the weak part of the capillary wall. The detection of exudate in retinal fundus images and the severity level is an important task in applications such as diabetic retinopathy screening and early treatment. Diabetic retinopathy is identified by pouring chemical solution to the eye and then capturing the dilated image of the patient’s eye. This process causes irritation to the patients. This paper proposes a method to find the severity level of diabetic retinopathy. It uses non-dilated retinal fundus image to help ophthalmologists diagnose the disease. The exudates from the low contrast images are detected. A neighborhood based segmentation technique is used for localizing the exudates from the images. A support vector machine (SVM) and Extreme learning Machine (ELM) are used as the classifiers. The method assess the severity of the disease. The average classification accuracy for the ELM is 94.76%.
关键词： Color fundus images,ELM classifier,Micro aneurysms,Diabetic retinopathy
更新于2025-09-09 09:28:46
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Multimodal imaging of foveal neovascularisation in diabetic retinopathy
摘要： Proliferative diabetic retinopathy is characterised by the growth of neovascular tissue, which almost always occurs at the optic disc and/or near the major nasal and temporal vascular arcades, sparing the foveal area.1 Finkelstein et al. ?rst described neovascular frond at the fovea arising from the perifoveal capillaries.2 A few other authors like Joondeph et al., Kurz et al., Rajagopal et al. and Seth et al. have also reported similar ?ndings.3–6 We report a rare case of unilateral foveal neovascularisation (NVF) in a middle-aged (40 years) woman of Asian origin who presented to us with chief complaints of blurring of vision in both eyes (left more than right) over the past few weeks, which was sudden in onset and progressive in nature. The patient had type 2 diabetes mellitus and dyslipidaemia for the past nine years. Her HbA1c was 10.5 per cent. On examination, her best-corrected visual acuity was 6/12 in the right eye and 6/24 in the left eye. The anterior segment was within normal limits for her age. Meticulous examination of the iris did not reveal any sign of neovascularisation. Posterior segment examination revealed proliferative diabetic retinopathy changes in both eyes with vitreous haemorrhage in the left eye only. The right eye was noted to have a whitish tuft at the fovea on biomicroscopy which turned out to be vascular in nature with distorted foveal avascular zone (FAZ) in both multicolor (Figure 1) and re?ectance (Figure 2) image. This was con?rmed with fundus ?uorescein angiography (confocal scanning laser ophthalmoscope-based; Figure 3) and spectral domain optical coherence tomography (Figure 4). Unlike previous reports, except for the recent report by Seth et al.,6 this patient had non-insulin-dependent diabetes mellitus. It is possible that this type of diabetes mellitus is not a predictor of NVF, but rather compromised ocular blood ?ow and duration and control of diabetes are predictors as reported by Summanen et al.7 In concordance with Finkelstein et al.,2 Joondeph et al.3 and Seth et al.,6 we noted macular ischaemia in our case, whereas Kurz et al.4 and Rajagopal et al.5 reported cases with perfused macula. Our case had unilateral NVF as reported by Joondeph et al.,3 Kurz et al.4 and Seth et al.,6 whereas Finkelstein et al.2 and Kurz et al.4 reported bilateral cases. We report for the ?rst time multimodal imaging of foveal neovascularisation in diabetic retinopathy. Limitations include a lack of early-phase fundus ?uorescein angiography imaging, green re?ectance, and optical coherence tomography angiography images. The early phase of ?uorescein angiography would have helped us with more effective visualisation of distorted FAZ and leakage from the NVF. Green re?ectance utilises a longer wavelength as compared to blue and has less absorption by the crystalline lens and xanthophyll pigments (at fovea) and therefore better delineates the fovea. In our case, this would have been the better imaging modality than blue re?ectance. Optical coherence tomography angiography beyond being non-invasive would have helped us to portray the FAZ and origin of foveal neovascularisation in a more desirable way, which we lacked.
关键词： multimodal imaging,diabetic retinopathy,foveal neovascularisation
更新于2025-09-09 09:28:46
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The Effects of Diabetic Retinopathy and Pan-Retinal Photocoagulation on Photoreceptor Cell Function as Assessed by Dark Adaptometry
摘要： The pathophysiology of vision loss in persons with diabetic retinopathy (DR) is complex and incompletely defined. We hypothesized that retinal pigment epithelium (RPE) and rod and cone photoreceptor dysfunction, as measured by dark adaptometry, would increase with severity of DR, and that pan-retinal photocoagulation (PRP) would exacerbate this dysfunction. Dark adaptation (DA) was measured in subjects with diabetes mellitus and healthy controls. Dark adaptation was measured at 58 superior to the fovea following a flash bleach, and the data were analyzed to yield cone and rod sensitivity curves. Retinal layer thicknesses were quantified using spectral-domain optical coherence tomography (OCT). The sample consisted of 23 controls and 73 diabetic subjects. Subjects with moderate nonproliferative diabetic retinopathy (NPDR) exhibited significant impairment of rod recovery rate compared with control subjects (P ? 0.04). Cone sensitivity was impaired in subjects with proliferative diabetic retinopathy (PDR) (type 1 diabetes mellitus [T1DM]: P ? 0.0047; type 2 diabetes mellitus [T2DM]: P < 0.001). Subjects with untreated PDR compared with subjects treated with PRP exhibited similar rod recovery rates and cone sensitivities. Thinner RPE as assessed by OCT was associated with slower rod recovery and lower cone sensitivity, and thinner photoreceptor inner segment/outer segment layer was associated with lower cone sensitivity. The results suggest that RPE and photoreceptor cell dysfunction, as assessed by cone sensitivity level and rod- and RPE-mediated dark adaptation, progresses with worsening DR, and rod recovery dysfunction occurs earlier than cone dysfunction. Function was preserved following PRP. The findings suggest multiple defects in retinoid function and provide potential points to improve visual function in persons with PDR.
关键词： pan-retinal photocoagulation,dark adaptation,diabetic retinopathy
更新于2025-09-09 09:28:46
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Choroidal atrophy in a patient with paraneoplastic retinopathy and anti-TRPM1 antibody
摘要： The purpose of this paper is to report choroidal atrophy in a patient with cancer-associated retinopathy who had autoantibodies against the transient receptor potential cation channel, subfamily M, member 1 (TRPM1). A 69-year-old man visited our clinic in July 2010 with complaints of blurred vision and night blindness in both eyes. The full-field electroretinograms were negative type, indicating ON bipolar cell dysfunction. General physical examination revealed small cell carcinoma of the lung, and Western blot of the patient’s serum showed autoantibodies against TRPM1. We diagnosed this patient with cancer-associated retinopathy and retinal ON bipolar dysfunction due to anti-TRPM1 autoantibody. We followed him for more than 2 years from the initial visit and his symptoms have not changed. However, consistent with the choroidal hypopigmentation of the fundus, spectral domain optical coherence tomography showed a decrease in choroidal thickness of about one third over a 2-year follow-up period. We suggest that this case of gradually progressive choroidal atrophy was caused by the autoantibody against TRPM1 directly, because TRPM1 is expressed not only on ON bipolar cells but also on melanocytes. These findings indicate that we should be aware of choroidal thickness in patients with paraneoplastic retinopathy who have retinal ON bipolar dysfunction with the anti-TRPM1 antibody.
关键词： cancer-associated retinopathy,choroidal thickness,TRPM1,paraneoplastic retinopathy,melanocyte
更新于2025-09-04 15:30:14
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[IEEE 2018 International Conference on Current Trends towards Converging Technologies (ICCTCT) - Coimbatore, India (2018.3.1-2018.3.3)] 2018 International Conference on Current Trends towards Converging Technologies (ICCTCT) - Detecting Hard Exudates In Retinal Fundus Images Using Convolutinal Neural Networks
摘要： The main objective of this project is to detect Exudates in retinal fundus images using Convolutional Neural Networks. Disorders in Retinal Images like Micro aneurysm, Hemorrhages, Hard Exudates, Soft Exudates, Macular Edema, Red lesions, Diabetic Retinopathy are likely to lead to severe visual loss Impairments. This work provides an automatic image processing techniques to diagnose Exudates in human eye and discussed various approaches used to detect Exudates in retinal images. Various publically available databases are listed and provide comparison between different approaches like SVM, KNN and CNN. Diabetic Retinopathy (DR) is the most essential causes of imaginative and prescient loss in diabetic patients. The most primary sign of DR is the presence of exudates, and detecting these in early screening is crucial in preventing vision loss. The automatic reputation of DR consisting of lesions, they are hard exudates (HEs), in fundus pix can make contributions to the diagnosis of this disease. On this take a look at, a fixed of functions from image regions are extracted and decided on the subset which quality discriminates between HEs and the retinal historical past. In proposed system, threshold based segmentation is used for extracting the features. After that, HOG (histogram of gradient), Classify the diseases using the convolutional Neural Network (CNN) classifier. The publicly available STARE of color fundus images was used for testing purposes and the values of sensitivity, specificity and accuracy were found as 96%, 98% and 99.68% respectively for the neural network based classification.
关键词： Hemorrhages,Diabetic Retinopathy,Edema,Microaneurysms,Red lesions,Retinopathy,Exudates
更新于2025-09-04 15:30:14
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Multifractal and Lacunarity Analyses of Microvascular Morphology in Eyes with Diabetic Retinopathy: A Projection Artifact Resolved Optical Coherence Tomography Angiography Study
摘要： Objective: To evaluate the degree of microvascular impairment in diabetic retinopathy using multifractal and lacunarity analyses and to compare the diagnostic ability between traditional Euclidean measures (fovea avascular zone area and vessel density) and fractal geometric features. Methods: This retrospective cross-sectional study included a total of 143 eyes of 94 patients with different stages of diabetic retinopathy. The retinal microvasculature was imaged by projection removed optical coherence tomography angiography. We examined the degree of association between fractal metrics of the retinal microvasculature and diabetic retinopathy severity. The area under the receiver operating characteristic curve was used to estimate the diagnostic performance. Results: With increasing diabetic retinopathy severity, the multifractal spectrum shifted towards the left bottom and exhibited less left skewness and asymmetry. The vessel density, multifractal features and lacunarity measured from the deep capillary plexus were strongly associated with diabetic retinopathy severity. The multifractal feature D5 showed the highest diagnostic ability. The combination of multifractal features further improved the discriminating power. Conclusions: Multifractal and lacunarity analyses can be potentially valuable tools for assessment of microvascular impairments in diabetic retinopathy. Multifractal geometric parameters exhibit a better discriminatory performance than Euclidean measures, particularly for detection of the early stages of diabetic retinopathy.
关键词： diabetic retinopathy,optical coherence tomography angiography,microvascular network,lacunarity,multifractal
更新于2025-09-04 15:30:14