Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Shandong．Methods A total of 16 330 residents in 8 counties in Shandong province underwent the screening of diabetes by multistage randomized clustersampling; while the standard of diagnosis of diabetes was in accordance with the WHO standard (1990). Diabetes was diagnosed in 707 residents who then underwent questionnaire survey and examinations of fasting bloodglucose，urine protein, visual acuity, slitlamp microscope, and direct opthalmoscope. The standard of DR screening was drawn according to the international DR classification (2002). The data were statistically analyzed with SPSS 11.5 software. Results In 16 330 residents,707 were with diabetes (4.33%), 26.30% of them (181 cases) had DR (1.11% of all the residents). Multivariable analysis showed that kidney damage, hypertension and high blood glucose were the risk factors for DR; while the age, sex, and family history were not related much to DR. Conclusion The prevalence rate of DR in rural residents of Shandong is high. Kidney involvement, hypertension and high blood glucose are the risk factors of DR.
ObjectiveTo observe the characteristics of magnetic resonance angiography of (MRA) ophthalmic artery in patients with diabetic retinopathy (DR).MethodsA total of 36 eyes of DR patients (DR group) diagnosed by clinical examination were included in the study. Among them, there were 42 eyes in 21 males and 15 eyes in 15 females. The average age was 55.2 years old. The average duration of diabetes was 7.56 years. All eyes were examined by MRA and fluorescein fundus angiography (FFA) in the ophthalmic artery. At the same time, 24 eyes of 12 patients were examined by computed tomography angiography (CTA). Twenty-two healthy volunteers with age and gender matching were selected as the control group. Among them, there were 13 males and 9 females. All patients underwent MRA examination of the ophthalmic artery; at the same time, 5 eyes of 5 eyes were examined by CTA. MRA and CTA were classified into three grades according to the development condition and shape change of the ophthalmic artery. 0 grade : no abnormality; grade Ⅰ: mild lesion; grade Ⅱ: obvious lesion. According to the results of FFA examination, it was divided into no obvious disease stage, background stage, proliferative stage, proliferative stage. The morphological features of the MRA of the ophthalmic artery in the DR group and the control group were compared. The relationship between the MRA grading of the ophthalmic artery and the FFA staging was observed in the DR group. The consistency analysis between the MRA and CTA grades of the ophthalmic artery in the DR group was performed by Kappa test; the relationship between the MRA grade and the FFA staging of the ophthalmic artery was analyzed by Spearson correlation analysis of the same data with two-way ordered attributes.ResultsIn 44 eyes of the control group, the MRA in grade 0 and Ⅰ of the ophthalmic artery were 41 and 3 eyes, respectively; all eyes of the CTA examination of the ophthalmic artery were grade 0. In 72 eyes of the DR group, the MRA in grade 0, Ⅰ, and Ⅱ of the ophthalmic artery were 28, 28, and 16 eyes, respectively. Among the 24 eyes examined by CTA, there were 13, 6, and 5 eyes in grade 0, Ⅰ, and Ⅱ, respectively. In the DR group, the classification of MRA and CTA of the ophthalmic artery was highly consistent (Kappa value = 0.86). There were significant differences in the number of eyes with different grades of MRA in the DR group and the control group (Z=-5.74, P=0.000). In 72 eyes of the DR group, there were 8, 12, 22, and 30 eyes in no obvious disease stage, background stage, proliferative stage, and proliferative stage, respectively. Correlation analysis showed that there was a significant correlation between MRA grading and FFA staging in the DR group (r=0.405, P=0.000).ConclusionsMRA can show the changes of ophthalmic artery morphology and reflect DR staging to a certain extent. It has a high consistency with FFA vascular changes.
ObjectiveTo analyze the consistency of diagnostic results using simple and comprehensive reading methods on stereoscopic color fundus photographs of diabetic retinopathy (DR) with diabetic macular edema (DME). Methods450 sets of 7-field stereoscopic color fundus photographs of DR DME were compared to standard fundus photographs of early treatment and DR study group. The pictures were read by two groups of reader with similar experience. Two strategies were used to make the judgments, including simple reading which based on the color fundus photographs only, and comprehensive reading which based on color fundus photographs, fundus fluorescein angiography (FFA) and optical coherence tomography (OCT). 15 parameters were scored, including micro-aneurysms (MA), intra-retinal hemorrhage (IRH), hard exudates (HE), cotton wood spot (CW), intra-retinal microvascular abnormalities (IRMA), neovascularization on optic disc (NVD), neovascularization elsewhere (NVE), optic fiber proliferation (FPD), fiber proliferation elsewhere (FPE), pre-retinal hemorrhage (PRH), vitreous hemorrhage (VH), retinal elevation (RE), retinal detachment of central macular (RDC), venous beading (VB), Venous leak (VL). The reliability was evaluated using weighted κ(κw) statistic values. According to Fleiss statistical theory, κw≥0.75, consistency is excellent; 0.60≤κw < 0.75, consistency is good; 0.40≤κw < 0.60, consistency is general; κw < 0.40, consistency is poor. ResultsThe κw values of these 15 parameters were 0.22-1.00, 0.28-1.00 for the simple reading and comprehensive reading respectively. For simple reading, the consistency was poor for 8 parameters (MA, NVD, NVE, FPE, PRH, IRMA, VB, VL), general for 3 parameters (CW, FPD, VH), good for 2 parameters (IRH, HE) and excellent for 2 parameters (RE, RDC). For comprehensive reading, the consistency was poor for 2 parameters (NVE, VB), general for 6 parameters (MA, IRH, CW, FPE, IRMA, VL), good for 2 parameters (NVD, HE), excellent for 5 parameters (FPE, PRH, VH, RE, RDC). ConclusionThe comprehensive reading has higher consistency to judge the abnormality parameters of the fundus photographs of DR with DME.
ObjectiveTo observe the preliminary clinical application value of the handheld non-mydriatic visual electrophysiological diagnostic system RETeval in screening for diabetic retinopathy (DR).MethodsRetrospective clinical study. Fifty-eight patients with type 2 diabetes mellitus and 16 normal subjects who were admitted to Wuhan General Hospital of the PLA from November 2017 to May 2018 were enrolled in this study. All patients had not received any ophthalmologic treatment. All patients were examined by the default “DR assessment protocol” model of the RETeval device, and the “DR score” were measured by the system. The FFA results were used as the gold standard, and the DR was graded according to the international DR grading standard established in 2002. Patients were divided into vision threatening DR (VTDR) positive group and VTDR (−) group, DR (+) group and DR (−) group. Two independent sample t tests was used to compare the implicit time, amplitude, and pupil area ratio between eyes of different groups. Spearman correlation analysis was used to analyze the relationship between “DR score” and DR severity. The receiver operating characteristic area under the curve (AUC) assesses the sensitivity and specificity of RETeval in detecting DR and VTDR. The threshold of sensitivity and specificity was determined by using the maximum Youden index as a standard.ResultsThe AUC of DR was 0.936, the sensitivity was 81%, the specificity was 92%; the AUC of VTDR was 0.976, the sensitivity was 96% and the specificity was 70%. Compared with DR (−) group, the implicit time of DR (+) group was delayed and the amplitude and pupil area were decreased (t=－13.43, 5.49, 6.09; P=0.000, 0.000, 0.000). Compared with VTDR (−) group, the implicit time of VTDR (+) group was delayed and the amplitude and pupil area were decreased (t=－11.05, 7.46, 5.73; P=0.000, 0.000, 0.000). The “DR score” was significantly correlated with the severity of DR (r=0.89, P＜0.05).ConclusionsThe “DR score” measured by the RETeval instrument has a high degree of specificity and sensitivity in the diagnosis of DR and VTDR. It is highly correlated with the severity of DR.
Objective To estimate the prevalence of diabetic retinopathy (DR) in residents at the age of ge; 60 years in Beixinjing blocks, Shanghai, and to analyze the changes and risk factors of the occurrence of DR while comparing with the previous epidemiology study in the same blocks in 2003.Methods With the help of an established resident health data,a epidemiology study was performed on all of the old residents (ge; 60 years old) with diabetes mellitus from November 2007 to April 2008.The epidemiology data included resident common information, health check, examination of visual acuity,slitlamp biomicroscopy, direct ophthalmoscopy, and photography of 2 pictures covering 450 posterior ocular fundus area acquired by digital nonmydriasis fundus camera. The diagnosis of DR was drawn according to the international DR classification (2002). The DR grade was compared in 254 residents who were involved in both of the two epidemiology studies in 2003 and 2007.Chisquare method was used to analyze the risk factors of DR and stepwise logistic analysis was used for identifying the independent factors.Results A total of 483 diabetic residents was included in this study with the inclusion rate of 91.30%, in whom 121 DR patients was found with the DR prevalence of 25.05％. The prevalence of non-proliferative DR and proliferative DR was 22.36% and 2.69%, respectively. The duration of diabetes was confirmed as the independent risk factor of DR prevalence, and no risk factor was found to affect the different ratio of non-proliferative and proliferative DR. Comparing to the results of the study in 2003,the DR grade remained steadily or decreased in 92.52% of the 254 diabetes residents.Conclusion The prevalence of DR is high in the diabetic residents at the age of ge; 60 years.The intervention work of DR prevention in Beixinjing blocks is effective.
Chinese Guideline of Diabetic Retinopathy was developed by the Chinese Ocular Fundus Society and Chinese Ophthalmological Society. It is the first prevention and intervention guideline document of diabetic retinopathy (DR) in China. Clinical pathways and strategies are clearly identified and described in this document for DR screening, referral, intervention, systematic management and patient education. The new DR stage classification combines the first Chinese DR classification since 1985 and the updated international classification of DR. This guideline is based on Chinese health care system, but also reflects the tradition and innovation, and reaches international practice standard. Learning and practice the guideline will promote the prevention and reduce the occurrence and development of DR in China.
ObjectiveTo compare the consistency and difference of nonmydriatic ultrawide field retinal imaging system versus nonmydriatic 2-field 45°digital fundus photography system in a large-scale diabetic retinopathy (DR) screening. MethodsA total of 733 with type 2 diabetic patients (1466 eyes) underwent nonmydriatic ultrawide field retinal imaging and nonmydriatic 2-field 45°digital fundus photography examination. Two independent readers graded images respectively to determine the stage of DR. A third masked retinal specialist adjudicated discrepancies. Using nonmydriatic 2-field 45°digital fundus photography examination as the standard, the consistency of nonmydriatic ultrawide field retinal imaging was evaluated. The statistic index included sensitivity, specificity, Youden index and Kappa value. The difference of two methods was analyzed by comparative t-test. ResultsBased on nonmydriatic ultrawide field retinal imaging, the results were as follows: non DR (NDR) in 1062 eyes (74.1%), DR in 340 eyes (23.7%), ungradable in 32 eyes (2.2%). Among 340 DR eyes, there were mild nonproliferative DR (NPDR) in 48 eyes, moderate NPDR in 216 eyes, severe NPDR in 57 eyes, proliferative DR (PDR) in 19 eyes. Based on nonmydriatic 2-field 45°digital fundus photography, the results were as follows: NDR in 1080 eyes (75.3%), DR in 270 eyes (18.8%), ungradable in 84 eyes (5.6%). Among 270 DR eyes, there were NPDR in 36 eyes, moderate NPDR in 175 eyes, severe NPDR in 53 eyes, PDR in 6 eyes. Compared with nonmydriatic 2-field 45°digital fundus photography for screening DR, the sensitivity was 98.0%, the specificity was 95.0%, and the kappa value was 0.87. For screening severe NPDR and PDR, the sensitivity was 100.0%, the specificity was 99.0%, and the kappa value was 0.94. The DR detection rate and the ratio of the picture can't interpretation between two methods both had significant difference (P=0.00). ConclusionsIn rapid large-scale DR screening, there is high consistency between nonmydriatic ultrawide field retinal imaging versus nonmydriatic 2-field 45°digital fundus photography. Nonmydriatic ultrawide field retinal imaging is proved to be more adaptive, and more comprehensive and precise.
Diabetic retinopathy (DR) is one of the most common causes of visual impairment and blindness in diabetic patients. It is particularly important to set up simpler, safer, non-invasive and highly effective methods for diagnosis as well as monitoring DR. A variety of new fundus imaging techniques show great advantages in early diagnosis, treatment and monitoring of DR in recent years. The main characteristics of wide-field scanning laser imaging system is achieving a large range of retinal image in a single photograph and without mydriasis. It provides several options for color images, FFA and FAF, which satisfy to detect the retina, choroid and vascular structure. Multi spectral fundus imaging system is suitable for DR screening, because it is able to recognize the typical characteristics of DR, such as microaneurysms, hemorrhage and exudation, and is non-invasive and convenient. OCT angiography is a quantitative examination that provides foveal avascular zone area, macular blood flow density, which provides strong evidence for DR diagnosis. The improvement of these new techniques will help us to build up a personalized evaluation system of DR.
Objective To verify the pattern characteristics of optical coherance tomography (OCT) images in diabetic maculopathy (DM). Methods OCT were performed in sixty cases of DM and 30 cases of normal control group,and in 54 cases of DM,fundus fluorescein angiography (FFA) was performed simutaneously.The results from 2 kinds of examinations were compared each other. Results The average retinal thickness at the central fovea was (314.54plusmn;154.13) mu;m in DM group.The macular edema in the cases of DM accounted to 57.1% on OCT examination. The rate of retinal swelling associated with cystoid macular edema (CME) was 38.5%,with retinal detachment (RD) 9.2%,and with both CME and RD was 16.9%Those with mormal macular thickness and mild macular edema primarily showed focal leakage in FFA exam,while those with moderate and severe macular edema showed diffuse leakage in FFA exam.The rate of CME was 28.6% presented in FFA and 58.9% in OCT examination (t= 3.39,Plt;0.05). Conclusion OCT images of DM reveal 3 kinds of morphological features：retinal welling,CME,and sensory retinals de tachment.OCT is superior to FFA in detecting CME. (Chin J Ocul Fundus Dis, 2001,17:184-186)
Optical coherence tomography angiography (OCTA) base on OCT with an algorithm that can image a high-resolution picture of retinal circulation. OCTA has allowed quantifying the characteristic lesions of diabetic retinopathy (DR) in early stage, such as fovea avascular zone, retinal vascular density and the counts of retinal microaneurysm. In addition, OCTA can objectively evaluate the progression and prognosis of DR in late stage through imaging involved retinal neovascularization. Understanding OCT angiography features of DR lesions with different course of the disease may provide reference value for the diagnosis and treatment of DR.