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  1. Fulltext Prevalence of falls and its associated factors among elderly diabetes in a tertiary center, Malaysia
    Azidah AK, Hasniza H, Zunaina E
    Curr Gerontol Geriatr Res, 2012;2012:539073.
    PMID: 22693496 DOI: 10.1155/2012/539073
    The purpose of this study is to determine the prevalence of falls and its associated factors among elderly diabetes type 2 patients attending a tertiary center in Malaysia. We conducted a cross-sectional study among 288 elderly diabetes type 2. The data collected includes data on sociodemographic, diabetes history, comorbid diseases, drug use, and activity of daily living (Barthel's index). The patient also was examined physically, and balance and gait assessment was carried out. Prevalence of falls among elderly diabetes was 18.8%. Female gender (OR: 2.54, P < 0.05), age group more than 75 (OR: 2.97, P < 0.05), retinopathy (OR: 2.19, P < 0.05), and orthostatic hypotension (OR: 2.87, P < 0.05) were associated with higher risk for falls. High balance and gait score was associated with reduced risk of fall in elderly diabetes (OR: 0.89, P < 0.05). In conclusion, the factors that are associated with higher risk for falls among elderly diabetes were female sex, age group more than 75, presence of retinopathy, and orthostatic hypotension. Those who had higher balance and gait score were found to be less likely to fall compared with those with lower score.
    Study site: Hospital Universiti Sains Malaysia, Kelantan, Malaysia
    Questionnaires, Scales, Device: Tinetti Balance and Gait Assessment; 5.07 Semmes- Weinstein monofilament; Barthel’s index
    Study site: Diabetic clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  2. Fulltext Intravitreal triamcinolone versus laser photocoagulation as a primary treatment for diabetic macular oedema--a comparative pilot study
    Norlaili M, Bakiah S, Zunaina E
    BMC Ophthalmol, 2011;11:36.
    PMID: 22111945 DOI: 10.1186/1471-2415-11-36
    BACKGROUND: Diabetic macular oedema is the leading causes of blindness. Laser photocoagulation reduces the risk of visual loss. However recurrences are common and despite laser treatment, patients with diabetic macular oedema experienced progressive loss of vision. Stabilization of the blood retinal barrier introduces a rationale for intravitreal triamcinolone treatment in diabetic macular oedema. This study is intended to compare the best corrected visual acuity (BCVA) and the macular oedema index (MEI) at 3 month of primary treatment for diabetic macular oedema between intravitreal triamcinolone acetonide (IVTA) and laser photocoagulation.
    METHODS: This comparative pilot study consists of 40 diabetic patients with diabetic macular oedema. The patients were randomized into two groups using envelope technique sampling procedure. Treatment for diabetic macular oedema was based on the printed envelope technique selected for every patient. Twenty patients were assigned for IVTA group (one injection of IVTA) and another 20 patients for LASER group (one laser session). Main outcome measures were mean BCVA and mean MEI at three months post treatment. The MEI was quantified using Heidelberg Retinal Tomography II.
    RESULTS: The mean difference for BCVA at baseline [IVTA: 0.935 (0.223), LASER: 0.795 (0.315)] and at three months post treatment [IVTA: 0.405 (0.224), LASER: 0.525 (0.289)] between IVTA and LASER group was not statistically significant (p = 0.113 and p = 0.151 respectively). The mean difference for MEI at baseline [IVTA: 2.539 (0.914), LASER: 2.139 (0.577)] and at three months post treatment [IVTA: 1.753 (0.614), LASER: 1.711 (0.472)] between IVTA and LASER group was also not statistically significant (p = 0.106 and p = 0.811 respectively).
    CONCLUSIONS: IVTA demonstrates good outcome comparable to laser photocoagulation as a primary treatment for diabetic macular oedema at three months post treatment.
    TRIAL REGISTRATION: ISRCTN05040192 (http://www.controlled-trial.com).
    Matched MeSH terms: Diabetic Retinopathy/drug therapy*; Diabetic Retinopathy/surgery*
  3. Fulltext The causes of low vision and pattern of prescribing at UKM low vision clinic
    Rokiah Omar, Knight, Victor Feizal, Zainora Mohammed
    Jurnal Sains Kesihatan Malaysia, 2008;6(2):55-64.
    MyJurnal
    When medical and surgical intervention cannot alleviate all of the impairments resulting from diseases of the eye, visual rehabilitation can help reduce the disability and increase the quality of life. Data from 169 patients seen at the UKM Low Vision Clinic (UKM LVC) over the past 2 years were examined and analysed. The age ranged from 6 to 87 years of age. The main cause of ocular pathological categories was conduction (63.9%), media (24.9%) and congenital (11.2%) related problems. The main causes of low vision at UKM LVC were congenital cataract, retinitis pigmentosa, glaucoma, cataract and diabetic retinopathy. 84% of these patients received low vision devices to improve their near or/and distance vision. The most common optical devices dispensed at UKM LVC were near high addition spectacle, hand magnifiers and stand magnifiers. Medical, vision care and rehabilitation professionals working together can offer a comprehensive treatment plan for the visually impaired, offering these patients the very best services to increase their quality of life.
    Matched MeSH terms: Diabetic Retinopathy
  4. Where is Malaysia in the midst of the Asian epidemic of diabetes mellitus?
    Zaini A
    Diabetes Res Clin Pract, 2000 Oct;50 Suppl 2:S23-8.
    PMID: 11024580 DOI: 10.1016/S0168-8227(00)00175-3
    Population studies all over the world have clearly showed that the prevalence of Type 2 diabetes mellitus (DM) is escalating at phenomenal scale and very likely we are heading towards epidemic proportions. In 1985, the estimated population of diabetic individuals in the world was 30 million but by 1995 this figure soared to 135 million. Based on current trends, epidemiologists predict that the population of diabetic individuals will swell up to a staggering 300 million by the year 2025. Almost half of that will be in the Asia Oceania region alone. Dr Hilary King of WHO pointed out that there will be a projected rise of about 42% in developed countries whereas the developing countries will see an escalation to the magnitude of 170% (H. King, R.E. Aubert, W.H. Herman, Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections, Diabetes Care 21 (1998) 1414-1431; WHO Health Report 1997, WHO Switzerland). There will be a 3-fold rise of the disease in Asia and much of these will be seen in China (40 million) and India (55 million) by virtue of the massive population of these countries. Nevertheless, the other rapidly developing Asian nations like Singapore, Malaysia, Thailand and those making up Indochina will experience the surge. At the same time the prevalence and incidence of diabetes complications will also increase. Based on recent WHO prediction (WHO Newsletter, The global burden of diabetes 1995-2025. World Diabetes 3 (1997) 5-6), it is estimated that by the year 2000 the following figures will be seen:Diabetes complications are major causes of premature death all over the world and most of these are avoidable. DCCT and UKPDS are landmark studies showing strong evidence that major complications can be drastically reduced by maintaining to near normoglycaemic control.
    Matched MeSH terms: Diabetic Retinopathy/epidemiology
  5. Fulltext Prevalence of diabetic retinopathy in the University Hospital diabetic population
    Teoh GH, Yow CS, Ngan A, Zaini A
    Med J Malaysia, 1983 Mar;38(1):77-9.
    PMID: 6633344
    One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
    Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    Matched MeSH terms: Diabetic Retinopathy/epidemiology*
  6. Fulltext The dimensions of ocular morbidity amongst the nursing home geriatrics population
    Normalina M, Zainal M
    Med J Malaysia, 1998 Sep;53(3):239-44.
    PMID: 10968160
    A cross-sectional prevalence study amongst a nursing home elderly population was carried out at Rumah Sri Kenangan, Seremban, Negeri Sembilan between June 1995 until June 1996. A total of 204 cases of 60 years and older were examined in order to determine the ocular morbidity amongst them. It was found that 47.5% had low vision and 19.1% were legally blind. Cataract was found to be the leading cause of low vision and blindness occurring in 81.4% and 74.3% respectively. Glaucoma occurred in 1% of those who had low vision and none due to macular degeneration or diabetic retinopathy. The magnitude of visual impairment and blindness in this nursing home is high but is preventable and avoidable.
    Matched MeSH terms: Diabetic Retinopathy
  7. Fulltext Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006
    Goh PP, Omar MA, Yusoff AF
    Singapore Med J, 2010 Aug;51(8):631-4.
    PMID: 20848059
    INTRODUCTION: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.
    METHODS: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.
    RESULTS: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.
    CONCLUSION: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.
    Study name: National Health and Morbidity Survey (NHMS-2006)
    Matched MeSH terms: Diabetic Retinopathy/diagnosis; Diabetic Retinopathy/epidemiology*
  8. Fulltext Diabetic retinopathy in the community
    Yang YF, Chong HH, Yang YK
    Med J Malaysia, 2001 Mar;56(1):104-5.
    PMID: 11503288
    Matched MeSH terms: Diabetic Retinopathy/epidemiology*
  9. Fulltext Retinal vascular geometry in Asian persons with diabetes and retinopathy
    Cheung CY, Lamoureux E, Ikram MK, Sasongko MB, Ding J, Zheng Y, et al.
    J Diabetes Sci Technol, 2012 May 01;6(3):595-605.
    PMID: 22768891 DOI: 10.1177/193229681200600315
    Purpose: Our purpose was to examine the relationship of retinal vascular parameters with diabetes and retinopathy in an older Asian population.

    Methods: Retinal photographs from participants of a population-based survey of Asian Malay persons aged 40-80 years were analyzed. Specific retinal vascular parameters (tortuosity, branching angle, fractal dimension, and caliber) were measured using a semiautomated computer-based program. Diabetes was defined as random plasma glucose ≥ 11.1 mmol/liter, the use of diabetes medication, or physician-diagnosed diabetes. Retinopathy signs were graded from photographs using the modified Airlie House classification system.

    Results: A total of 2735 persons were included in the study. Persons with diabetes (n = 594) were more likely to have straighter (less tortuous) arterioles and wider arteriolar and venular caliber than those without diabetes (n = 2141). Among subjects with diabetes, those with retinopathy had wider venular caliber than those without retinopathy (211.3 versus 204.9 mm, p = .001). Among nondiabetic subjects, however, those with retinopathy had more tortuous venules than those without retinopathy [5.19(×10(4)) versus 4.27(×10(4)), p < .001].

    Conclusions: Retinal vascular parameters varied by diabetes and retinopathy status in this older Asian cohort. Our findings suggest that subtle alterations in retinal vascular architecture are influenced by diabetes.
    Matched MeSH terms: Diabetic Retinopathy/ethnology; Diabetic Retinopathy/pathology*
  10. Glycaemic control and quality of life among ethnically diverse Malaysian diabetic patients
    Daher AM, AlMashoor SA, Winn T
    Qual Life Res, 2015 Apr;24(4):951-8.
    PMID: 25352036 DOI: 10.1007/s11136-014-0830-5
    PURPOSE: To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus.

    METHODS: This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables.

    RESULTS: The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years' duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL.

    CONCLUSIONS: The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.
    Matched MeSH terms: Diabetic Retinopathy
  11. Fulltext Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes
    Jew OM, Peyman M, Chen TC, Visvaraja S
    Int J Ophthalmol, 2012;5(4):499-504.
    PMID: 22937513 DOI: 10.3980/j.issn.2222-3959.2012.04.18
    AIM: To determine the risk factors of clinically significant macular edema (CSME) in patients with non-proliferative diabetic retinopathy (NPDR) in a multi-ethnics Malaysian population.
    METHODS: We performed a case control study in which 150 patients with bilateral NPDR and CSME in either eye were compared to 150 patients with bilateral NPDR and no CSME in both eyes. CSME and NPDR were graded according to Early Treatment of Diabetic Retinopathy Study criteria. Student's t-test, odds ratio and multiple logistic regression analysis were performed to analyze the duration of diabetes, body mass index (BMI), blood pressure(BP), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), fasting blood glucose (FBG), HbA1c, full blood count, serum creatinine and proteinuria between the two groups.
    RESULTS: Both groups were matched in terms of age, gender and ethnicity. Duration of diabetes, total serum cholesterol, serum LDL, FBG, HbA1c and serum creatinine were significantly higher in the CSME group (P<0.05). The hemoglobin, packed cell volume were significantly lower in the CSME group (p<0.05). There was no significant difference for serum HDL, TG, BMI, systolic and diastolic BP. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c had significantly high odds of developing CSME.
    CONCLUSION: HbA1c and total cholesterol are the two most important risk factors associated with CSME in patients with NPDR.
    KEYWORDS: clinically significant macular edema; diabetes; risk factors
    Study site: Ophthalmology clinic, Hospital Melaka, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  12. Application of different imaging modalities for diagnosis of Diabetic Macular Edema: A review
    Mookiah MR, Acharya UR, Fujita H, Tan JH, Chua CK, Bhandary SV, et al.
    Comput Biol Med, 2015 Nov 1;66:295-315.
    PMID: 26453760 DOI: 10.1016/j.compbiomed.2015.09.012
    Diabetic Macular Edema (DME) is caused by accumulation of extracellular fluid from hyperpermeable capillaries within the macula. DME is one of the leading causes of blindness among Diabetes Mellitus (DM) patients. Early detection followed by laser photocoagulation can save the visual loss. This review discusses various imaging modalities viz. biomicroscopy, Fluorescein Angiography (FA), Optical Coherence Tomography (OCT) and colour fundus photographs used for diagnosis of DME. Various automated DME grading systems using retinal fundus images, associated retinal image processing techniques for fovea, exudate detection and segmentation are presented. We have also compared various imaging modalities and automated screening methods used for DME grading. The reviewed literature indicates that FA and OCT identify DME related changes accurately. FA is an invasive method, which uses fluorescein dye, and OCT is an expensive imaging method compared to fundus photographs. Moreover, using fundus images DME can be identified and automated. DME grading algorithms can be implemented for telescreening. Hence, fundus imaging based DME grading is more suitable and affordable method compared to biomicroscopy, FA, and OCT modalities.
    Matched MeSH terms: Diabetic Retinopathy
  13. Fulltext Automated microaneurysm detection in diabetic retinopathy using curvelet transform
    Ali Shah SA, Laude A, Faye I, Tang TB
    J Biomed Opt, 2016 Oct;21(10):101404.
    PMID: 26868326 DOI: 10.1117/1.JBO.21.10.101404
    Microaneurysms (MAs) are known to be the early signs of diabetic retinopathy (DR). An automated MA detection system based on curvelet transform is proposed for color fundus image analysis. Candidates of MA were extracted in two parallel steps. In step one, blood vessels were removed from preprocessed green band image and preliminary MA candidates were selected by local thresholding technique. In step two, based on statistical features, the image background was estimated. The results from the two steps allowed us to identify preliminary MA candidates which were also present in the image foreground. A collection set of features was fed to a rule-based classifier to divide the candidates into MAs and non-MAs. The proposed system was tested with Retinopathy Online Challenge database. The automated system detected 162 MAs out of 336, thus achieved a sensitivity of 48.21% with 65 false positives per image. Counting MA is a means to measure the progression of DR. Hence, the proposed system may be deployed to monitor the progression of DR at early stage in population studies.
    Matched MeSH terms: Diabetic Retinopathy/complications*; Diabetic Retinopathy/pathology
  14. Fulltext Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry
    Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.
    Med J Malaysia, 2012 Aug;67(4):369-74.
    PMID: 23082443
    This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).
    Matched MeSH terms: Diabetic Retinopathy/ethnology*
  15. Fulltext Risk factors for diabetic retinopathy in diabetic screened using fundus photography at a primary health care setting in East Malaysia
    Mallika PS, Lee PY, Cheah WL, Wong JS, Syed Alwi SAR, Nor Hayati H, et al.
    Malays Fam Physician, 2011;6(2):60-65.
    MyJurnal
    Introduction: This study reports on the prevalence of diabetic retinopathy (DR) and risk factors among diabetic patients, who underwent fundus photography screening in a primary care setting of Borneo Islands, East Malaysia. We aimed to explore the preliminary data to help in the planning of more effective preventive strategies of DR at the primary health care setting.
    Materials and Methods: A cross-sectional study on 738 known diabetic patients aged 19-82 years was conducted in 2004. Eye examination consists of visual acuity testing followed by fundus photography for DR assessment. The fundus pictures were reviewed by a family physician and an ophthalmologist. Fundus photographs were graded as having no DR, NPDR, PDR and maculopathy. The data of other parameters was retrieved from patient’s record. Bi-variate and multivariate analysis was used to elucidate the factors associated with DR.
    Results: Any DR was detected in 23.7% (95% CI=21 to 27%) of the patients and 3.2% had proliferative DR. The risk factors associated with any DR was duration of DM (OR =2.5, CI=1.6 to 3.9 for duration of five to 10 years when compared to <5 years) and lower BMI (OR=1.8, CI=1.1 to 3.0). Moderate visual loss was associated with DR (OR=2.1, CI=1.2 to 3.7).
    Conclusions: This study confirms associations of DR with diabetic duration, body mass index and visual loss. Our data provide preliminary findings to help to improve the screening and preventive strategies of DR at the primary health care setting.
    Keywords: Diabetic retinopathy, epidemiology, screening, primary health care, Malaysia
    Study site: Klinik Kesihatan Jalan Masjid, Kuching, Sarawak, Malaysia
    Matched MeSH terms: Diabetic Retinopathy
  16. Fulltext Developing and evaluating the usability of a web-based Diabetic Retinopathy Health Education Program for patients with type 2 diabetes mellitus
    Isa RM, Chong MC, Lee WL, Iqbal T, Mansor M, Zainudin AA, et al.
    Saudi Med J, 2023 Dec;44(12):1290-1294.
    PMID: 38016754 DOI: 10.15537/smj.2023.44.12.202320029
    OBJECTIVES: To describe the development of a webpage based on the Intervention Mapping (IM) protocol and usability testing of the Diabetic Retinopathy Health Education Profram (DRHEP).

    METHODS: The mixed methods pilot feasibility study was carried out between April and September 2021, involving 16 patients with type 2 diabetes mellitus and 5 experts. The usability score was rated according to the System Usability Scale (SUS).

    RESULTS: The average SUS score by the experts was 88. The patients gave a higher score of 85 for SUS, with 58 as the lowest. The average SUS score was 72. The findings indicate that the webpage is acceptable, good, and highly usable for users.

    CONCLUSION: The outcomes of this study signify the relationship between effective health applications and how their design might hamper their effectiveness in changing patients' behavior.

    Matched MeSH terms: Diabetic Retinopathy*
  17. Fulltext Association of potential salivary biomarkers with diabetic retinopathy and its severity in type-2 diabetes mellitus: a proteomic analysis by mass spectrometry
    Chee CS, Chang KM, Loke MF, Angela Loo VP, Subrayan V
    PeerJ, 2016;4:e2022.
    PMID: 27280065 DOI: 10.7717/peerj.2022
    AIM/HYPOTHESIS: The aim of our study was to characterize the human salivary proteome and determine the changes in protein expression in two different stages of diabetic retinopathy with type-2 diabetes mellitus: (1) with non-proliferative diabetic retinopathy (NPDR) and (2) with proliferative diabetic retinopathy (PDR). Type-2 diabetes mellitus without diabetic retinopathy (XDR) was designated as control.
    METHOD: In this study, 45 saliva samples were collected (15 samples from XDR control group, 15 samples from NPDR disease group and 15 samples from PDR disease group). Salivary proteins were extracted, reduced, alkylated, trypsin digested and labeled with an isobaric tag for relative and absolute quantitation (iTRAQ) before being analyzed by an Orbitrap fusion tribrid mass spectrometer. Protein annotation, fold change calculation and statistical analysis were interrogated by Proteome Discoverer. Biological pathway analysis was performed by Ingenuity Pathway Analysis. Data are available via ProteomeXchange with identifiers PXD003723-PX003725.
    RESULTS: A total of 315 proteins were identified from the salivary proteome and 119 proteins were found to be differentially expressed. The differentially expressed proteins from the NPDR disease group and the PDR disease group were assigned to respective canonical pathways indicating increased Liver X receptor/Retinoid X receptor (LXR/RXR) activation, Farnesoid X receptor/Retinoid X receptor (FXR/RXR) activation, acute phase response signaling, sucrose degradation V and regulation of actin-based motility by Rho in the PDR disease group compared to the NPDR disease group.
    CONCLUSIONS/INTERPRETATION: Progression from non-proliferative to proliferative retinopathy in type-2 diabetic patients is a complex multi-mechanism and systemic process. Furthermore, saliva was shown to be a feasible alternative sample source for diabetic retinopathy biomarkers.
    Matched MeSH terms: Diabetic Retinopathy*
  18. Scanning laser edema index: a reliable tool to correlate with diabetic retinopathy and systemic risk factors?
    Peyman M, Tajunisah I, Loo A, Chuah KC, Subrayan V
    J Diabetes Complications, 2012 May-Jun;26(3):210-3.
    PMID: 22520399 DOI: 10.1016/j.jdiacomp.2012.03.019
    To correlate Heidelberg Retina Tomograph (HRT) derived macular edema (DME) index with severity of diabetic retinopathy and systemic factors. A total of 300 diabetic patients were recruited for the study for each of them a value for the macular edema index was obtained using the HRT II. Patients' age, gender, duration and type of diabetes mellitus, latest HbA1c result and presence or absence of co-morbid factors (hypertension, ischemic heart disease, nephropathy) were recorded together with the stage of diabetic retinopathy. These were correlated with DME. Out of 300 patients, HRT defined macula edema was seen in 68 patients (22.6%). There is a wider and higher range (95% percentile) of macula edema index in the severe non proliferative diabetic retinopathy (NPDR) group. Independent samples t test showed significant difference between the severe NPDR group and no DR group (p<0.001), mild NPDR group (p<0.05) and moderate NPDR group (p<0.05). A higher macula edema index was also found to have a low degree of correlation with more advanced stages of retinopathy (r=0.310; p<0.001). Also nephropathy showed a strong and significant correlation with DME. Hypertension had moderately significant correlation with DME. This study found no correlation between ischemic heart disease and DME. HRT derived scanning laser edema index is a reliable objective tool to evaluate diabetic retinopathy and systemic risk factors.
    Matched MeSH terms: Diabetic Retinopathy/blood; Diabetic Retinopathy/diagnosis*; Diabetic Retinopathy/etiology*; Diabetic Retinopathy/physiopathology
  19. Plasma, aqueous and vitreous homocysteine levels in proliferative diabetic retinopathy
    Lim CP, Loo AV, Khaw KW, Sthaneshwar P, Khang TF, Hassan M, et al.
    Br J Ophthalmol, 2012 May;96(5):704-7.
    PMID: 22353698 DOI: 10.1136/bjophthalmol-2011-301044
    To compare homocysteine (Hcy) concentration in the blood plasma, vitreous and aqueous of eyes with proliferative diabetic retinopathy (PDR) against control, and to investigate associations between Hcy concentration in blood plasma with that of aqueous and vitreous in these two groups.
    Matched MeSH terms: Diabetic Retinopathy/blood*
  20. Fulltext Sensitivity and specificity of automated analysis of single-field non-mydriatic fundus photographs by Bosch DR Algorithm-Comparison with mydriatic fundus photography (ETDRS) for screening in undiagnosed diabetic retinopathy
    Bawankar P, Shanbhag N, K SS, Dhawan B, Palsule A, Kumar D, et al.
    PLoS One, 2017;12(12):e0189854.
    PMID: 29281690 DOI: 10.1371/journal.pone.0189854
    Diabetic retinopathy (DR) is a leading cause of blindness among working-age adults. Early diagnosis through effective screening programs is likely to improve vision outcomes. The ETDRS seven-standard-field 35-mm stereoscopic color retinal imaging (ETDRS) of the dilated eye is elaborate and requires mydriasis, and is unsuitable for screening. We evaluated an image analysis application for the automated diagnosis of DR from non-mydriatic single-field images. Patients suffering from diabetes for at least 5 years were included if they were 18 years or older. Patients already diagnosed with DR were excluded. Physiologic mydriasis was achieved by placing the subjects in a dark room. Images were captured using a Bosch Mobile Eye Care fundus camera. The images were analyzed by the Retinal Imaging Bosch DR Algorithm for the diagnosis of DR. All subjects also subsequently underwent pharmacological mydriasis and ETDRS imaging. Non-mydriatic and mydriatic images were read by ophthalmologists. The ETDRS readings were used as the gold standard for calculating the sensitivity and specificity for the software. 564 consecutive subjects (1128 eyes) were recruited from six centers in India. Each subject was evaluated at a single outpatient visit. Forty-four of 1128 images (3.9%) could not be read by the algorithm, and were categorized as inconclusive. In four subjects, neither eye provided an acceptable image: these four subjects were excluded from the analysis. This left 560 subjects for analysis (1084 eyes). The algorithm correctly diagnosed 531 of 560 cases. The sensitivity, specificity, and positive and negative predictive values were 91%, 97%, 94%, and 95% respectively. The Bosch DR Algorithm shows favorable sensitivity and specificity in diagnosing DR from non-mydriatic images, and can greatly simplify screening for DR. This also has major implications for telemedicine in the use of screening for retinopathy in patients with diabetes mellitus.

    Study site: India
    Matched MeSH terms: Diabetic Retinopathy/diagnosis*; Diabetic Retinopathy/physiopathology
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