Purpose To observe the color motion perception of patients with diabetic retinopathy (DR) in very early stage and find a good way to diagnose early DR in time． Methods The motion perceptions of patients with early DR and normal subjects were tested by using equiluminant moving chromatic grating and moving luminance grating generated on VGA monitor in a PC compatible computer and the results were compared with those of electroretinogram(ERG),oscillatory potentials(OPs) and color perception． Results When the two gratings were of equal spatial frequency and equal time frequency,the normal subjects judged that chromatic grating moved faster than luminance grating．Very signifincant differences were detected between blue/yellow grating and black/white grating while the luminance contrast of was 80% and the velocity was 20.2 mm/s or 14.3mm/s(Plt;0.01).The abnormal ratio of color motion perception(69.2%)was higher than that of color vision(43.6%) and ERG OPs(48.9%) when the luminance contrast of black/white grating was 80% and the velocity was 20.2mm/s. Conclusion The test of color motion perception provides new method for diagnosing early DR. (Chin J Ocul Fundus Dis,1998,14:135-138)
Diabetic retinopathy (DR) is one of the microvascular complications of diabetes mellitus (DM). Like other macrovascular complications of DM, the development and progression of DR is influenced by a variety of systemic and local factors. It is essential to understand the importance of multidisciplinary collaboration. Systemic risk fators such as hyperglycemia, hypertension, dyslipidemia and diabetic nephropathy should be treated before effective DR management can be implemented. Through multidisciplinary collaboration, we can prevent the development of DR, slow the progression of DR, and improve the safety of perioperative care. Thereby enhancing the level of prevention and control of DM complications, including DR.
The ocular fundus changes and the damage of visual function were various at different stages of diabetic retinopathy (DR). To get hold of timing and different therapic method correctly of early diagnosis, whole body treatment, laser photocoagulation and vitreous-retina surgery and adopting targeted interventions could help patients receiving the most reasonable and effective treatment at different stages, both of them are keys to reduce the damage of visual function. （Chin J Ocul Fundus Dis，2008，24：240-243）
Objective To estimate the prevalence rate and risk factors of diabetic retinopathy (DR) in rural residents in Changzhi. Methods With the help of an established resident health data, a epidemiology study was performed on 63 409 residents (ge;15 years old) in the rural area of Changzhi; while the standard of diagnosis of diabetes was in accordance with the standard made by WHO in 1997. Diabetes was diagnosed in 2632 residents, and these patients underwent the investigation and examination including the disease history, glycosylated hemoglobin (HbA1c), fasting blood glucose, visual acuity, ocular diseases and intraocular pressure. The standard of DR was drawn according to the diagnosis standard made by Chinese Ocular Fundus Diseases Society, Chinese Ophthalmological Society, Chinese Medical Association in 1985. The data was statistically analyzed by SPSS 13.0 software. Results A total of 57 500 residents underwent the examination with the participating rate of 90.68%; 2632(4.58%) were diagnosed as with diabetes, in whom 986 were with DR (with DR prevalence of 37.46%). The duration of diabetes was the independent risk factor of DR (r=0.210,P＜0.001). The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The visual acuity in residents with or without DR differed significantly（P＜0.01）. The level of HbA1c was positively related to DR. Conclusions The incidence of DR is high in residents with diabetes in eastern countryside area of Changzhi. The duration of diabetes and combined with hypertension were the influence factors of the development of DR. The level of HbA1c may be the important indicator which can monitor the occurrence and development of DR in patients with diabetes.
Purpose To investigate the relationship between the changes of the thickness of retina in macula and the abnormalities in multifocal electroretinog rams (mERG) in diabetic retinopathy. Methods mERG and optical coherence tomography (OCT) examination were performed in 38 patients (60 eyes) with DR (phase Ⅲ～Ⅳ). The data were processed with software SPSS and line relation analysis was done. Results The response densities of N1, P1 and N2 in central 5deg; area was significantly negative related to the thickness of neuroretina in macular fovea (correlation efficient -0.252～-0.266，Plt;0.05). The response density of N2 in central 10deg; area was also significantly negative related to the thickness of neuroretina in macular fovea (correlation efficient -0. 332，P=0.01).There was no significant relationship between the latencies of N1 in central 5deg;, 10deg; area and the thickness of macula, whereares the latenc ies of P1 and N2 in central 5deg; were negatively related to the thickness of retinal pigment epithelium in the macular fovea (correlation efficient-0.271～ - 0.322，Plt;0.05). Conclusion The changes of the thickness of neuroretina in macula may affect the local retinal function in macula, which may be revealed by the reduction of response densities in mERG in patients with diabetic retinopathy. (Chin J Ocul Fundus Dis, 2001,17:257-259)
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.
Objective To investigate the distribution patterns of diabetic macular edema (DME) based on optical coherence tomography (OCT), and explore its correlation with diabetic retinopathy (DR) stages and systemic factors. Methods A total of 135 patients (242 eyes) with type 2 diabetes were included in this retrospective study. There were 75 males (138 eyes) and 60 females (104 eyes), the ages were from 29 to 83 years, with an average age of (58.8±11.1) years. The general information such as height, weight, smoking history and blood glucose [such as glycosylated hemoglobin (HbA1c)], blood pressure, blood lipid, 24 hours urine protein and other examinations were collected. The diagnosis of DR and DME were made, and the staging of DR and typing of DME were performed based on fundus color imaging and OCT. DR were divided into mild non-proliferative DR (NPDR), moderate NPDR, severe NPDR and proliferative DR (PDR). DME were categorized into 4 types including sponge-like retinal swelling (SME), cystoid macular edema (CME), serous retinal detachment (SRD) and posterior hyaloid traction (PHT). The correlation between DME types and DR staging were analyzed byχ2 test and Fisher exact test. Multivariate logistic regression analysis was used to analyze the correlation between DME types and systemic factors. Results In 242 DR eyes the proportions of mild, moderate, severe NPDR and PDR were 30.99%, 32.64%, 23.14% and 13.23%, respectively. There were 199 eyes (82.23%) with DME. There were statistically significant differences in the proportion of DME in different stages of DR (χ2=21.077,P＜0.01). In the 199 eyes with DME, There were 165 eyes (68.18%) of SME, 22 eyes (9.09%) of CME, 7 eyes (2.89%) of SRD and 5 eyes (2.07%) of PHT. The distribution of DME patterns in different stages of DR was statistically significant (χ2=156.273,P＜0.01). Logistic regression analysis showed that the duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME [odds ratio (OR)=1.090, 1.510, 4.123;P＜0.05], and were also independent for SME (OR=1.092, 1.445, 3.942;P＜0.05); HbA1c was an independent risk factor for SRD (OR=2.337,P＜0.05). Conclusions There are differences in the distribution of different DME types in each stage of DR. The duration of diabetes, HbA1c and macroalbuminuria were independent risk factors for DME and SME, and macroalbuminuria and HbA1c for CME and SRD.
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.
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.
ObjectiveTo compare the imaging characteristics and detection of various types of lesions in diabetic retinopathy (DR) with colorful laser scanning fundus imaging (MSLI) and traditional color fundus photography (CFP).MethodsProspective case series observational study. A total of 38 eyes of 38 patients with DR diagnosed by clinical examination were included in the study. Among them, 21 were male and 17 were female; the mean age was 62.6±11.2 years; the average duration of diabetes was 14.3±7.5 years. All the patients were performed CFP, MSLI, frequency domain optical coherence tomography (SD-OCT), fluorescein angiography (FFA) examination. Using the Helielberg Spectralis HRA+OCT MSLI inspection, one scan simultaneously obtained 488 nm blue reflection (BR), 515 nm green light reflection (GR), 820 nm infrared light reflection (IR), and multicolor image (MC). The detection of traditional CFP and MC on microaneurysm (MA), hard exudation (HEX), cotton plaque (CWS), intraretinal hemorrhage (IRH), intraretinal microvascular abnormality (IRMA), venous bead (VB), venous ring (VL), macular edema (DME), macular anterior membrane (MEM) and laser photocoagulation (LB) were comparatively observed. The results of FFA examination were used as the diagnostic criteria for lesions. SD-OCT was used to determine the location and depth of lesions and the diagnostic reference for DME and MEM.ResultsThe numbers of eyes with MA (χ2=10.460), DME (χ2=4.006), MEM (χ2=4.444) was significantly higher in MC than that of traditional CFP. But the number of eyes with IRH (χ2=0.103), CWS (χ2=1.515), HEX (χ2=0.227), IRMA (χ2=0.051), VB (χ2=0.001), VL (χ2=0.149), VH (χ2=0.693) and LB (χ2=0.720) were not statistically significant between two methods (P>0.05). The imaging quality of MSLI mode is obviously better than that of traditional CFP. Among them, GR imaging shows the best structural changes of superficial retina in MA, CWS, HEX, MEM, etc. IR imaging shows clear depth in deep retina such as LB. DME was green on MC and the weak low-reflection dark area was visible on the IR image, which were consistent with the DME range indicated by the SD-OCT examination.ConclusionsCompared with the traditional CFP, the MSLI can clearly show the DR lesion. The number of checkouts is high on MA, DME and MEM by MC image.