This significant progress in management of diabetic retin- opathy was coupled with, and made possible by, important developments in ocular imaging . Optical coherence tomography (OCT) is a non-invasive diagnostic test that is performed in the office, providing detailed cross-sectional anatomic images of the retina. In its widest application, OCT allows for early detection of anatomical changes in the macula, such as the development of thickening and cys- tic spaces noted in diabetic macular edema. OCT testing is routinely used to clinically diagnose and manage patients with diabetic macular edema, and data on central retinal thickness from the OCT is used as an end-point in large clinical trials . Additional imaging techniques such as ultra-wide-field fundus photography and angiography allow better visualization of the peripheral retina than conven- tional cameras, and better identification of areas of poor vascular perfusion . These imaging modalities help with clinical management of patients, and provide further insight into structural changes in every stage of DR.
Despite extensive literature detailing the prevalence and incidence of diabetes in the UK, population-wide measures of incidence and prevalence of DR in the UK context have not been determined. Previous UK focussed research on retinopathy has largely been limited to estimates based on regional screening pro- grammes or small general practices samples. 28–32 Having a more complete understanding of the burden of disease due to DR across the diverse UK population will help improve future service planning and provision of preventive and therapeutic care. The aim of this study was to generate nationally representative estimates of the incidence and prevalence of DR in the UK between 2004 and 2014 using the ClinicalPracticeResearch Datalink (CPRD), and to examine trends in the preva- lence and relative risk of retinopathy by diabetes type, age, sex, ethnicity, socioeconomic deprivation and region.
The STEPwise survey  for risk factors of non-communicable diseases in 2015 reported that diabetes mellitus (DM) affects an estimated 2% of the Kenyan popu- lation aged 18–69 years, with the highest proportion (5%) being in the 45–59 years age group. Every person living with diabetes (PLWD) is at risk of potentially blinding dia- betic retinopathy (DR). In turn, visual loss from DR is asso- ciated with additional morbidity, such as falls, fractures, and difficulties with taking medications. Both DM and DR are associated with significant morbidity, mortality, and ex- cess health care costs. The prevalence of DM is predicted to rise steeply over the next decade , and consequently DM and DR are important public health concerns.
Research has also revealed differences in risk perception between men and women (Homko et al., 2010). Differences in risk perception have also been found in relation to ethnicity and other social divisions. For example, Buster et al. (2012) conducted a quantitative study to evaluate skin cancer risk perception across race and other demographic factors. Buster and colleagues (2012) reported that the black population, the elderly, and people with less education perceived themselves as lower risk of developing skin cancer. In terms of diabetes, Macaden and Clarke (2006) conducted a qualitative study to report perception of risk among older South Asian people in the UK with type 2 diabetes. Data was collected via focus group interviews with ethnic health development workers together with seven individual interviews with Health Care Professionals and twenty interviews with participants with type 2 diabetes from a South Asian background. The study found that risk perception was influenced by a number of issues such as the belief about the cause of diabetes, perceived severity of diabetes, food and its social function, religion and beliefs about external control, and diabetes management. The study reported that individuals were required to make decisions by weighing up different risks. For example, participants weighed up the risk when making decisions about dietary management where the risk of causing social offence to others had to be taken into account together with the risk of less than perfect diabetes management. The study only recruited participants of South Asian origin. The author conducted more than one interview with each participant in order to cover specific issues in detail. Whilst interpreters were involved, the transcripts were not reinterpreted or verified by language experts due to financial constraints (Macaden and Clarke, 2006).
Consequently, research about perspective of care pro- viders should also focus on those working in the private sector due to their greater prevalence. The levels of knowledge, attitude and practice among Primary health- care (PHC) physicians concerning both DR screening and treatment of sight-threatening diabeticretinopathy have been studied by different groups such as medical students , pharmacists , PHC staff  and opticians . In some studies, the levels were very high while, in others, they were noted to be less than desired.
factors. Only English language was included in this meta- analysis, so some eligible studies, which were unpub- lished or reported in other languages, were likely missed. The intervals of MPV collection and measurement are not completely consistent. Some diabetes-related factors, such as glycaemic control, duration of diabetes and kid- ney complications, were difficult to be corrected. In addi- tion, many studies have reported that drugs, including statins and metformin, also could affect platelets [50–54], but none of the included articles mentioned patients’ medication status. All the factors mentioned above may be sources of heterogeneity, which should be paid atten- tion to in future research design.
Objective: This study is aimed at investigating the knowledge, practice and attitude of the patients with type-2 diabetes mellitus regarding diabeticretinopathy in Saudi Arabia. Introduction: Diabetes self-management is defined as a crucial factor in patients’ care. Many studies show that the lack of sufficient knowledge, good practice, and positive attitude among the patients concerning their disease and its complications is due to illiteracy. Therefore, presenting knowledge, practices, and attitudes towards the management of diabetes should be done before considering any possible intervention. The materials and methods section explains the data collection and analysis along with their limitations. In the results part, the data collected from each section are explained and summarized in tables. In the discussion section, the results are explained and then related to the previous studies. Then the conclusion sums up all the results found and subsequently recommends the best way for the future researchers to improve the results of the research.
particular, the modified classification used in the ETDRS has been used widely in research settings but involved a complex scoring system ranging from 10 to 85 and required comparison with the standard photographs. 12 As a result, even more simplified, clinical classification systems are more commonly used nowadays. 13,14 However, whether more granular, feature-based criteria can predict PDR progression in a large scale has not been studied to our knowledge. In addition, progression rates of retinopathy in the context of current systemic management have not been adequately explored with real world data. This information will be important in guiding follow-up intervals on monitoring for diabeticretinopathy, advising the patient and their diabetic care team regarding progression risk, as well as the powering of clinical trials for interventions that may prevent the progression of diabeticretinopathy.
Background and aim: Diabeticretinopathy is a serious and common complication of diabetes that causes irreversible blindness. The aim of the present study was to assess the knowledge, attitudes, and practice regarding diabeticretinopathy among patients attending a diabetic clinic and identify the effect of an educational program about diabeticretinopathy. Patients and methods: Two hundred diabetic patients were recruited from the outpatient ’ s diabetic clinic, Assiut University hospitals, Egypt. Quasi-experimental (pretest-posttest) research design was applied using a structured interview questionnaire; including socio-demographic data, assessment of the patients ’ knowledge, attitude, and practices toward diabeticretinopathy. Results: The mean score of knowledge and attitude showed signi ﬁ cant improvement (5.3 and 15.1, respectively in pretest vs 16.7 and 16.8, respectively in posttest) among the diabetic patients (p<0.001). From multivariate linear regression model; the predictors for knowledge score were educational level, family history of diabetes and diabeticretinopathy and hyper- tension. Likewise, attitude score predictors were age, residence, and smoking. Predictors for practice score were hypertension, blood sugar level, and weight.
Abstract: Timely intervention for diabeticretinopathy (DR) lessens the possibility of blindness and can save considerable costs to health systems. To ensure that interventions are timely and effective requires methods of screening and monitoring pathological changes, including assessing outcomes. Fractal analysis, one method that has been studied for assessing DR, is potentially relevant in today’s world of telemedicine because it provides objective indices from digital images of complex patterns such as are seen in retinal vasculature, which is affected in DR. We introduce here a protocol to distinguish between nonproliferative (NPDR) and proliferative (PDR) changes in retinal vasculature using a fractal analysis method known as local connected dimension (D conn ) analysis. The major ﬁ nding is that compared to other fractal analysis methods, D conn analysis better differentiates NPDR from PDR (p = 0.05). In addition, we are the ﬁ rst to show that fractal analysis can be used to differentiate between NPDR and PDR using automated vessel identiﬁ cation. Overall, our results suggest this protocol can complement existing methods by including an automated and objective measure obtainable at a lower level of expertise that experts can then use in screening for and monitoring DR.
Abstract: The treatment of center-involving diabetic macular edema (DME) has improved because of the proven efficacy of drugs that inhibit the effects of vascular endothelial growth factor (VEGF). The newest anti-VEGF drug, aflibercept, has recently been approved by the United States Food and Drug Administration for the treatment of center-involving DME and for diabeticretinopathy in eyes with DME. In the pivotal Phase III VISTA and VIVID trials, intravitreal aflibercept 2 mg injections every 4 or 8 weeks (after 5 monthly loading doses) pro- duced superior gains in BCVA compared to laser/sham injections. In the DiabeticRetinopathyClinicalResearch Network Protocol T trial, which featured monthly anti-VEGF monotherapy for 6 months, followed by monthly pro re nata anti-VEGF injections with laser rescue therapy from months 6 through 12, aflibercept 2 mg monthly was superior to bevacizumab 1.25 mg and ranibizumab 0.5 mg in eyes with BCVA of 20/50 or worse (aflibercept versus bevacizumab: P,0.001; aflibercept versus ranibizumab: P=0.003), but the three regimens were comparable for eyes with VA of 20/40 or better. Only in the 20/50 or worse subgroup did aflibercept achieve clinical superiority (.5 letter difference) to bevacizumab. Each treatment regimen led to sig- nificant macular thinning, with aflibercept being superior to bevacizumab in both visual acuity subgroups (P,0.001 for each), but it was not statistically superior to ranibizumab in either group. In diabetic patients, aflibercept has an excellent safety profile that does not appear to differ from laser/sham or other VEGF inhibitory drugs.
I wish to express my deepest gratitude and heart felt thanks to my teacher and guide Dr. V.R. VijayaRaghavan MS, DO, DNB, FRCS, Professor and Head of Department of Ophthalmology for allowing me to do the research work under his guidance. I am very grateful for his constant source of encouragement and support from the very initial stage of topic selection to the completion of the research work. It is his guidance and advice that helped the research attain this shape.
Toan Bui, Noppadol Maneerat, proposed an evaluation method based on a number of pixel samples to detect number of the cotton wool blobs. The proposed method was applied to DIARETDB1, a popular public database for any research based. They were use color features as red green blue (RGB) space, intensity and the texture features as contrast, range, mean, and entropy. An optic disc removal was applied to enhance image quality of database image. A feature extraction method was used to take useful elements from the database image. This method was used for increasing accuracy in classification step. A neural network model was employed for learning task and tested by k fold cross validation. The method was also calculated the percentage of the cotton wool blobs .
The VIMOC retinal images were obtained from a pre- vious Norwegian population survey . The study fol- lowed the tenets of the Declaration of Helsinki for research involving humans and was approved by the Re- gional Committee for Medical Research Ethics, REC Central (January 19. 2009). Blinded to patient informa- tion, all images had been independently assessed by two ophthalmologists who graded the presence of retinop- athy according to the DiabeticRetinopathy Disease Se- verity Scale . The ophthalmologists viewed the images on a 21” monitor with screen resolution of 1600×1200 pixels. From a total of 239 images, only those that had been graded with full agreement between the two ophthalmologists (n=217) were considered for inclu- sion in our study. Seven images of retinas affected by non-proliferative diabeticretinopathy (NPDR) and seven images of retinas unaffected by DR were randomly selected. The DR images included five examples of mild NPDR (Figure 1) and two examples of moderate,
Experimentally, mice and rats are still the most popular models of DR, not only because of the advantages mentioned above, but also since there have been many standardized protocols of modeling approaches available for reference to researchers, such as the STZ-injection model, oxygen- induced retinopathy model, and genetic model. In addi- tion, rodents are suitable for the vast majority of detection reagents used in the laboratory. Monkey models share the most similar features of human DR compared with other animal models, which could be applied in research fields like live imaging examinations, diagnosing biomarker screening, and medical or surgical therapeutic trials; how- ever, the approaches for monkeys are far from mature when compared with those for rodents. In addition, the large size, long lifespan, and inevitable ethical requirements have largely limited their applications. Other large animals, like cats and dogs, have large-sized eye balls, which are more convenient for handling than rodent eyes. However, their gene backgrounds are far from human, the number of suit- able experimental reagents is far less than for rodents, and their large size needs more housing space, which all limited their usage as the choice of animal models for DR. However, compared with all the above species of animals, the zebrafish has its own advantages as a potential DR model, for eg, the experimental methods of STZ injection, 63 high-glucose diet
Previous studies of optometrist's effectiveness in screening for diabeticretinopathy have revealed a specificity ranging from 62 to 95% and a sensitivity of 70 to 87% [11-13,17] Based on the reported prevalence of diabeticretinopathy in the Norwegian diabetic population (13.8%)  and the number of retinopathies missed (n = 9) and detected (n = 17) by the optometrists in this study, we propose that the diagnostic specificity must be high. It is unlikely that report/referral of cases of suspected retinopathy will impose undue pressure on the health care services. This is supported by a previous study by Riise et al  which concluded that 94% of referrals form Norwegian optome- trists were clinically relevant. However, taking the low diagnostic sensitivity into consideration suggests that the routine examination as currently undertaken by Norwe- gian optometrists is an unreliable method of screening for diabeticretinopathy. Moreover, the study illustrates the disparity of optometric practice in Europe and worldwide with regard to training and the role in the health care sys- tem, emphasizing the importance that health policies decisions are founded on the practice in the community were the policy will be employed.
21. Wang SK, Callaway NF, Wallenstein MB, Henderson MT, Leng T, Moshfeghi DM. SUNDROP: six years of screening for retinopathy of pre- maturity with telemedicine. Can J Ophthalmol. 2015;50(2):101–106. 22. Lorenz B, Spasovska K, Elflein H, Schneider N. Wide-field digital imag- ing based telemedicine for screening for acute retinopathy of prematurity (ROP). Six-year results of a multicentre field study. Graefes Arch Clin Exp Ophthalmol. 2009;247(9):1251–1262.
The major ocular conditions under therapy included diabeticretinopathy in 39 patients (21 with proliferative retinopathy and twelve with background retinopathy), wet age-related macular degeneration in 25, and retinal venous occlusion in 18 (13 central and five branch varieties). The ocular vascular events registered were ocular vascular occlu- sions (of an unspecified type in 30 cases), ipsilateral central retinal artery occlusion (19 cases), contralateral central retinal artery occlusion (one case), branch retinal artery occlusion (four cases), unspecified retinal artery occlusion (14 cases), ophthalmic artery occlusion (two cases), choroidal ischemia (one case), retinal capillary occlusion (31 cases, 19 of which were causing macular ischemia), central retinal vein occlu- sion (three cases), branch retinal vein occlusion (four cases), unspecified retinal vein occlusion (twelve cases), retinal artery spasm (two cases), anterior ischemic optic neuropathy (16 cases), ischemic optic neuropathy (four cases), and one case of vision loss of unspecified origin (Tables 1 and 2).
complications in diabetic patients as some patients were ignorant regarding this matter. Our study showed similar results in awareness of diabeticretinopathy as that one of the study conducted in Malaysia (Tajunisah et al., 2011) except one finding which was in higher percentage i.e 75% in our study thought that achieving good control of diabetes alone is enough to cure compared to 8% in Malaysian study. This can be because the sample used in their study were diabetic patients who visited hospital for the first time unlike our population. The lacunaes found in the knowledge suggests the need for more aggressive awareness campaigns on this subject. We found that higher percentage of practice amongst diabetics compared to a study conducted in Bangladesh (Islam et al., 2014) this may be because of population taken for study were patients and attendants of patients who visited various OPDs of hospital. The potential drawback of our study is a report from a collection of data from patients and attendants of patients visiting various OPDs of hospital. The study would need to be repeated in a random sample of remote areas in order for the results to be truly representative of a national perspective. This baseline information of this study can be used to compare the outcomes of similar study after health promotion campaign. While planning the health promotion, lacunae of knowledge should be focused intensely. Health improvement can be done by increasing the capacity of the health workforce to detect and manage priority and emerging conditions, and improving the general and diabetes-specific health literacy of the population.
The diabeticretinopathy remains humanoid eye illness among persons through diabetics which reasons harm toward retina of eye in addition this might finally principal towards comprehensive blindness. Revealing of diabeticretinopathy cutting-edge initial phase is vital to evade broad blindness. Actual cures aimed at diabeticretinopathy remain obtainable however the situation needs initial diagnosis and the incessant detecting of diabetic patients. Similarly numerous somatic tests similar graphic acuity test, pupil dilation, and optical coherence tomography be able to detect diabeticretinopathy nonetheless stand time overwhelming. The objective of our thesis is to give choice around the attendance of diabeticretinopathy through smearing collaborative of deep learning categorizing procedures continuously features extracted after production of dissimilar retinal appearance. It will give us accuracy of which algorithm will be suitable and more accurate for prediction of the disease [1-5, 18-23]. The diabetes retinopathy stays a medicinal ailment anywhere the retina stands dented since of liquefied escapes after blood vessels hooked on the retina. It is one of the greatest shared diabetic eye illnesses then a foremost reason of blindness. Nearly 0.415 billion diabetic patients are at risk of having blindness because of diabetics. The situation happens once diabetes harms the little blood vessels confidential the retina,