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CURRENT OPHTHALMOLOGY
Year : 2012  |  Volume : 60  |  Issue : 5  |  Page : 428-431

The worldwide epidemic of diabetic retinopathy


1 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
2 State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People's Republic of China

Date of Submission12-Jun-2012
Date of Acceptance20-Jun-2012
Date of Web Publication4-Sep-2012

Correspondence Address:
Nathan Congdon
Department of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, People's Republic of China

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Source of Support: Dr. Zheng is supported by National Natural Science Foundation of China 81100686. Dr. He is supported by National Natural Science Foundation of China 30772393. Dr. Congdon is supported by a Thousand Man grant from the Chinese government, Conflict of Interest: None


DOI: 10.4103/0301-4738.100542

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  Abstract 

Diabetic retinopathy (DR), a major microvascular complication of diabetes, has a significant impact on the world's health systems. Globally, the number of people with DR will grow from 126.6 million in 2010 to 191.0 million by 2030, and we estimate that the number with vision-threatening diabetic retinopathy (VTDR) will increase from 37.3 million to 56.3 million, if prompt action is not taken. Despite growing evidence documenting the effectiveness of routine DR screening and early treatment, DR frequently leads to poor visual functioning and represents the leading cause of blindness in working-age populations. DR has been neglected in health-care research and planning in many low-income countries, where access to trained eye-care professionals and tertiary eye-care services may be inadequate. Demand for, as well as, supply of services may be a problem. Rates of compliance with diabetes medications and annual eye examinations may be low, the reasons for which are multifactorial. Innovative and comprehensive approaches are needed to reduce the risk of vision loss by prompt diagnosis and early treatment of VTDR.

Keywords: Compliance, diabetic retinopathy, services


How to cite this article:
Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol 2012;60:428-31

How to cite this URL:
Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol [serial online] 2012 [cited 2024 Feb 24];60:428-31. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2012/60/5/428/100542

The prevalence of Diabetic Retinopathy (DR) is intimately linked to the upsurge in prevalence of diabetes. [1],[2],[3],[4],[5] Diabetes was once thought of as a disease of the affluent but it has now reached epidemic proportion in both developed and developing countries. Currently, at least 366 million people worldwide have diabetes, and this number is likely to increase as a result of an aging global population, urbanization, a rising prevalence of obesity, and sedentary lifestyles. [1] While recent improvement in diabetes treatment has decreased macrovascular mortality, more patients with diabetes live long enough for DR and vision-threatening diabetic retinopathy (VTDR) to develop. [6]


  What is the Prevalence of Diabetic Retinopathy? Top


A recent systematic review of 35 population-based studies showed that the prevalence of DR, proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), and VTDR among individuals with diabetes is 34.6%, 7.0%, 6.8%, and 10.2%, respectively. [7] By extrapolating these results to the global number of diabetics, we can estimate that the number of people with DR will grow from 126.6 million in 2011 to 191.0 million by 2030, and the number of people with VTDR will increase from 37.3 million to 56.3 million, if no urgent action is taken.

In the American National Health and Nutrition Examination Survey (NHNES, 2005-2008), 28.5% of diabetic patients had some degree of DR, 4.4% had VTDR. [8] Similar prevalence estimates are seen in many other developed countries. [7] In the not-so-distant past, DR was thought to be relatively uncommon in developing countries like China and India. [9],[10] It has now become apparent that many low- and middle-income countries are also confronting this challenge, and the prevalence is similar or even higher than that reported in developed countries. [7] China is a good example of a country facing both, the epidemic of diabetes and DR. China is estimated to have 92.4 million adults with diabetes, and a recent report in rural China showed that 43% of the patients with diabetes already have retinopathy and 6.3% have VTDR. [6],[11]


  What is the Incidence of Diabetic Retinopathy? Top


While accurate figures are difficult to obtain for the incidence of DR, the results of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) showed that the overall incidence of DR in a 10-year interval from 1980-1982 to 1990-1992 was 74%, and among those with DR at baseline, 64% had more severe retinopathy and 17% developed PDR. [12] These figures were 89%, 76%, and 30%, respectively among the younger-onset group (diagnosed before age 30 years); and 67%, 53%, and 10%, respectively, among the older-onset group who did not use insulin. In the 25-year follow-up of the WESDR type-1 diabetes group, almost all patients (97%) developed DR, and among these, 42% progressed to PDR, 29% developed macular edema (ME) and 17% had clinically significant ME. [13],[14]


  Has there been a Decline in the Prevalence/Incidence of Diabetic Retinopathy among those with Diabetes? Top


In the past three decades, the prevalence and incidence of DR among patients with type 1 diabetes have declined in the US, Australia, and other developed countries. A systemic review of 28 studies showed that participants reported on between1986 and 2008 had a lower incidence of PDR (2.6% vs. 19.5%) and severe visual loss (3.2% vs. 9.7%) at 4 years, compared with the 1975-1985 cohort, although the results do not differentiate type-1 from type-2 diabetes. [15] This decline may be due to improved glycemic control in recent decades, but it is too early to know if the decrease is on-going. There is also a lack of data to compare the effects of different treatment regimens (e.g., multiple daily injections versus continuous subcutaneous insulin infusion) on the incidence and progression of DR. In the WESDR cohort, the annual incidence of PDR declined from 3.4% to 1.4% among the type-1 diabetes, and the incidence of clinically significant macular edema (CSME) from 1.0% to 0.4%. [12] Nevertheless, this decline may not occur in low- or middle-income countries where the programs on early HbA1c screening and effective blood sugar and blood pressure control are unavailable. While studies have documented a decline in the incidence of DR among those with type-1 diabetes, the trend of DR among patients with type-2 diabetes remains uncertain.


  What are the Risk Factors Associated with Diabetic Retinopathy? Top


Cross-sectional and longitudinal studies have identified some factors associated with a higher risk of DR. These include hyperglycemia, hypertension, dyslipidemia, duration of diabetes, pregnancy, puberty, and cataract surgery. [16] Despite the importance of glycemic control in diminishing the progression of DR, intensive glycemic control appeared to increase mortality among participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, [17] which raises concerns over the care of persons with type-2 diabetes who are at high risk of cardiovascular events, and highlights the need for close collaboration between diabetologists and ophthalmologists.


  Is there a Socioeconomic Gradient in Prevalence of Diabetic Retinopathy? Top


The impact of socioeconomic inequality on health is now well recognized, and people with diabetes are unlikely to be immune. However, the extent to which socioeconomic status may influence patients with DR is unclear. In fact, the relationship between socioeconomic status and DR is only apparent in some but not all studies. [10],[18],[19] This observed weak or absent social gradient may be attributed to a number of competing influences, including lifestyle, health behaviors, attitude, mortality rate, and health-care systems. In many low- and middle-income countries, for example, higher socioeconomic groups are more likely to consume western foods and pursue a sedentary lifestyle than their poorer counterparts; these factors may counter the beneficial effects of good diabetes care and glycemic control among the rich. [19] These findings do not negate the importance of developing and evaluating ways of addressing the underlying sociocultural factors that render individuals vulnerable to DR and DR-related visual impairment.


  What are the Consequences of Diabetic Retinopathy? Top


DR is rapidly emerging as a global health issue that may threaten patients' visual acuity and visual functioning. Although treatment of established retinopathy can reduce the risk for visual loss by 60%, [20] DR remains the leading cause of blindness among working-age adults in the world. The proportion of blindness attributable to DR ranges from 3-7% in much of South-East Asia and the Western Pacific region to 15-17% in the developed regions of the Americas and Europe. [21] In addition to the direct consequences of visual impairment, DR, particularly in its vision-threatening stages, has a substantial and negative impact on patients' emotional well-being, although the exact mechanisms remain to be determined. [22]

The financial costs of DR are mounting. Depending on the prevalence of diabetes and the organization of particular health systems, diabetes is estimated to account for 11.6% of the annual health-care budgets in most countries, and DR makes a big contribution to this figure. [23] In the United States alone, the direct annual costs of DR were estimated to be USD$490 million in 2004. [24] In Sweden, the annual average healthcare cost of any DR, PDR, and DME amounts to USD$93.6, USD$334.1, and USD$280.8, respectively, per patient. [25] Health economic data on the cost of DR in low- and middle-income countries is currently not available.


  Challenges and Opportunities Top


Capacity

Globally, the backlog of diabetes has far outstripped the capacity and resources to implement DR eye care. Although many low- and middle-income countries (e.g., India and China) have begun to tackle the leading causes of remedial blindness, that is, cataract, the need for DR eye care remains largely unaddressed. [3],[4] The fundamental problem is lack of access to high-quality ophthalmologists, health care resources and facilities. Many countries still have one ophthalmologist per million population (1% of the scale in the United States), with the vast majority of ophthalmologists residing in large cities, leaving many rural and remote areas underserved. Even if basic eye screening is available, many patients with DR still have no adequate access to laser treatment. For example, a 2003 national survey in China showed that 90% of public hospitals have no lasers facilities. [26]

There is no simple solution to build capacity. In addition to poverty eradication programs, new health care delivery strategies should be promoted to meet the demand for DR eye care. Telemedicine, the use of telecommunication and information technologies to provide clinical health care at a distance, represents the single most promising technology in the context of rural DR care. It provides a tool whereby scattered delivery systems may be transformed into a comprehensive DR network that can capitalize on many of the resources, tools, and training already in place in urban areas. In regions where tertiary eye care services (e.g., laser and vitrectomy surgery) are not available, special referral mechanisms and education programs should be established so that advanced cases of DR can receive adequate treatment. There is also a need for the development of a low-cost, portable, and easy-to-operate laser devices. [27]

Sustainability

Sustainability is traditionally defined as the ability to maintain the benefits of eye care programs and support such programs financially, even when both technical and financial assistance are no longer provided from the outside. To be sustainable, a service or program should become politically and culturally integrated into the local environment. While "Sustainability" has, to an extent, become a buzzword in research and program proposals, provisions for this vary widely between eye care programs in developing areas. In the majority of developing countries, DR eye care does not exist in isolation from other eye care (cataract, refractive error, etc.) and opportunistic screening remains the predominant model. The operation of DR care depends on the sustainable development of the entire eye care program. Meanwhile, some countries (e.g., UK and Singapore) have begun to implement stand-alone DR eye care programs to tackle the burden of the disease, resulting in the issue of sustainability becoming even more important.

Management capacity is critically important for a sustainable DR eye care program, but this has been neglected in health-care planning and research. Many previous research projects have focused simply on technical aspects of DR eye care and service delivery (e.g., screening settings, grading thresholds, photographic methods, referral intervals), but without a sufficient appreciation of the role of good management. A local DR screening clinic should not only adapt to a country's resources and available health-care infrastructure, but it should also operate like a business in a competitive marketplace to optimize services and maximize returns. Like chronic disease management, management of DR requires a high level of organization over a patient's lifetime. Project managers and investigators should be encouraged to identify differences between DR eye care centers, and undertake investigations to evaluate market-driven strategies and business models, so that programs can operate without grant funding or charitable contributions. Moreover, health economic data should be made available to evaluate the cost-effectiveness of different business models under various scenarios. Logistics cost is one of the key areas for cost saving, and a well-organized program should constantly review and improve its supply chain operations (e.g., how to identify DR patients, notify results, offer education and treatment, and then repeat annual fundus examination or laser treatment). Although sustainability is critically important, continuous charitable care may still be needed in rural areas and refugee camps with insufficient financial or human resources to provide eye care.

Key performance indicators

Many epidemiologic studies have used a self-reported history of "yearly eye examination after pupillary dilation" as a measure of access to DR eye care. [3],[4] This measure, however, may not be an ideal health metric to reflect either the quality or the quantity of DR eye care. In fact, the "Key Performance Indicators (KPIs)" of DR eye care have been variably defined. At the point of care, the performance of a DR program is influenced by technology, resources, and patient-related factors and at the structural level, by health systems and policy regulations. Due to the complex interplay of these factors, the KPIs of DR eye care are often poorly characterized. In assessing DR screening, the KPIs should go beyond diagnostic indexes such as sensitivity and specificity. Important factors such as uptake; personal training; quality assurance; and follow up of the cases with DR (e.g., time from referral to ophthalmic consultation, time from listing to laser treatment, time from screening event to ophthalmic consultation and the proportion of referred patients who fail to be present for ophthalmic review), should be continuously evaluated. The UK National Screening Committee has recently produced a catalogue of KPIs for DR eye screening programs in England, [28] a move that may stimulate similar proposals elsewhere. In addition to screening, other key questions involved in the evaluation of DR eye care are as follows: What is patients' accessibility to DR eye screening? What are the quality, training and practice standard of health providers? How successful are the strategies used to improve compliance and self-management? Are the programs financially and logistically sustainable?

Another concern is that many policy makers and NGO funders ignore the equity implication of population-based eye care delivery. Patients' health beliefs and attitudes are known to have an important influence on participation in screening and follow up, and these effects vary significantly between socioeconomic classes and ethnic groups. Therefore, efforts must be made to ensure that any regional or national DR eye care program does not exacerbate health inequalities.

Physician-patient relationship

Lack of adherence to diabetes vision care guidelines among patients with diabetes has been recognized as a persistent and complex health issue. In the US, one-third of the patients with diabetes failed to follow vision care guidelines (absence of a dilated eye examination), [29] and in developing countries like China, nonadherence has reached crisis proportion-more than 60%. [3] Nonadherence affects patients of all ages and it can lead to avoidable visual impairment. There are numerous socioeconomic, behavioral, medical, and policy-related factors that contribute to this problem; among these, low health literacy level in patients is a significant contributing factor to noncompliance with treatment, which ultimately leads to worse glycemic control and higher rates of retinopathy. There is therefore, a need to develop materials and tools to facilitate diabetes education and management in patients with low literacy. Additionally, adequate patient outreach and reminder programs may be useful to improve compliance. Injecting an incentive mechanism into eye care programs may be helpful in improving compliance to annual eye examination and laser treatment as well, though the effectiveness and sustainability of such interventions has rarely been evaluated. Lessons from behavioral economics suggest that an incentive program is more attractive if it provides immediate rather than delayed rewards, while success is less likely in the face of immediate as opposed to delayed costs. [30]

The physician-patient relationship is a two-way street, and both parties are accountable to each other. The challenge of improving physician's compliance with guideline-recommended care is not new. In a recent survey in urban Indonesia, less than 50% of the patients with diabetes reported being told of the need for eye examinations by their physicians. [4] Nonadherence to guidelines may occur due to physicians' lack of awareness of the rationale behind the guidelines, lack of time for communication, lack of reimbursement, lack of resources, and a combination of these factors. Furthermore, many residency projects and continued medical education (CME) programs offer limited education about effective communication. Finally, without organizational support, reimbursement mechanisms and computerized tracking systems, effective physician-patient communication may be very difficult.


  The Way Forward Top


The natural history and global burden of DR are well-known. Prevention of diabetes is the best approach for the prevention of DR, but it will require fundamental social and political changes. Among those with diabetes, good glycemic and blood pressure control, regular ophthalmic examinations, and timely laser treatment for macular edema and proliferative retinopathy can markedly reduce the risk of visual impairment. Public health initiatives will be required to make affordable DR screening available and initiatives in education will be needed to improve patient compliance with ophthalmic examinations and facilitate follow ups. Efforts are needed to strengthen the capacity of existing national and local institutions to provide screening services, to train eye-care personnel, and to develop low-cost interventions to improve compliance. Investment is urgently needed to build sustainable business models and evaluate their cost-effectiveness. Current management of DR eye care networks lacks a scientific basis and measurable KPIs; electronic medical records (EMR) may represent an effective approach to monitor performance and accountability. The challenge will be to implement new, practical and sustainable strategies to curb the rising tide of DR.

 
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16 Identification of key ferroptosis genes in diabetic retinopathy based on bioinformatics analysis
Yan Huang, Jun Peng, Qiuhua Liang, Yoshiaki Tsuji
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17 Towards a New Biomarker for Diabetic Retinopathy: Exploring RBP3 Structure and Retinoids Binding for Functional Imaging of Eyes In Vivo
Vineeta Kaushik, Luca Gessa, Nelam Kumar, Humberto Fernandes
International Journal of Molecular Sciences. 2023; 24(5): 4408
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18 A Novel Soft Clustering Method for Detection of Exudates
Kittipol Wisaeng
Computer Systems Science and Engineering. 2023; 46(1): 1039
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19 Serum levels of interleukin-18 in diabetic retinopathy patients: A meta-analysis
Yingling Jiang, Lihua Zhou, Yao Li
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20 Can oestrogen be a game changer in diabetic retinopathy progress: A novel study
Abdul Waris, Asma Anjum, Saif Ahmed, Sheelu Shafiq
Indian Journal of Clinical and Experimental Ophthalmology. 2023; 9(1): 49
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21 Effects of Methylenetetrahydrofolate Reductase (MTHFR) Polymorphisms on Retinal Tissue Perfusion in Mild Diabetic Retinopathy Patients Receiving the Medical Food, Ocufolin®
Hong Jiang, Zhiping Liu, Justin H Townsend, Jianhua Wang
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22 ASSESSMENT OF AWARENESS OF DIABETIC RETINOPATHY AMONG PATIENTS WITH DIABETES MELLITUS ATTENDING THE CARE DIABETES CENTER
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Asian Journal of Pharmaceutical and Clinical Research. 2023; : 55
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23 Application of Deep Learning Methods in a Moroccan Ophthalmic Center: Analysis and Discussion
Zineb Farahat, Nabila Zrira, Nissrine Souissi, Safia Benamar, Mohammed Belmekki, Mohamed Nabil Ngote, Kawtar Megdiche
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24 Changes and related factors of blood CCN1 levels in diabetic patients
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25 Comparison of Chorioretinal Parameters in Diabetic Retinopathy with or without Pan-Retinal Photocoagulation Using Ultrawide-Field Swept-Source Optical Coherence Tomography Angiography
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26 Diabetes Reshapes the Circadian Transcriptome Profile in Murine Retina
Suna Ye, Zhijie Wang, Jacey Hongjie Ma, Shangli Ji, Yanfang Peng, Yinhua Huang, Jiansu Chen, Shibo Tang
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27 Potential Retinal Biomarkers in Alzheimer’s Disease
Mariana Yolotzin García-Bermúdez, Rupali Vohra, Kristine Freude, Peter van Wijngaarden, Keith Martin, Maj Schneider Thomsen, Blanca Irene Aldana, Miriam Kolko
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28 Vitreous Levels of Vascular Endothelial Growth Factor and Platelet-Derived Growth Factor in Patients with Proliferative Diabetic Retinopathy: A Clinical Correlation
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29 Identification of miRNA-mRNA Regulatory Networks Associated with Diabetic Retinopathy using Bioinformatics Analysis
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30 Cost-effectiveness analysis of artificial intelligence-based diabetic retinopathy screening in rural China based on the Markov model
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31 Development of LuxIA, a Cloud-Based AI Diabetic Retinopathy Screening Tool Using a Single Color Fundus Image
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32 Safety and Efficacy of Brolucizumab in the Treatment of Diabetic Macular Edema and Diabetic Retinopathy: A Systematic Review and Meta-Analysis
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33 Efficacy and safety of pan retinal photocoagulation combined with intravitreal anti-VEGF agents for high-risk proliferative diabetic retinopathy: A systematic review and meta-analysis
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34 A Cross-Lesion Attention Network for Accurate Diabetic Retinopathy Grading With Fundus Images
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35 Vision Transformer Model for Predicting the Severity of Diabetic Retinopathy in Fundus Photography-Based Retina Images
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36 Ocular and Systemic Risk Factors for Disease Worsening Among Patients with NPDR: Post Hoc Analysis of the PANORAMA Trial
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37 Perivenular capillary rarefaction in diabetic retinopathy: inter-device characterization and association to clinical staging.
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38 Effects of fluorescein on corneal endothelial morphology after fundus fluorescein angiography in patients with diabetic macular edema
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39 Integration of Vitreous Lipidomics and Metabolomics for Comprehensive Understanding of the Pathogenesis of Proliferative Diabetic Retinopathy
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40 Organizational intervention to improve access to retinopathy screening for patients with diabetes mellitus: health care service improvement project in a tertiary public hospital
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41 Automatic detection of microaneurysms using a novel segmentation algorithm based on deep learning techniques
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42 Role of oxidative stress in diabetes-induced complications and their management with antioxidants
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43 CLC-Net: Contextual and Local Collaborative Network for Lesion Segmentation in Diabetic Retinopathy Images
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44 Identification of critical autophagy-related proteins in diabetic retinopathy: A multi-dimensional computational study
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45 Edad retiniana como biomarcador predictivo del grado de retinopatía diabética
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46 HbA1C, proliferative and non-proliferative retinopathy in diabetic patients
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48 Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial
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49 Systemic reduction of Glut1 normalizes retinal dysfunction, inflammation, and oxidative stress in the retina of spontaneous Type 2 diabetic mice
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51 Retinal and Choroidal Alterations in Diabetic Retinopathy Treatment using Subthreshold Panretinal Photocoagulation with Endpoint Management Algorithm: A Secondary Analysis of a Randomized Clinical Trial
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52 A correlation between oxidative stress and diabetic retinopathy: An updated review
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53 Subconjunctival therapy by cubic liquid crystalline nanoparticles to deliver Triamcinolone acetonide for the management of diabetic Retinopathy: In vivo evidences
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54 Segmentation of hard exudate lesions in color fundus image using two-stage CNN-based methods
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55 Targeting Long Non-Coding RNAs in Cancer Therapy using CRISPR-Cas9 Technology: A Novel Paradigm for Precision Oncology
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56 First Report Globally of Bariatric and Metabolic Surgery in Patients Who Have Blindness or Significant Visual Impairment: Lessons Learnt and Recommendations
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57 A deep learning framework with edge computing for severity level detection of diabetic retinopathy
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58 Nicotinamide mononucleotide, a potential future treatment in ocular diseases
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59 Domain and label efficient approach for diabetic retinopathy severity detection
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60 Hinge attention network: A joint model for diabetic retinopathy severity grading
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61 A computer-aided diagnosis system for detecting various diabetic retinopathy grades based on a hybrid deep learning technique
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62 Diabetic retinopathy screening using improved support vector domain description: a clinical study
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63 RDD-Net: retinal disease diagnosis network: a computer-aided diagnosis technique using graph learning and feature descriptors
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64 Modified residual networks for severity stage classification of diabetic retinopathy
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65 A modified convolutional neural network architecture for diabetic retinopathy screening using SVDD
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66 A novel approach for fundus image enhancement
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67 Comparison of early diabetic retinopathy staging in asymptomatic patients between autonomous AI-based screening and human-graded ultra-widefield colour fundus images
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68 Joint modeling of time to diabetic retinopathy and change in fasting blood sugar among type 2 diabetic patients, Northwest Ethiopia
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69 Determining the role of SGLT2 inhibition with Empagliflozin in the development of diabetic retinopathy
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70 Structure–Function Relationships in the Rodent Streptozotocin-Induced Model for Diabetic Retinopathy: A Systematic Review
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71 Predictors of vision-related quality of life in patients with macular oedema receiving intra-vitreal anti-VEGF treatment
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72 Downregulation of fatty acid binding protein 4 alleviates lipid peroxidation and oxidative stress in diabetic retinopathy by regulating peroxisome proliferator-activated receptor ?-mediated ferroptosis
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73 Joint Learning of Multi-Level Tasks for Diabetic Retinopathy Grading on Low-Resolution Fundus Images
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74 Rationale for integration of services for diabetes mellitus and diabetic retinopathy in Kenya
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75 Clinical significance of metabolic quantification for retinal nonperfusion in diabetic retinopathy
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76 Multimorbidity and multi-disability among the elderly in residential care in India: the Hyderabad Ocular Morbidity in Elderly Study (HOMES)
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77 Single-modality and joint fusion deep learning for diabetic retinopathy diagnosis
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78 Association of renal function with diabetic retinopathy and macular oedema among Chinese patients with type 2 diabetes mellitus
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79 Comparative Study of Transfer Learning Models for Retinal Disease Diagnosis from Fundus Images
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80 Fatty Acid-Binding Protein 4 in Patients with and without Diabetic Retinopathy
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81 High Fasting Blood Sugar and Increased Waist Circumference as Risk Factors for Diabetic Retinopathy in Type 2 Diabetes Patients Older than 45 Years
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82 Preliminary Results of Noninvasive Ocular Rigidity in Diabetic Retinopathy Using Optical Coherence Tomography
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83 Gingerol, a Natural Antioxidant, Attenuates Hyperglycemia and Downstream Complications
Khalid Saad Alharbi, Muhammad Shahid Nadeem, Obaid Afzal, Sami I. Alzarea, Abdulmalik S. A. Altamimi, Waleed Hassan Almalki, Bismillah Mubeen, Samia Iftikhar, Luqman Shah, Imran Kazmi
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84 Supply and demographic characteristics of Ontario’s ophthalmologists from 2010 to 2019: a population-based analysis
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85 Telemedicine Screening of the Prevalence of Diabetic Retinopathy Among Type 2 Diabetic Filipinos in the Community
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86 Blindness and visual impairment in Central Europe
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87 Plasma and Vitreous Metabolomics Profiling of Proliferative Diabetic Retinopathy
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88 Evaluation of Microvascular and Visual Acuity Changes in Patients with Early Diabetic Retinopathy: Optical Coherence Tomography Angiography Study
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89 Different Anti-Vascular Endothelial Growth Factor for Patients With Diabetic Macular Edema: A Network Meta-Analysis
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90 MitoTEMPOL Inhibits ROS-Induced Retinal Vascularization Pattern by Modulating Autophagy and Apoptosis in Rat-Injected Streptozotocin Model
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91 Automatic Detection of Microaneurysms in OCT Images Using Bag of Features
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92 Identifying gene variants underlying the pathogenesis of diabetic retinopathy based on integrated genomic and transcriptomic analysis of clinical extreme phenotypes
Qiaoling Song, Yuchao Zhang, Minghui Zhang, Xiaoli Ma, Qianyue Zhang, Chenyang Zhao, Zhongwen Zhang, Huichen Zhao, Wenchao Hu, Xinxin Zhang, Xiwen Ren, Ming An, Jinbo Yang, Yuantao Liu
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93 Safety and Outcomes of Intravitreal Aflibercept in Diabetic Macular Edema – A Systematic Review
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94 Validity of smartphone-based retinal photography (PEEK-retina) compared to the standard ophthalmic fundus camera in diagnosing diabetic retinopathy in Uganda: A cross-sectional study
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95 Will GLP-1 Analogues and SGLT-2 Inhibitors Become New Game Changers for Diabetic Retinopathy?
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96 Gene Biomarkers Related to Th17 Cells in Macular Edema of Diabetic Retinopathy: Cutting-Edge Comprehensive Bioinformatics Analysis and In Vivo Validation
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97 IMNets: Deep Learning Using an Incremental Modular Network Synthesis Approach for Medical Imaging Applications
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98 The Molecular Mechanism of Long Non-Coding RNA (LncRNA) Regulation of Notch Signaling in Glucose-Induced Apoptosis of Human Retinal Vascular Endothelial Cell
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99 Expressions of Serum lncRNAs in Diabetic Retinopathy – A Potential Diagnostic Tool
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100 Differential Effects of Resveratrol on HECa10 and ARPE-19 Cells
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101 Potential Use of Artificial Intelligence in a Healthcare System
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102 Artificial intelligence use in diabetes
David Eduardo Pelayes, Jose A. Mendoza, Anibal Martin Folgar
Latin American Journal of Ophthalmology. 2022; 5: 6
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103 TYPE 2 DIABETES MELLITUS AND ITS VASCULAR COMPLICATIONS
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104 “AN AVERAGE BURDEN OF FINANCE IN PATIENT WITH DIABETIC RETINOPATHY”
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105 Need for Vitreous Surgeries in Proliferative Diabetic Retinopathy in 10-Year Follow-Up: India Retinal Disease Study Group Report No. 2
Rehana Khan, Janani Surya, Ramachandran Rajalakshmi, Padmaja Kumari Rani, Giridhar Anantharaman, Mahesh Gopalakrishnan, Alok Sen, Abhishek Desai, Rupak Roy, Sundaram Natarajan, Lanin Chen, Gajendra Chawla, Umesh Chandra Behera, Lingam Gopal, Vinata Muralidharan, Sobha Sivaprasad, Rajiv Raman
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106 Relationship between renal function and prognosis of Chinese proliferative diabetic retinopathy patients undergoing the first vitrectomy: protocol for a prospective cohort study
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BMJ Open. 2021; 11(12): e052417
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107 Diabetes and Its Complications: Therapies Available, Anticipated and Aspired
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108 Effect of Type-2 Diabetes Mellitus in Retinopathy Patients on MDA, SOD Activity and its Correlation with HbA1c
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109 Exploring the Pharmacological Mechanism of Liuwei Dihuang Decoction for Diabetic Retinopathy: A Systematic Biological Strategy-Based Research
Mengxia Yuan, Qi He, Zhiyong Long, Xiaofei Zhu, Wang Xiang, Yonghe Wu, Shibin Lin, Yu Hsiang Kuan
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110 miR-126 Mimic Counteracts the Increased Secretion of VEGF-A Induced by High Glucose in ARPE-19 Cells
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111 Anti-Vascular Endothelial Growth Factor Therapy as an Adjunct to Diabetic Vitrectomy
Mushfig Karimov, Lala Akhundova
The Open Ophthalmology Journal. 2021; 15(1): 137
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112 Diet Sugar-Free Carbonated Soda Beverage, Non-Caloric Flavors Consumption, and Diabetic Retinopathy: Any Linkage
Hyder O Mirghani, Naif M Alali, Hani B Albalawi, Ruba M ALselaimy
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113 Situational analysis of diabetic retinopathy screening in India: How has it changed in the last three years?
GV S Murthy
Indian Journal of Ophthalmology. 2021; 69(11): 2944
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114 Regulatory role of miRNA-23a in diabetic retinopathy
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Experimental and Therapeutic Medicine. 2021; 22(6)
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115 Posterior Segment Ophthalmic Drug Delivery: Role of Muco-Adhesion with a Special Focus on Chitosan
Ayah Mohammad Burhan, Butsabarat Klahan, Wayne Cummins, Vanessa Andrés-Guerrero, Mark E. Byrne, Niall J. O’Reilly, Anuj Chauhan, Laurence Fitzhenry, Helen Hughes
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116 Sleep apnea and eye diseases: evidence of association and potential pathogenic mechanisms
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117 Ocular Delivery of Polyphenols: Meeting the Unmet Needs
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118 Performance and Limitation of Machine Learning Algorithms for Diabetic Retinopathy Screening: Meta-analysis
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119 Inhibition of APE1/Ref-1 for Neovascular Eye Diseases: From Biology to Therapy
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120 Photobiomodulation Therapy for Age-Related Macular Degeneration and Diabetic Retinopathy: A Review
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121 Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
Sameer P Leley, Thomas A Ciulla, Ashay Bhatwadekar
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122 Altered resting cerebral blood flow specific to patients with diabetic retinopathy revealed by arterial spin labeling perfusion magnetic resonance imaging
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123 Statin reduces the incidence of diabetic retinopathy and its need for intervention: A systematic review and meta-analysis
Raymond Pranata, Rachel Vania, Andi Arus Victor
European Journal of Ophthalmology. 2021; 31(3): 1216
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124 Circ_001209 aggravates diabetic retinal vascular dysfunction through regulating miR-15b-5p/COL12A1
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125 Ocular Implications in Patients with Sleep Apnea
Nicoleta Anton, Roxana Elena Ciuntu, Dorin Chiselita, Ciprian Danielescu, Anisia Iuliana Alexa, Alina Cantemir, Camelia Margareta Bogdanici, Daniel Constantin Brani?teanu, Bogdan Doroftei
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126 Correlation of Renal Profiles with Choroidal Vascularity Index in Eyes with Diabetic Retinopathy
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127 Feasibility Study of a Multimodal, Cloud-Based, Diabetic Retinal Screening Program in a Workplace Environment
Jeffrey R. Willis, Ferhina S. Ali, Braelyn Argente, Amitha Domalpally, Jacqueline Gannon, Simon S. Gao, Shagun Grover, Purti Kanodia, Sparkle Russell-Puleri, Diana Sun, Cory Thrasher, Costas Tsougarakis, J. Jill Hopkins
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128 Evaluating Awareness and Practices Towards Diabetes and Diabetic Retinopathy in Adult Patients Attending the Eye Clinic in a Tertiary Academic Hospital in Jordan
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129 Optimizing 3D retinal vasculature imaging in diabetic retinopathy using registration and averaging of OCT-A
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130 Ocular Complications of Obstructive Sleep Apnea
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131 Mitophagy in Human Diseases
Laura Doblado, Claudia Lueck, Claudia Rey, Alejandro K. Samhan-Arias, Ignacio Prieto, Alessandra Stacchiotti, Maria Monsalve
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132 New Insight into the Effects of Metformin on Diabetic Retinopathy, Aging and Cancer: Nonapoptotic Cell Death, Immunosuppression, and Effects beyond the AMPK Pathway
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133 Association of four gene polymorphisms in Chinese Guangxi population with diabetic retinopathy in type 2 diabetic patients
He Jin, Dongdong Jiang, Zhixiang Ding, Yu Xiong, Xinsheng Zeng, Miaoyun Liao, Liu Zheng, Binbin Yang
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134 Gut Microbiota Composition and Fecal Metabolic Profiling in Patients With Diabetic Retinopathy
Zixi Zhou, Zheng Zheng, Xiaojing Xiong, Xu Chen, Jingying Peng, Hao Yao, Jiaxin Pu, Qingwei Chen, Minming Zheng
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135 Identification of Prognostic Factors and Predicting the Therapeutic Effect of Laser Photocoagulation for DME Treatment
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136 Detection of the Microvascular Changes of Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography
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137 Circ_0000615 promotes high glucose-induced human retinal pigment epithelium cell apoptosis, inflammation and oxidative stress via miR-646/YAP1 axis in diabetic retinopathy
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138 Global burden and gender disparity of vision loss associated with diabetes retinopathy
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139 Diabetic Retinopathy Detection Using VGG-NIN a Deep Learning Architecture
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140 Potential of medang reso (Cinnamomum parthenoxylon) as raw material source for antidiabetic drugs
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141 Automatic Diabetic Retinopathy Grading System Based on Detecting Multiple Retinal Lesions
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142 Cost-effectiveness of dexamethasone and triamcinolone for the treatment of diabetic macular oedema in Finland: A Markov-model
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143 Predictors of attendance at diabetic retinopathy screening among people with type 2 diabetes: Secondary analysis of data from primary care
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144 Federated Learning for Microvasculature Segmentation and Diabetic Retinopathy Classification of OCT Data
Julian Lo, Timothy T. Yu, Da Ma, Pengxiao Zang, Julia P. Owen, Qinqin Zhang, Ruikang K. Wang, Mirza Faisal Beg, Aaron Y. Lee, Yali Jia, Marinko V. Sarunic
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145 HDAC9 rs11984041 polymorphism is associated with diabetic retinopathy in Slovenian patients with type 2 diabetes mellitus
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146 Exendin-4 inhibits high glucose-induced oxidative stress in retinal pigment epithelial cells by modulating the expression and activation of p66Shc
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147 MicroRNA-431-5p encapsulated in serum extracellular vesicles as a biomarker for proliferative diabetic retinopathy
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148 Current Status and Associated Factors of Annual Eye Examination Among People with Type 2 Diabetes Mellitus: Using the 7th National Health and Nutrition Examination Survey
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149 Age-related ocular conditions: Current treatments and role of cyclodextrin-based nanotherapies
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150 MicroRNAs and Their Delivery in Diabetic Fibrosis
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151 Intravitreal ketamine promotes neuroprotection in rat eyes after experimental ischemia
Lays Fernanda Nunes Dourado, Lucas Gomes Oliveira, Carolina Nunes da Silva, Cibele Rodrigues Toledo, Silvia Ligório Fialho, Rodrigo Jorge, Armando Silva-Cunha
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152 Robust segmentation of exudates from retinal surface using M-CapsNet via EM routing
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153 Different retinopathy phenotypes in type 2 diabetes predict retinopathy progression
Inês P. Marques, Maria H. Madeira, Ana L. Messias, António C.-V. Martinho, Torcato Santos, David C. Sousa, João Figueira, José Cunha-Vaz
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154 Circular RNAs: Novel target of diabetic retinopathy
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155 Lesion-aware attention with neural support vector machine for retinopathy diagnosis
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156 Association between retinol binding protein 4 and diabetic retinopathy among type 2 diabetic patients: a meta-analysis
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157 Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis
Wondimeneh Shibabaw Shiferaw, Tadesse Yirga Akalu, Melaku Desta, Ayelign Mengesha Kassie, Pammla Margaret Petrucka, Hilina Ketema Assefa, Yared Asmare Aynalem
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158 The effect of total lignans from Fructus Arctii on Streptozotocin-induced diabetic retinopathy in Wistar rats
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159 Sodium-glucose co-transporter 2 inhibitors and diabetic retinopathy: insights into preservation of sight and looking beyond
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160 Oxidative stress and diabetic retinopathy: Molecular mechanisms, pathogenetic role and therapeutic implications
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161 Gene Therapy Intervention in Neovascular Eye Disease: A Recent Update
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162 Association between community outpatient clinic care accessibility and the uptake of diabetic retinopathy screening: A multi-level analysis
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163 Application of artificial intelligence methods to recognize pathologies on photographs of fundus
Georgy Lebedev, Anna Meshcheryakova, Viacheslav Kurenkov, Vitaliy Kluganov, Artem Sologubov, Nataliya Logacheva, Georgiy Radzievskiy, Herman Klimenko
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164 Relationship Between Aqueous Humor Levels of Cytokines and Axial Length in Patients With Diabetic Retinopathy
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Asia-Pacific Journal of Ophthalmology. 2020; 9(2): 149
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165 DISTINGUISHING INTRARETINAL MICROVASCULAR ABNORMALITIES FROM RETINAL NEOVASCULARIZATION USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
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166 Swept-source OCTA quantification of capillary closure predicts ETDRS severity staging of NPDR
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167 Direct and indirect therapeutic effect of traditional Chinese medicine as an add-on for non-proliferative diabetic retinopathy: a systematic review and meta-analysis
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168 Importance of the Use of Oxidative Stress Biomarkers and Inflammatory Profile in Aqueous and Vitreous Humor in Diabetic Retinopathy
Ana Karen López-Contreras, María Guadalupe Martínez-Ruiz, Cecilia Olvera-Montaño, Ricardo Raúl Robles-Rivera, Diana Esperanza Arévalo-Simental, José Alberto Castellanos-González, Abel Hernández-Chávez, Selene Guadalupe Huerta-Olvera, Ernesto German Cardona-Muñoz, Adolfo Daniel Rodríguez-Carrizalez
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169 Pemafibrate Protects Against Retinal Dysfunction in a Murine Model of Diabetic Retinopathy
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170 Cost-effectiveness of diabetic retinopathy screening programs using telemedicine: a systematic review
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171 A Higher Proportion of Eicosapentaenoic Acid (EPA) When Combined with Docosahexaenoic Acid (DHA) in Omega-3 Dietary Supplements Provides Higher Antioxidant Effects in Human Retinal Cells
Manuel Saenz de Viteri, María Hernandez, Valentina Bilbao-Malavé, Patricia Fernandez-Robredo, Jorge González-Zamora, Laura Garcia-Garcia, Nahia Ispizua, Sergio Recalde, Alfredo Garcia-Layana
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172 The American Society of Retina Specialists Artificial Intelligence Task Force Report
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173 Changes in choroidal thickness in advanced diabetic retinopathy treated with pan-retinal photocoagulation using a pattern scanning laser versus a conventional laser
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174 Association between Normal Thyroid Hormones and Diabetic Retinopathy in Patients with Type 2 Diabetes
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175 Metformin Corrects Abnormal Circadian Rhythm and Kir4.1 Channels in Diabetes
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176 Classification of advanced and early stages of diabetic retinopathy from non-diabetic subjects by an ordinary least squares modeling method applied to OCTA images
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177 Neuroprotective effects and mechanisms of action of nicotinamide mononucleotide (NMN) in a photoreceptor degenerative model of retinal detachment
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178 Ensemble Framework of Deep CNNs for Diabetic Retinopathy Detection
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179 DMENet: Diabetic Macular Edema diagnosis using Hierarchical Ensemble of CNNs
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180 Foveal serous detachment and its association with body mass index and severity in diabetic retinopathy
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181 Diabetic Retinopathy: Mitochondria Caught in a Muddle of Homocysteine
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182 Genotypes and Phenotypes: A Search for Influential Genes in Diabetic Retinopathy
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183 Curcumin Metabolite Tetrahydrocurcumin in the Treatment of Eye Diseases
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184 Transfer Learning with Convolutional Neural Networks for Diabetic Retinopathy Image Classification. A Review
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185 Towards implementation of AI in New Zealand national diabetic screening program: Cloud-based, robust, and bespoke
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186 Intravitreal ranibizumab for persistent diabetic vitreous haemorrhage: a randomised, double-masked, placebo-controlled feasibility study.
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191 Automatic Diabetic Retinopathy Grading via Self-Knowledge Distillation
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192 Algorithmic Analysis of Vesselness and Blobness for Detecting Retinopathies Based on Fractional Gaussian Filters
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198 Validation of Smartphone-Based Retinal Photography for Diabetic Retinopathy Screening
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200 PERIPAPILLARY NEUROVASCULAR COUPLING IN THE EARLY STAGES OF DIABETIC RETINOPATHY
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205 Update on Screening for Sight-Threatening Diabetic Retinopathy
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207 Current perspectives on established and novel therapies for pathological neovascularization in retinal disease
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208 Aflibercept regulates retinal inflammation elicited by high glucose via the PlGF/ERK pathway
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210 Translational Preclinical Pharmacologic Disease Models for Ophthalmic Drug Development
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212 Artificial intelligence in healthcare
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213 Relationship between the morphology of the foveal avascular zone, retinal structure, and macular circulation in patients with diabetes mellitus
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214 Resistance to retinopathy development in obese, diabetic and hypertensive ZSF1 rats: an exciting model to identify protective genes
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217 The relation between smoking and smoker timing and diabetic complications in type 2 diabetes mellitus patients
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224 Lutein and Zeaxanthin Isomers in Eye Health and Disease
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240 TREATMENT OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR–RESISTANT DIABETIC MACULAR EDEMA WITH DEXAMETHASONE INTRAVITREAL IMPLANT
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