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Objective: To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. Methods: We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. Results: In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50–59 years and those living in areas with higher deprivation. Conclusions: Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring. [ABSTRACT FROM AUTHOR]

Deep learning (DL) models have shown promise in detecting chronic kidney disease (CKD) from fundus photographs. However, previous studies have utilized a serum creatinine-only estimated glomerular rate (eGFR) equation to measure kidney function despite the development of more up-to-date methods. In this study, we developed two sets of DL models using fundus images from the UK Biobank to ascertain the effects of using a creatinine and cystatin-C eGFR equation over the baseline creatinine-only eGFR equation on fundus image-based DL CKD predictors. Our results show that a creatinine and cystatin-C eGFR significantly improved classification performance over the baseline creatinine-only eGFR when the models were evaluated conventionally. However, these differences were no longer significant when the models were assessed on clinical labels based on ICD10. Furthermore, we also observed variations in model performance and systemic condition incidence between our study and the ones conducted previously. We hypothesize that limitations in existing eGFR equations and the paucity of retinal features uniquely indicative of CKD may contribute to these inconsistencies. These findings emphasize the need for developing more transparent models to facilitate a better understanding of the mechanisms underpinning the ability of DL models to detect CKD from fundus images. [ABSTRACT FROM AUTHOR]

Convolutional Neural Networks (CNNs) have become a prominent method of AI implementation in medical classification tasks. Grading Diabetic Retinopathy (DR) has been at the forefront of the development of AI for ophthalmology. However, major obstacles remain in the generalization of these CNNs onto real-world DR screening programs. We believe these difficulties are due to use of 1) small training datasets (<5,000 images), 2) private and 'curated' repositories, 3) locally implemented CNN implementation methods, while 4) relying on measured Area Under the Curve (AUC) as the sole measure of CNN performance. To address these issues, the public EyePACS Kaggle Diabetic Retinopathy dataset was uploaded onto Microsoft Azure™ cloud platform. Two CNNs were trained; 1 a "Quality Assurance", and 2. a "Classifier". The Diabetic Retinopathy classifier CNN (DRCNN) performance was then tested both on 'un-curated' as well as the 'curated' test set created by the "Quality Assessment" CNN model. Finally, the sensitivity of the DRCNNs was boosted using two post-training techniques. Our DRCNN proved to be robust, as its performance was similar on 'curated' and 'un-curated' test sets. The implementation of 'cascading thresholds' and 'max margin' techniques led to significant improvements in the DRCNN's sensitivity, while also enhancing the specificity of other grades. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy is a vascular disease of the retina characterised by hyperglycaemic and inflammatory processes. Most animal models of diabetic retinopathy are hyperglycaemia-only models that do not account for the significant role that inflammation plays in the development of the disease. In the present study, we present data on the establishment of a new animal model of diabetic retinopathy that incorporates both hyperglycaemia and inflammation. We hypothesized that inflammation may trigger and worsen the development of diabetic retinopathy in a hyperglycaemic environment. Pro-inflammatory cytokines, IL-1β and TNF-α, were therefore injected into the vitreous of non-obese diabetic (NOD) mice. CD1 mice were used as same genetic background controls. Fundus and optical coherence tomography images were obtained before (day 0) as well as on days 2 and 7 after intravitreal cytokine injection to assess vessel dilation and beading, retinal and vitreous hyper-reflective foci and retinal thickness. Astrogliosis and microgliosis were assessed using immunohistochemistry. Results showed that intravitreal cytokines induced vessel dilation, beading, severe vitreous hyper-reflective foci, retinal oedema, increased astrogliosis and microglia upregulation in diabetic NOD mice. Intravitreal injection of inflammatory cytokines into the eyes of diabetic mice therefore appears to provide a new model of diabetic retinopathy that could be used for the study of disease progression and treatment strategies. [ABSTRACT FROM AUTHOR]