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This paper proposes a new joint model for pairs of failure times in the presence of a cure fraction. The proposed model relaxes some of the assumptions required by the existing approaches. This allows us to add some flexibility to the dependence structure and to widen the range of association measures that can be defined. A numerically stable iterative algorithm based on estimating equations is proposed to estimate the parameters. The estimators are shown to be consistent and asymptotically normal. Simulations show that they have good finite-sample properties. The added flexibility of the proposal is illustrated with an application to data from a diabetes retinopathy study.

Este artículo se ha publicado de forma definitiva en: https://www.mdpi.com/2076-3921/8/3/53 Este artículo pertenece al número especial "Antioxidants and Retinal Disease". Oxidative stress has been documented to be a key factor in the cause and progression of different retinal diseases. Oxidative cellular unbalance triggers a sequence of reactions which prompt cell degeneration and retinal dysfunction, both hallmarks of several retinal pathologies. There is no effective treatment, yet, for many retinal diseases. Antioxidant treatment have been pointed out to be an encouraging palliative treatment; the beneficial effects documented involve slowing the progression of the disease, a reduction of cell degeneration, and improvement of retinal functions. There is a vast information corpus on antioxidant candidates. In this review, we expose three of the main antioxidant treatments, selected for their promising results that has been reported to date. Recently, the sulforaphane, an isothiocyanate molecule, has been unveiled as a neuroprotective candidate, by its antioxidant properties. Progesterone, a neurosteroid has been proposed to be a solid and effective neuroprotective agent. Finally, the lipoic acid, an organosulfur compound, is a well-recognized antioxidant. All of them, have been tested and studied on different retinal disease models. In this review, we summarized the published results of these works, to offer a general view of the current antioxidant treatment advances, including the main effects and mechanisms described.

Purpose: To analyse the effects of intravitreal dexamethasone implant (DEX) in patients with diabetic macular oedema (DME) unresponsive to ranibizumab treatment, in relation to the inflammatory optical coherence tomography (OCT) retinal features, subfoveal neuroretinal detachment (SND) and hyperreflective retinal spots (HRS). Methods: Patients with DME poorly responsive to three injections of ranibizumab were treated with DEX. Best-corrected visual acuity (BCVA) and central macula thickness (CMT, measured by Spectralis SD-OCT) were assessed at baseline and at 1, 3, and 6months. Results: Overall, 44 eyes were included in the study. In the whole group, mean BCVA (baseline 51.5±8.3 letters) increased significantly at 1month (to 56.9±8.8 letters; Tukey HSD p=0.017) and was 55.5±8.8 letters at 3months (Tukey HSD p=0.128). Central macula thickness (CMT) reduced significantly at 1 and 3months (417±149μm and 469±128μm, respectively, both Tukey HSD p&nbsp

Diabetes Retinopathy is a disease which results from a prolonged case of diabetes mellitus and it is the most common cause of loss of vision in man. Data mining algorithms are used in medical and computer fields to find effective ways of forecasting a particular disease. This research was aimed at determining the effect of using feature selection in predicting Diabetes Retinopathy. The dataset used for this study was gotten from diabetes retinopathy Debrecen dataset from the University of California in a form suitable for mining. Feature selection was executed on diabetes retinopathy data then the Implementation of k-Nearest Neighbour, C4.5 decision tree, Multi-layer Perceptron (MLP) and Support Vector Machines was conducted on diabetes retinopathy data with and without feature selection. There was access to the algorithms in terms of accuracy and sensitivity. It is observed from the results that, making use of feature selection on algorithms increases the accuracy as well as the sensitivity of the algorithms considered and it is mostly reflected in the support vector machine algorithm. Making use of feature selection for classification also increases the time taken for the prediction of diabetes retinopathy.

Young persons who develop DR may represent a high-risk group for early development of other complications. In young persons with youth-onset T1D, we evaluated associations between DR status and markers of other T1D complication risk. Youth (N=127), mean age 21.7 y (range 10.7-31.9), mean T1D onset 6.3 y (range 0.5-17.6) underwent DR assessment (ETDRS-protocol 7 field fundus photos); renal, neuropathic, and CVD risk screenings; and risk screening by blood/urine studies. DR was classified as none (No DR, 37%), mild nonproliferative (Mild DR, 46%), and more than mild NPDR (Advanced DR, 17%). More severe DR was associated with greater age, T1D duration, A1c, and weight status (Table). DR severity was associated with neuropathy, vascular stiffness by pulse wave (aortic AIx), and inflammatory, oxidative stress, and endothelial activation markers (CRP, isoprostane, e-selectin). Paradoxically, greater DR was associated with less PAI-1. After adjustment for age, T1D duration, weight, and A1c by ANCOVA, DR status was associated with differences in cooling threshold (7.6, 8.6, 12.3, p=.0003) and e-selectin (39.8, 34.0, 46.0, p=.02). Young persons with DR have high risk for neuropathic, renal, and CVD complications. While PAI-1 is lower, markers of inflammation and oxidative stress are higher in this group. Optimal glycemic control must be prioritized to prevent or delay DR progression and other complications in young persons with DR. Unadjusted Associations Between Clinical Factors and DR Status, *indicates ln transformed p valueClinical FactorNo DR (n=47) Mean or Median or %Mild DR (n=59) Mean or Median or %Advanced DR (n=21) Mean or Median or %P value ANOVA or Chi-squareAge (yrs)/T1D Duration (yrs)/A1c (%)18.9/13.2/8.022.6/15.8/8.625.8/19.6/9.1 Disclosure M. Katz: None. G.L. King: Research Support; Self; Sanofi-Aventis. J. Sun: Other Relationship; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Genentech, Inc., Optovue, Incorporated, Boston Micromachines Corporation, Adaptive Sensory Technology, Kalvista Pharmaceuticals, Inc.. Other Relationship; Self; Novo Nordisk Inc. L.M. Laffel: Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Sanofi US, MannKind Corporation, Roche Diagnostics Corporation, Dexcom, Inc., Insulet Corporation, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Johnson & Johnson Diabetes Institute, LLC..

INTRODUCTION: Diabetic retinopathy (DR) is a leading cause of blindness worldwide. In Saudi Arabia and other Arab countries, several studies estimated the prevalence of DR ranging from 30 - 40%.AIM: To assess the DR knowledge and its association with diabetes control among Type 2 diabetic patients.METHODS: A cross-sectional study of patients with Type II diabetes (T2D) who had a routine visit to the endocrine clinic to assess the DR knowledge and its relation to the glycemic control. We used a questionnaire that was used in previously published studies, and the reliability was assessed using the alpha Cronbach coefficient. Patients who answered correctly > 60% were considered to have good knowledge about DR.RESULTS: Total of 253 patients participated, 43.4% has diabetes > 10 years and 30.7% have it for 5 - 10 years, 36.4% did college degree or higher, 40.8% considered having low income. 37.7% of participants were not screened for the DR in the past year. 28.4% of participants think that seeing optometrist is enough for DR diagnosis. Diabetics with good knowledge who have T2D > 10 years were 46.3% compared to 38.6% (p = 0.04). Diabetics with good knowledge have mean A1c of 8.55 vs. 8.59 (p = 0.32), mean BMI 30.4 vs. 30.2 (p = 0.46), mean diastolic pressure was 77.12% vs. 79.48% (p = 0.03).CONCLUSION: Almost two-thirds of screened T2D were considered to have good knowledge about DR. The good knowledge group tends to have a longer duration of T2D, more likely to have a college degree, and tend to have non -significantly better A1c control.

Diabetic retinopathy (DR) is caused by damage the retina because fluid leaks from blood vessels into the retina. Damage the posterior part of the eye of the diabetic patient. This disease that occurs when does not secrete enough insulin or the body is unable to process it properly. The main two types of diabetic retinopathy the first are non-proliferate diabetes retinopathy (NPDR) and second are proliferate diabetes retinopathy (PDR). The increasing number of DR cases world-wide demands to the development of an automated detection system. We have proposed a computer based method for the detection of diabetic retinopathy using the fundus images. Using Image pre-processing, morphological processing techniques involves processing of fundus images for detect features, such as blood vessel area, exudates, microaneurysms, hemorrhages, and texture. Proposed techniques used for the extraction of these features from digital fundus images. The proposed techniques have been tested on the images of DIARETDB0 database. In which have total 130 images they all images are tested and it’s classified into microaneurysms, hemorrhages, and texture using Support Vector Machine (SVM) for an automatic classification. The detection results obtained by comparing it with expert ophthalmologists. We demonstrated a classification sensitivity of 96.43%, specificity of 95.9 % and accuracy of 99.27 %.

The identification of MAs is an important phase in the research and grading of suffering from diabetes retinopathy. We present clustering strategy to identify the microaneurysms from the optic disk and cup in the retinal fundus pictures. Fuzzy C-Means (FCM) Clustering is used for clustering the information in which the information factors are grouped with different account level. The first and major phase is preprocessing function, in which the optic cup and disk of the feedback picture is being turned. Originally the optic hard disk is turned in some position and the range between the information factors is calculated and a group is established in accordance with the centroid. For retrieving micro aneurysms in all retinal images in our previous work we used SVM Classification filter in Fuzzy C-Means Clustering. In this paper we propose an effective filtering technique for micro aneurysms detection in retinal image preprocessing. Instead of SVM Filtering technique we used NLM in terms of Anisotropic Filter to process retinal images. Tested on the various simulated retina data repositories combining rotation and scaling, the developed method presents good results and shows robustness to rotations and scale changes.

The current study was carried out in Baghdad-Iraq from March to November 2018 and included 110 participant (50 patients with diabetic retinopathy, 35 without diabetic retinopathy and 25 healthy control). Diabetic patients who attended who attended specialized center for Endocrinology and diabetes in Baghdad city, all diabetic retinopathy were diagnosis by specialist ophthalmologist, control group was from blood donors who haven’t any chronic disorders. Patient other ocular, patients with previous vitrectomy, other ocular surgery were excluded from the study. Blood sample were collected from each participant in the study for determination of HbA1c, Interleukin-12 and IFN- ? levels. The study demonstrated that 29 (58%) of patients with diabetes retinopathy were males compared with 21(42%) were females, 15(42.86%) of diabetes patients without retinopathy were males compared with 10(57.14%) were females, so mean age of diabetes retinopathy patients was 55.5±1.1 year while 42.8±2.1 year in diabetes without retinopathy (P

The results of morphological and functional research of macular zone of the retina in patients with diabetes mellitus (DM) and without diabetic retinopathy (DR) are presented. Analysis of tomographic and retinographic parameters revealed decrease of thickness and damage of functional activity of the macular zone.

Large-scale clinical trials, such as the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and the Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies, have shown that the administration of fenofibrate, a peroxisome proliferator-activated receptor alpha (PPAR&alpha, ) agonist, suppresses the progression of diabetic retinopathy. In this paper, we reveal a therapeutic effect of a selective PPAR&alpha, modulator (SPPARM&alpha, ), pemafibrate, against pathological angiogenesis in murine models of retinopathy. Oxygen-induced retinopathy (OIR) was induced in C57BL/6J mice by exposure to 85% oxygen from postnatal day eight (P8) for 72 h. Vehicle, pemafibrate or fenofibrate was administrated by oral gavage from P12 to P16 daily. Administration of pemafibrate, but not fenofibrate, significantly reduced pathological angiogenesis in OIR. After oral pemafibrate administration, expression levels of downstream PPAR&alpha, targets such as acyl-CoA oxidase 1 (Acox1), fatty acid binding protein 4 (Fabp4), and fibroblast growth factor 21 (Fgf21) were significantly increased in the liver but not in the retina. A significant increase in plasma FGF21 and reduced retinal hypoxia-inducible factor-1&alpha, (HIF-1&alpha, ) and vascular endothelial growth factor A (Vegfa) were also observed after this treatment. In an in vitro HIF-luciferase assay, a long-acting FGF21 analogue, but not pemafibrate, suppressed HIF activity. These data indicate that SPPARM&alpha, pemafibrate administration may prevent retinal pathological neovascularization by upregulating FGF21 in the liver.

Diabetic microangiopathy, including retinopathy, is characterized by abnormal growth and leakage of small blood vessels, resulting in local edema and functional impairment of the depending tissues. Mechanisms leading to the impairment of microcirculation in diabetes are multiple and still largely unclear. However, a dysregulated vascular regeneration appears to play a key role. In addition, oxidative and hyperosmolar stress, as well as the activation of inflammatory pathways triggered by advanced glycation end-products and toll-like receptors, have been recognized as key underlying events. Here, we review recent knowledge on cellular and molecular pathways of microvascular disease in diabetes. We also highlight how new insights into pathogenic mechanisms of vascular damage in diabetes may indicate new targets for prevention and treatment.

Human eye is one of the most sophisticated organ, with retina, pupil, iris cornea, lens and optic nerve. Automatic retinal image analysis is emerging as an important screening tool for early detection of eye diseases. Uncontrolled diabetes retinopathy (DR) and glaucoma may lead to blindness. DR is caused by damage to the small blood vessels of the retina in the posterior part of the eye of the diabetic patient. The main stages of DR are non-proliferate diabetes retinopathy (NPDR) and proliferate diabetes retinopathy (PDR). The retinal fundus photographs are widely used in the diagnosis and treatment of various eye diseases in clinics. It is also one of the main resources used for mass screening of DR. We present an automatic screening system for the detection of normal and DR stages (NPDR and PDR). The proposed systems involves processing of fundus images for extraction of abnormal signs, such as area of hard exudates, area of blood vessels, bifurcation points, texture and entropies. Our protocol uses total of 156 subjects consisting of two stages of DR and normal. In this work, we have fed thirteen statistically significant (p

Automatic diabetes retinopathy (DR) recognition can help DR carriers to receive treatment in early stages and avoid the risk of vision loss. In this paper, we emphasize the role of multiple filter sizes in learning fine-grained discriminant features and propose: (i) two deep convolutional neural networks - Combined Kernels with Multiple Losses Network (CKML Net) and VGGNet with Extra Kernel (VNXK), which are an improvement upon GoogLeNet and VGGNet in context of DR tasks. Learning from existing research, (ii) we propose a hybrid color space, LGI, for DR recognition via proposed nets. (iii) Transfer learning is applied to solve the challenge of imbalanced dataset. The effectiveness of proposed new nets and color space is evaluated using two grand challenge retina datasets: EyePACS and Messidor. Our experimental results show: (iv) CKML Net improves upon GoogLeNet and VNXK improves upon VGGNet on both datasets using the LGI color space. Additionally, proposed methodology improves upon other state of the art results on Messidor dataset for referable/non-referable screening.

Diabetes retinopathy is a retinal disease that is affected by diabetes on the eyes. The main risk of the disease can lead to blindness. Detection the disease at early stage can rescue the patients from loss of vision. The major purpose of this paper is to automatically detect as well as to classify the severity of diabetic retinopathy. At first, the lesions on the retina especially blood vessels, exudates and microaneurysms are extracted. Features such as area, perimeter and count from these lesions are used to classify the stages of the disease by applying artificial neural network (ANN). We used 214 fundus images from DIARECTDB1 and local databases. We found that the system can give the classification accuracy of 96% and it supports a great help to ophthalmologists.

Background To provide a normal database of choroidal thickness (CT) in nine Early Treatment Diabetes Retinopathy Study (ETDRS) subfields in Egypt using deep-range imaging swept source optical coherence tomography (DRI SS OCT). Methods This study included a total of 129 eyes of 71 normal Egyptian subjects, comprising 63 males and 66 females. The mean age was 36.85 ± 14.22 years (range, 16–67 years). The mean axial length was 23.84 ± 0.78 mm. CT was measured in nine subfields as defined by the ETDRS-style grid using a DRI SS OCT, and line measurements of subfoveal choroidal thicknesses (SFCT) were also performed. Results Mean SFCT was 300.87 ± 72.256 μm for ring measurements and 319.72 ± 76.45 μm for line measurements (P = 0.04). CT was higher in the superior and temporal quadrants than the inferior and nasal quadrants. A negative correlation between subfoveal choroidal thickness and age was detected in all regions (P

Objective: Diabetes retinopathy is one of the most common and earliest complications of diabetes mellitus. Blindness is 25 times more common at the diabetics than in common population and its incidence in Europe amounts to 60-65 at the population of 100.000 diabetics, yearly. The aim of this study is to analyse causality of the diabetes retinopathy with the sex, age, family predisposition, time of duration and type of the diabetes mellitus. Method: Research was conducted at the Institute for the the workers health care, in Kragujevac, for period from 15th November 2009. to 15th November 2010. and involved 135 patients. Experimental group had 90 patients with progressive diabetes retinopathy and the other, control one, involved 45 patientswith diabetes mellitus without progressive diabetes retinopathy. Results: In both examined groups men make two thirds of patients. Positive family predisposition was found in 68 patients (50,4%), from wich 47 (69,1%) were from experimental group. Most of patients were 51-60 years old, and average oldness is 57,5 years in control group and 60,1 years in experimental group. The average duration of diabetes in control group was 11,7 years and 14,4 years in experimental group. Conclusion: Researching show that the sex and family predisposition don't influence to the manifestation and progress of the diabetes retinopathy. The age of the patients also doesn't influence to the manifestation of this complication. Time of duration diabetes mellitus influences to the appearance of diabetes retinopathy. If the time of illness duration is prolonged for one year, chance for appearance diabetes retinopathy is increased for 1,068 time, more exactly 6,8%.

Diabetic retinopathy (DR) is a common retinal complication associated with diabetes. It is a major cause of blindness in middle as well as older age groups. Therefore early detection through regular screening and timely intervention will be highly beneficial in effectively controlling the progress of the disease. Since the ratio of people afflicted with the disease to the number of eye specialist who can screen these patients is very high, there is a need of automated diagnostic system for diabetic retinopathy changes in the eye so that only diseased persons can be referred to the specialist for further intervention and treatment. Various aspects and stages of retinopathy are analyzed by examining the colored retinal images. Microaneurysms are small saccular pouches caused by local distension of capillary walls and appear as small red dots. Their walls are thin and rupture easily to cause hemorrhages. Hard exudates are yellow lipid deposits which appear as bright yellow lesions. The bright circular region from where the blood vessels emanate is called the optic disk. The fovea defines the center of the retina, and is the region of highest visual acuity. The spatial distribution of exudates and microaneurysms and hemorrhages, especially in relation to the fovea can be used to determine the severity of diabetic retinopathy. Image analysis tools can be used for automated detection of these various features and stages of Diabetes Retinopathy and can be referred to the specialist accordingly for intervention, thus making it a very effective tool for effective screening of Diabetic Retinopathy patients. DR patients require frequent, at least six monthly screening of vast number of patients and automating the process will go a long way in relieving the burden on the specialist and reducing the most common cause of preventable blindness. General Terms Image processing, Automated Diagnostic System

Background The purpose of this study was to observe whether invisible morphological changes are presented in the two types of diabetes mellitus patients without diabetic retinopathy. Methods Twenty-six type 1 diabetes mellitus (T1DM) patients and 34 type 2 diabetes mellitus (T2DM) patients without diabetic retinopathy (DR) were recruited for this study. They underwent complete examinations that included stereoscopic color fundus photography and optical coherence tomography (OCT). The OCT patterns were used to measure the macular retinal thickness (RT), the ganglion cell and inner plexiform layer (GC-IPL) complex thickness, the inner nuclear layer (INL) thickness, the outer nuclear layer (ONL) thickness and the subfoveal choroidal thickness (SFCT) using the enhanced depth imaging (EDI) patterns and the retinal fiber layer (RNFL) thickness around the optic disc. All results were compared to those of age- and sex-matched control groups. Results In the patients with T1DM, the mean RT and GC-IPL complex thicknesses were significantly thinner than those of the control group (p

OBJETIVO: Trabalho com o objetivo de identificar as alterações do pé diabético causadas pelas lesões microangiopáticas e das lesões do fundo de olho secundárias aretinopatia diabética. MÉTODOS: 76 pacientes com Diabetes Melito tipos 1 e 2atendidos no ambulatório de Oftalmologia e Cirurgia Vascular do HUOL/UFRN, Natal, RN, no período de novembro de 2004 a janeiro de 2005, com queixas relativas a alterações da retinopatia diabéticae/oudo pé diabético. Em todos os pacientes foi realizado exame clínico geral, vascular e oftalmológico. Na avaliação específicado pé diabético deu-se ênfase paraa investigação do status vascular pela Classificação de Fontaine para Doença Arterial Obstrutiva Periférica, biomecânica,e teste do monofilamento de Semmes-Weinstein. O exame oftalmológico constou de refração e fundoscopiaatravés da qual identificou-se as formas clínicas da retinopatia diabética. Os dados foram submetidos à análise estatística das variáveis primárias que consistiu em caracterizar o grupo quanto a idade, tempo de doença, nível de glicose A segunda estratégia da análise dos dados constituiu na realização de testes de associação entrealgumas variáveis secundárias selecionadas. O software utilizado para os testes estatísticos foi o Statistica Versão 5, 1997. RESULTADOS: Dos 76 pacientes diabéticos 97% tinham idade superior a 40 anos. O tempo de doença65% tinham mais de 10 anos. Com relação à glicose 72,72% apresentaram níveis de glicose em jejum acima de 100mg/dl. 55,26% apresentavam algum grau de retinopatia diabética contra 44,74% que não apresentavamesses sinais. Com as alterações do pé diabético, identificou-se 59,93% com lesões com área de predominância isquêmica, enquanto 41,07% tinham ausência de sinais. 58,82% apresentaram área de predominância neuropática, e 41,18% sem sinais de neuropatia. Dos com retinopatia diabética 78,57% tinham comprometimento isquêmico no pé e 47,62% tinham algum grau de neuropatia diabética. Observou-se que a retinopatia diabética não proliferativa, nos seus diversos graus de comprometimento apresentou-se com percentuais em torno de 80% junto às lesões do pé diabético, seja isquêmico ou neuropático. Dos pacientes que tinham retinopatia 60,46% tinham alterações biomecânicas dos pés. CONCLUSÃO: Concluiu-se que a RDNP leve foi mais freqüente nas lesões do pé diabético isquêmico, enquanto a RDNP severa mostrou-se mais presente no pé diabético neuropático. PURPOSE: To identify diabetic foot abnormal changes caused by microvascular events and fundoscopy eye lesions due to diabetic retinopathy. METHODS: A survey was performed with 76 diabetic patients from the Hospital Onofre Lopes out-patient department of ophtalmology and vascular surgery. To evaluate the diabetic foot the patients were submmited to an individual interview using Fontaine classification. The vascular test used was Semmes-Weinstein monofilament. Refraction and eye fundoscopy were acomplished in all patients to arrange the diabetic retinopathy.The study results consisted in characterized the group as age,time of disease and glicose level. The second analyse was performed with association tests among the selected secondary study results. " Statística Versão 5,1997 " was the software available. RESULTS: From 76 diabetics patients 97% had age higher than 40 years. 65% had more than 10 years of time disease. 72,72% obtained glicose level>100mg/dl. 55,5% had some degree of diabetic retinopathy against 44,74% had not. About the diabetic foot abnormalities, 59,93% had ischemic damages and 41,07% had not signs. 58,82% had neuropathic foot and there were 41,18% patients without diabetic neuropathy signs. Talking about the diabetic retinopathy population, 78,57% had ischemic foot and 47,62% had neuropathic foot. It was seen 80% of no proliferative diabetic retinopathy in all diabetics foot ( isquemic and neuropathic).The patients with retinopathy 60,46% of them had foot biomechanics abnormalities. CONCLUSION: Light no proliferative diabetic retinopathy was most common in patients with ischemic diabetic foot. The severe no proliferative diabetic retinopathy was most common in patients with neuropathic diabetic foot.

Antalet patienter med sjukdomen diabetes förväntas öka vilket kommer innebära att ett ännu större antal patienter behöver screenas för att upptäcka diabetesretinopati. Syftet med den här pilotstudien var att beskriva patienters erfarenheter av screening för diabetesretinopati på en ögonmottagning. Pilotstudien utformades efter en kvalitativ induktiv ansats och data samlades in genom semistrukturerade intervjuer. Materialet bearbetades genom kvalitativ innehållsanalys. De huvudkategorier som framkom var: trygghet, informationens betydelse, tillgänglighetens betydelse, oro för undersökningsresultatet och dess konsekvenser samt obehagligt och tidskrävande. Resultatet visade på att det var viktigt för informanterna med screening för diabetesretinopati. Det var en trygghet att få gå på kontroller för att upptäcka komplikationer i tid. Det framkom att de kände en oro för att utveckla diabetesretinopati och vilken påverkan detta skulle ha på deras livssituation. Informanterna ville få ett tydligare resultat från undersökningen och att tillgängligheten förbättrades. Det behövs vidare omvårdnadsforskning kring information, kunskap och ökad tillgänglighet vid screening för diabetesretinopati. Sådan forskning kommer att vara till hjälp för att förstå och därmed hitta strategier för att förbättra omvårdnaden för patienter med diabetes samt för att nå ut till dem som uteblir från screeningen för diabetesretinopati. The number of patients with the disease diabetes expects to increase, which means that even a larger number of patients will need to be screened to detect diabetic retinopathy. The purpose of this study was to describe the experiences of screening for diabetes retinopathy at an ophtalmology department. The pilotstudy was developed by a qualitative inductive approach and data were collected through semi-structured interviews. The material was processed by qualitative content analysis. The main categories that emerged were: security, the importance of information, the importance of accessibility, concerns about the result and its consequences and uncomfortable and time-consuming. The result showed that screening for diabetes retinopathy was important for the informants. It was a security to check their eyes to detect complications in time. It was revealed that they felt a concern for complications due to diabetic retinopathy and what effect this would have on their lives. The informants wanted to get a clearer result of the examination and that the availability would improve. Further nursing research about information, knowledge and increased availability in screening for diabetes retinopathy is needed. Such research would be helpful to improve care patients with diabetes, and to find strategies for reaching out to those who fail to attend screening for diabetes retinopathy.

Blindness is one of the most feared complications of diabetes but also one of the most preventable. Diabetes is the commonest cause of blindness in people aged 30 to 69 years. Twenty years after the onset of diabetes, almost all patients with type 1 diabetes and over 60% of patients with type 2 diabetes will have some degree of retinopathy. Even at the time of diagnosis of type 2 diabetes, about a quarter of patients have established background retinopathy. Treatment can now prevent blindness in the majority of cases, so it is essential to identify patients with retinopathy before their vision is affected.

Registration of retinal images provided by different modalities is required to facilitate diagnosis of the retina specifically in context with Diabetes Retinopathy (DR). Temporal registration is necessary in order to follow the various stages DR, whereas multimodal registration allows us to improve the identification of some lesions or to compare pieces of information gathered from different sources. This paper presents an algorithm for temporal and/or multimodal registration of retinal images based on directional gradient of salient vessel bifurcation points. Gradient along 0, +45 and 90 degrees around bifurcation point is invariant to rotation. We have validated this by using Fourier transform. This enables to estimate the correspondence of bifurcation points between the image pairs to be aligned. The retinal vessel tree is first segmented and vessel bifurcation points are located. A feature vector comprising of directional gradients along 0, +45 and 90 degrees around labeled bifurcation point in its 3 × 3 neighborhood is then computed in order to determine correspondence. The rotation is estimated from the coordinates of the matched vessel bifurcation points. The algorithm is tested on publically available DRIVE and STARE database. The overall registration error is observed to be 0.8% and 0.7% for STARE and DRIVE database respectively.

The retina is a highly metabolically active tissue with large demands on the supply of nutrients. Disorders affecting the retina often include some vasculopathy with an impact on retinal circulation. Studies of retinal haemodynamics could thus help to detect, differentiate and diagnose diseases, to monitor changes in disease as well as progression and efficiency of the therapy. The present studies were an attempt to validate and determine the clinical usefulness of a newly developed technique for studying the retinal circulation in human eyes. We used different techniques to evaluate different parameters of retinal circulation. We examined how leukocyte velocity determined with Blue Field Simulation and transit times, mean transite time (MTT) and arterio-venous passage (AVP), and vessel diameter, determined from fluorescein angiograms, together reflects the retinal circulation. MTT was determined with a method based on an Impulse-Response technique, MTTIR. In a study on monkeys we compared our method, together with two conventional methods, with an absolute measurement of retinal blood flow (RBF) determined with labelled microspheres. There was a weak, but not statistically significant, correlation between retinal blood flow and MTTIR (r2 = -0.60, p = 0.06), but no useful correlation between retinal blood flow and either of the other two measures of transit times. In a study on healthy eyes we determined the effect of a physiological provocation, changes in arterial blood gases, on retinal circulation. Breathing pure oxygen or increased level of carbon dioxide in inspired air had no effect on MTT, but oxygen reduced leukocyte velocity and vessel diameter and carbon dioxide increased leukocyte velocity significantly. We concluded that unchanged transit time trough the retinal tissue was not due to a lack of effect of the gas provocation but a result due to concomitant changes in volume and flow. In a study on eyes of patients with diabetic retinopathy we investigated the relation between the extent of retinal circulation changes and the severity of the diabetes retinopathy (DRP). Transit times were relatively unaffected until proliferative DRP (PDRP) developed. In eyes with PDRP both MTTIR and AVP were increased. After panretinal photocoagulation treatment MTTIR returned to normal levels and vessel diameters tended to decrease while leukocyte velocity and AVP remained unchanged. We concluded that the increase in MTTIR in eyes with PDRP is at least partly explained by vessel dilation, causing an increased volume of the retinal vascular bed.

Methods Data on children with T2DM referred to and managed in UMMC from 2000 until 2013 were collected. Their body mass index (BMI and blood tests (HbA1c and Lipids) were compared at presentation to their latest clinic appointment. Treatment modalities and duration of follow up were documented. T2DM was dignosed if they had hyperglycaemia (Random BG > 11.8mmol/L or fasting BG > 7mmol/L or 2hpp OGTT >11.1mmol/L with low C-Peptide). Hypertension (HPT) if BP> 90th centile for age,sex and height. Dyslipidemia is considered if either triglycerides> 1.7mmol/L, cholesterol >5.2mmol/L, HDL 2.50mmol/L. Non-alcoholic fatty liver disease (NAFLD) was confirmed with ultrasound, diabetic nephropathy (DN) if urine microalbumin>3.5 in boys , >4.5 in girls and diabetes retinopathy(DR) if reported by opthalmologist.

Objectives: To assess uptake of the diabetes retinopathy screening programme in South East London and examine variation in attendance and screening outcomes. Methods: Cross-sectional study of patients on a centralized disease register invited for retinal screening during 2003. The influence of age, gender, deprivation, region of birth and type of diabetes on screening attendance and outcomes was assessed. Results: An estimated 46% of residents with known diabetes (9750/21,104) were offered digital retinopathy screening during 2003. In all, 88.9% of patients who were invited for screening attended. Attendance rates were significantly lower in younger patients (≤40 years), in those with type 1 diabetes and in patients residing in areas with the highest levels of deprivation. A total of 28.9% of patients had background retinopathy or worse during 2003. Retinopathy was more common in older patients (>40 years) and in individuals with type 1 diabetes after adjusting for other factors. Patients born outside the United Kingdom and the Republic of Ireland were significantly more likely to present with retinopathy. Conclusions: This study identified considerable inequity in the delivery of a local diabetic retinopathy screening programme. Equity audits should form an integral component of ongoing quality assurance monitoring of retinopathy screening programmes.

Ninety-seven laser treated eyes from 55 highly selected childhood onset diabetics (diabetes before the age of 15, proliferative retinopathy before the age of 31, and a follow-up time of at least 5 years) were examined retrospectively. The eyes were divided into two groups, with or without high-risk characteristics according to DRS classification. They were all treated with a blue-green argon laser in the years 1974 to 1981. Of 34 eyes with high-risk characteristics, 12 (35%) were blind (less than FC 1 M) after 5 years. Of 63 eyes without high-risk characteristics, 8 (13%) were blind after 5 years.