Dataset Information

Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh.

ABSTRACT: Importance:Diabetic retinopathy (DR) is the leading cause of low vision among working-age adults. An estimated 6.9 million people in Bangladesh were living with diabetes in 2017, which is projected to increase to more than 10 million people in 2025. Currently, no standardized and/or large-scale DR screening program exists in Bangladesh. Objective:To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individuals with diabetes. Design, Setting, and Participants:In this cross-sectional study, 49?264 patients with diabetes underwent opportunistic eye screening at 2 eye hospitals and 1 diabetic hospital in Bangladesh between June 1, 2010, and September 30, 2017. The data set was analyzed from April 8 to December 30, 2018. Technicians were trained to obtain 2-field digital fundus photographs and to grade each according to a standardized DR severity scale. Each patient was counseled and triaged for treatment using defined DR referral criteria. Main Outcomes and Measures:Primary DR grading outcomes, visual acuity, and treatment outcomes. Results:A total of 49?264 patients (54.3% male; mean [SD] age, 50.8 [12.3] years) underwent DR screening during a 7-year period. The DR prevalence rate across all 3 sites was 33% (95% CI, 33%-33%). Prevalence rates varied by center (Chittagong, 64.6% [95% CI, 64.0%-65.0%]; Dhaka, 39.8% [95% CI, 39.0%-41.0%]; and Feni, 13.0% [95% CI, 13.0%-14.0%]). Across all age groups, male patients were at higher risk of prevalent DR than female patients (odds ratio, 1.99; 95% CI, 1.90-2.07). The prevalence was 3.9% for preproliferative DR, 7.8% for proliferative DR, and 19.2% for maculopathy. Individuals with DR had significantly worse visual acuity than those with no DR (best-corrected visual acuity, 0.35 vs 0.21 logMAR; P?

SUBMITTER: Muqit MMK

PROVIDER: S-EPMC6902843 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh.

Muqit Mahiul M K MMK Kourgialis Nick N Jackson-deGraffenried Meredith M Talukder Zaman Z Khetran Erica R ER Rahman Arifur A Chan Weng Onn WO Chowdury Fakrhul A FA Nag Dipak D Ahmad Jasmin J Friedman David S DS

JAMA network open 20191101 11

<h4>Importance</h4>Diabetic retinopathy (DR) is the leading cause of low vision among working-age adults. An estimated 6.9 million people in Bangladesh were living with diabetes in 2017, which is projected to increase to more than 10 million people in 2025. Currently, no standardized and/or large-scale DR screening program exists in Bangladesh.<h4>Objective</h4>To develop a novel fundus photograph-based eye screening model for early detection of DR to prevent vision loss in Bangladeshi individua ...[more]

PMID: 31774523

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Project description:Importance:Capillary dropout is a hallmark of diabetic retinopathy, but its role in visual loss remains unclear. Objective:To examine how macular vessel density is correlated with visual acuity (VA) in patients younger than 40 years who have type 1 diabetes without macular edema but who have diabetic retinopathy requiring panretinal photocoagulation. Design, Settings, and Participants:Retrospective cohort study of VA and optical coherence tomography angiography data collected from consecutive patients during a single visit to Lariboisière Hospital, a tertiary referral center in Paris, France. The cohort included 22 eyes of 22 patients with type 1 diabetes without macular edema but with bilateral rapidly progressive diabetic retinopathy that was treated with panretinal photocoagulation between August 15, 2015, and December 30, 2016. Eyes were classified into 2 groups by VA: normal (logMAR, 0; Snellen equivalent, 20/20) and decreased (logMAR, >0; Snellen equivalent, <20/20). The control group included 12 eyes from age-matched healthy participants with normal vision. Main Outcomes and Measures:Visual acuity and mean vessel density in 4 retinal vascular plexuses: the superficial vascular plexus and the deep capillary complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Results:Of the 22 participants, 11 (50%) were men, mean (SD) age was 30 (6) years, and mean (SD) hemoglobin A1c level was 8.9% (1.6%). Of the 22 eyes with diabetic retinopathy, 13 (59%) had normal VA and 9 (41%) had decreased VA (mean [SD]: logMAR, 0.12 [0.04]; Snellen equivalent, 20/25). Mean [SE] vessel density was lower for eyes with diabetic retinopathy and normal VA compared with the control group in the superficial vascular plexus (44.1% [0.9%] vs 49.1% [0.9%]; difference, -5.0% [1.3%]; 95% CI, -7.5% to -2.4%; P < .001), in the deep capillary complex (44.3% [1.2%] vs 50.6% [1.3%]; difference, -6.3% [1.8%]; 95% CI, -9.9% to -2.7%; P = .001), in the intermediate capillary plexus (43.8% [1.2%] vs 49.3% [1.2%]; difference, -5.5% [1.7%]; 95% CI, -9.0% to -2.0%; P = .003), and in the deep capillary plexus (24.5% [1.0%] vs 30.5% [1.0%]; difference, -6.1% [1.4%]; 95% CI, -8.9% to -3.2%; P < .001). Mean vessel density was lower in eyes with diabetic retinopathy and decreased VA compared with eyes with diabetic retinopathy and normal VA; the mean (SE) loss was more pronounced in the deep capillary complex (34.6% [1.5%] vs 44.3% [1.2%]; difference, -9.6% [1.9%]; 95% CI, -13.6% to -5.7%; P < .001), especially in the deep capillary plexus (15.2% [1.2%] vs 24.5% [1.0%]; difference, -9.3% [1.5%]; 95% CI, -12.4% to -6.1%; P < .001), than in the superficial vascular plexus (39.6% [1.1%] vs 44.1% [0.9%]; difference, -4.5% [1.4%]; 95% CI, -7.3% to -1.7%; P = .002). Conclusions and Relevance:These data suggest that in patients with type 1 diabetes without macular edema but with severe nonproliferative or proliferative diabetic retinopathy, decreased VA may be associated with the degree of capillary loss in the deep capillary complex.

Project description:Retinal blood vessels are considered valuable biomarkers for the detection of diabetic retinopathy, hypertensive retinopathy, and other retinal disorders. Ophthalmologists analyze retinal vasculature by manual segmentation, which is a tedious task. Numerous studies have focused on automatic retinal vasculature segmentation using different methods for ophthalmic disease analysis. However, most of these methods are computationally expensive and lack robustness. This paper proposes two new shallow deep learning architectures: dual-stream fusion network (DSF-Net) and dual-stream aggregation network (DSA-Net) to accurately detect retinal vasculature. The proposed method uses semantic segmentation in raw color fundus images for the screening of diabetic and hypertensive retinopathies. The proposed method's performance is assessed using three publicly available fundus image datasets: Digital Retinal Images for Vessel Extraction (DRIVE), Structured Analysis of Retina (STARE), and Children Heart Health Study in England Database (CHASE-DB1). The experimental results revealed that the proposed method provided superior segmentation performance with accuracy (Acc), sensitivity (SE), specificity (SP), and area under the curve (AUC) of 96.93%, 82.68%, 98.30%, and 98.42% for DRIVE, 97.25%, 82.22%, 98.38%, and 98.15% for CHASE-DB1, and 97.00%, 86.07%, 98.00%, and 98.65% for STARE datasets, respectively. The experimental results also show that the proposed DSA-Net provides higher SE compared to the existing approaches. It means that the proposed method detected the minor vessels and provided the least false negatives, which is extremely important for diagnosis. The proposed method provides an automatic and accurate segmentation mask that can be used to highlight the vessel pixels. This detected vasculature can be utilized to compute the ratio between the vessel and the non-vessel pixels and distinguish between diabetic and hypertensive retinopathies, and morphology can be analyzed for related retinal disorders.

Dataset Information

Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh.

Publications

Trends in Diabetic Retinopathy, Visual Acuity, and Treatment Outcomes for Patients Living With Diabetes in a Fundus Photograph-Based Diabetic Retinopathy Screening Program in Bangladesh.

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