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Diabetic Retinopathy: Current Understanding, Mechanisms, and Technological Integration for Managing Treatment Strategies

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 4772

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Dr. Minhaj Nur Alam

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Department of Electrical and Computer Engineering, University of North Carolina at Charlotte, Charlotte, NC 28223, USA
Interests: medical imaging; medical artificial intelligence; self-supervised learning; ophthalmic diagnostics; optical coherence tomography; imaging biomarkers; diabetic retinopathy; age-related macular degeneration; artificial intelligence in healthcare

Special Issue Information

Dear Colleagues,

Diabetic retinopathy (DR) is a major ocular manifestation of diabetes, which is a global epidemic with a projected estimate of 592 million adults living with it worldwide (according to the World Health Organization). DR can be initially asymptomatic at its non-proliferative stage but can lead to irreversible vision loss if it progresses to the proliferative stage. Therefore, DR can have a major impact on public health and global economic wellbeing since it requires long-term management. The American Academy of Ophthalmology (AAO) recommends that patients with the prevalent diabetes should be screened every year after the initial diagnosis. Therefore, it is imperative to find an efficient way to improve the treatment management for DR and enable mass screening, early onset detection, and clinical diagnostics.

DR is currently diagnosed based on signs of retinal vascular pathology, including the presence of microaneurysms, hemorrhages, and exudates, with help from imaging modalities such as fundus, optical coherence tomography (OCT), fluorescein angiography (FA), and more recently OCT angiography (OCTA). Recent studies have also demonstrated that functional biomarkers in retinal photoreceptors can also be used for predicting onset of DR.

The aim of this Special Issue is to provide an updated point of view about multiple pathophysiological mechanisms implicated in DR, understand the underlying predictors of DR onset, and showcase state-of-the-art imaging and machine-learning-based algorithmic integrations for better management of DR in terms of clinical diagnosis and prognosis.

Dr. Minhaj Nur Alam
Guest Editor

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Published Papers (3 papers)

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Research

15 pages, 863 KiB

Open AccessArticle

Surgical Treatment of Neovascular Glaucoma Secondary to Proliferative Diabetic Retinopathy in Japanese Patients without the Use of Glaucoma Drainage Devices

by Masaru Takeuchi, Takayuki Kanda, Kozo Harimoto, Daisuke Sora, Rina Okazawa and Tomohito Sato

J. Clin. Med. 2024, 13(11), 3252; https://doi.org/10.3390/jcm13113252 - 31 May 2024

Abstract

Purpose: The purpose of this study is to investigate outcomes of visual acuity (VA) and intraocular pressure (IOP) in proliferative diabetic retinopathy (PDR)-associated neovascular glaucoma (NVG) in Japanese patients treated with surgical therapies without the use of glaucoma drainage devices. Methods: A retrospective analysis of medical records was conducted for 31 consecutive PDR-associated NVG patients who underwent surgical treatments in our institution between 2013 and 2022. Patient demographics, clinical characteristics, VA, and IOP were recorded at the first and last visits, and surgical procedures, including pars plana vitrectomy with extensive panretinal and ciliary photocoagulation (PPV–PRCP), diode laser trans-scleral cyclophotocoagulation (DCPC), and trabeculectomy with mitomycin C (TLE–MMC), with or without a prior intravitreal bevacizumab (IVB) injection, were reviewed. Results: Of the thirty-one PDR patients with NVG, two patients received PPV–PRCP or DCPC alone (6.5%), respectively, three patients received TLE–MMC alone (9.7%), two patients received TLE–MMC after IVB (6.5%), six patients received PPV–PRCP and TLE–MMC (19.4%), seven patients received PPV–PRCP and TLE–MMC after IVB (22.6%), five patients received PPV–PRCP and DCPC and TLE–MMC (16.1%), and four patients received PPV–PRCP and DCPC and TLE–MMC after IVB (12.9%). The VA of two patients (6.5%) deteriorated to no light perception. In all patients, the mean logMAR VA was 1.28 ± 1.05 at the first visit and remained at 1.26 ± 1.08 at the last visit, with no significant change; the mean IOP was 33.0 ± 15.2 mmHg at the initial visit and decreased significantly to 14.0 ± 7.4 mmHg at the last visit. The number of eyes with IOP ≥ 21 decreased from twenty-eight (90.3%) to three (9.7%). Although IOP in patients with IOP > 30 mmHg at the initial visit reduced to a level comparable to that of patients with IOP ≤ 30 mmHg, the IOP > 30 mmHg group received IVB more frequently and had significantly higher logMAR VA at the last visit compared to the IOP ≤ 30 mmHg group. Hypotony (<6 mmHg) was observed in four eyes (12.9%). Conclusions: In PDR patients with NVG, various combinations of PPV–PRCP, DCPC, and TLE–MMC after adjunctive IVB without the use of glaucoma drainage devices lowered IOP sufficiently; for these patients, neovascular regression was observed, with no further deterioration of VA. However, surgical procedures should be performed for PDR patients with NVG before visual impairment occurs. On the other hand, approximately less than 15% of patients developed blindness or low IOP. Full article

(This article belongs to the Special Issue Diabetic Retinopathy: Current Understanding, Mechanisms, and Technological Integration for Managing Treatment Strategies)

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9 pages, 1763 KiB

Open AccessArticle

Automated Region of Interest Selection Improves Deep Learning-Based Segmentation of Hyper-Reflective Foci in Optical Coherence Tomography Images

by Sarang Goel, Abhishek Sethi, Maximilian Pfau, Monique Munro, Robison Vernon Paul Chan, Jennifer I. Lim, Joelle Hallak and Minhaj Alam

J. Clin. Med. 2022, 11(24), 7404; https://doi.org/10.3390/jcm11247404 - 14 Dec 2022

Cited by 2 | Viewed by 2245

Abstract

Hyperreflective foci (HRF) have been associated with retinal disease progression and demonstrated as a negative prognostic biomarker for visual function. Automated segmentation of HRF in retinal optical coherence tomography (OCT) scans can be beneficial to identify the formation and movement of the HRF biomarker as a retinal disease progresses and can serve as the first step in understanding the nature and severity of the disease. In this paper, we propose a fully automated deep neural network based HRF segmentation model in OCT images. We enhance the model’s performance by using a patch-based strategy that increases the model’s compute on the HRF pixels. The patch-based strategy is evaluated against state of the art HRF segmentation pipelines on clinical retinal image data. Our results shows that the patch-based approach demonstrates a high precision score and intersection over union (IOU) using a ResNet34 segmentation model with Binary Cross Entropy loss function. The HRF segmentation pipeline can be used for analyzing HRF biomarkers for different retinopathies. Full article

(This article belongs to the Special Issue Diabetic Retinopathy: Current Understanding, Mechanisms, and Technological Integration for Managing Treatment Strategies)

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13 pages, 920 KiB

Open AccessArticle

Diabetic Retinopathy and Eye Screening: Diabetic Patients Standpoint, Their Practice, and Barriers; A Cross-Sectional Study

by Naif Mamdouh Alali, Alanuad Albazei, Horia Mohammed Alotaibi, Ahad Massd Almohammadi, Eilaf Khaled Alsirhani, Turki Saleh Alanazi, Badriah Jariad Alshammri, Mohammed Qasem Alqahtani, Moustafa Magliyah, Shaker Alreshidi and Hani B. Albalawi

J. Clin. Med. 2022, 11(21), 6351; https://doi.org/10.3390/jcm11216351 - 27 Oct 2022

Cited by 4 | Viewed by 1845

Abstract

Diabetes mellites (DM) is one of the most common systemic disorders in Saudi Arabia and worldwide. Diabetic retinopathy (DR) is a potentially blinding ophthalmic consequence of uncontrolled DM. The early detection of DR leads to an earlier intervention, which might be sight-saving. Our aim in this cross-sectional study is to assess patients’ knowledge and practices regarding DR, and to detect the barriers for eye screening and receiving a check-up from an ophthalmologist. The study included 386 diabetic patients. One hundred and thirty-one patients (33.9%) had T1DM and 188 (48.7%) had T2DM. Most of the diabetic patients (73.3%) know that they must have an eye check-up regardless of their blood sugar level. DM was agreed to affect the retina in 80.3% of the patients, 56% of patients agree that DM complications are always symptomatic, and 84.5% know that DM could affect their eyes. The fact that blindness is a complication of diabetic retinopathy was known by 65% of the diabetic patients. A better knowledge was detected among patients older than 50 years of age (54.9%) compared to those aged less than 35 years (40.9%), which was statistically significant (p = 0.030). Additionally, 61.2% of diabetic patients who were university graduates had a significantly better knowledge in comparison to 33.3% of illiterate patients (p = 0.006). Considering the barriers to not getting one’s eyes screened earlier, a lack of knowledge was reported by 38.3% of the patients, followed by lack of access to eye care (24.4%). In conclusion, there is a remarkable increase in the awareness of DR among the Saudi population. This awareness might lead to an earlier detection and management of DR. Full article

(This article belongs to the Special Issue Diabetic Retinopathy: Current Understanding, Mechanisms, and Technological Integration for Managing Treatment Strategies)

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