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Midena E, Polo C, Frizziero L, Marini MG, Lattanzio R, Vadalà M, Pilotto E, Varano M. The Narrative Medicine Approach in the Treatment of Diabetic Macular Edema: An Italian Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159367. [PMID: 35954724 PMCID: PMC9368569 DOI: 10.3390/ijerph19159367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 12/04/2022]
Abstract
The study retraces the healthcare pathway of patients affected by diabetic macular edema (DME) through the direct voice of patients and caregivers by using a “patient journey” and narrative method approach. The mapping of the patient’s journey was developed by a multidisciplinary board of health professionals and involved four Italian retina centers. DME patients on intravitreal injection therapy and caregivers were interviewed according to the narrative medicine approach. Narratives were analyzed through a quali-quantitative tool, as set by the narrative medicine method. The study involved four specialized retina centers in Italy and collected a total of 106 narratives, 82 from DME patients and 24 from caregivers. The narratives reported their difficulty in identifying the correct pathway of care because of a limited awareness of diabetes and its complications. Patients experienced reduced autonomy due to ocular complications. In the treatment of diabetes and its complications, a multidisciplinary approach currently appears to be missing. DME reduces the quality of life of affected patients. The narrative medicine approach offers qualitative and emotional patient-guided information. The patient journey provides all of those involved in the management of DME with flowcharts to refer to, identifying the critical points in the healthcare journey of DME patients to improve the management of the disease.
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Affiliation(s)
- Edoardo Midena
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
- IRCCS—Fondazione Bietti, 00198 Rome, Italy;
- Correspondence: ; Tel.: +39-049-8212110
| | - Chiara Polo
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | - Luisa Frizziero
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, Scientific Institute Ospedale San Raffaele, University Vita-Salute, 20132 Milan, Italy;
| | - Maria Vadalà
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, 90127 Palermo, Italy;
| | - Elisabetta Pilotto
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy; (C.P.); (L.F.); (E.P.)
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Scanlon PH. The contribution of the English NHS Diabetic Eye Screening Programme to reductions in diabetes-related blindness, comparisons within Europe, and future challenges. Acta Diabetol 2021; 58:521-530. [PMID: 33830332 PMCID: PMC8053650 DOI: 10.1007/s00592-021-01687-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
The aim of the English NHS Diabetic Eye Screening Programme (DESP) is to reduce the risk of sight loss amongst people with diabetes by the prompt identification and effective treatment if necessary of sight-threatening diabetic retinopathy, at the appropriate stage during the disease process, with a long-term aim of preventing blindness in people with diabetes.For the year 2009-2010, diabetic retinopathy (DR) was no longer the leading cause of blindness in the working age group. There have been further reductions in DR certifications for WHO severe vision impairment and blindness from 1,334 (5.5% of all certifications) in 2009/2010 to 840 (3.5% of all certifications) in 2018/2019. NHS DESP is a major contributor to this further reduction, but one must also take into account improvements in glycaemic and blood pressure control, timely laser treatment and vitrectomy surgery, improved monitoring techniques for glycaemic control, and vascular endothelial growth factor inhibitor injections for control of diabetic macular oedema. The latter have had a particular impact since first introduced in the UK in 2013.Current plans for NHS DESP include extension of screening intervals in low-risk groups and the introduction of optical coherence tomography as a second line of screening for those with screen positive maculopathy with two dimensional markers. Future challenges include the introduction of automated analysis for grading and new camera technologies.
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Affiliation(s)
- Peter H Scanlon
- Gloucestershire Retinal Research Group, Office Above Oakley Ward, Cheltenham General Hospital, Sandford Road, Cheltenham, GL53 7AN, UK.
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
- University of Gloucestershire, Cheltenham, UK.
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Incidence and Risk Factors for Tractional Macular Detachment after Anti-Vascular Endothelial Growth Factor Agent Pretreatment before Vitrectomy for Complicated Proliferative Diabetic Retinopathy. J Clin Med 2019; 8:jcm8111960. [PMID: 31766241 PMCID: PMC6912392 DOI: 10.3390/jcm8111960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 01/29/2023] Open
Abstract
The study’s purpose was to determine the incidence, risk factors, and outcomes of tractional macular detachment after anti-vascular endothelial growth factor (VEGF) pretreatment before vitrectomy for complicated proliferative diabetic retinopathy. Patients who underwent primary vitrectomy for complicated proliferative diabetic retinopathy, from January 2012 to 31 December 2018, were enrolled. Ophthalmic and pre-operative data were extracted from electronic record systems. All eyes with a valuable Optical Coherence Tomography (OCT)performed within 5 days before injection of anti-VEGF and on the day of vitrectomy were included. Multivariable logistic regression showed that significant risk factors for developing tractional macular detachment included days between anti-VEGF and vitrectomy (OR, 0.71 [95% CI 0.65–0.76]; p < 0.001), vitreous hemorrhage (OR, 0.23 [95% CI 0.11–0.49]; p < 0.001), and age (OR, 1.05 [95% CI 1.02–1.08]; p < 0.001). Decision-tree analysis showed that the stronger predictors of tractional macular detachment were the time between anti-VEGF injection and vitrectomy (p < 0.001). Secondary predictors were the presence of vitreous hemorrhage (p = 0.012) in eyes that underwent vitrectomy between 6 and 10 days after anti-VEGF injection and younger age (p = 0.031) in eyes that underwent vitrectomy 10 days after anti-VEGF injection. Tractional macular detachment occurs in 10% of eyes after anti-VEGF injection, the main risk factors being days between anti-VEGF injection and vitrectomy, vitreous hemorrhage, and age.
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Bandurska-Stankiewicz E, Wiatr D. Diabetic Blindness Significantly Reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration Targets Achieved. Eur J Ophthalmol 2018; 16:722-7. [PMID: 17061224 DOI: 10.1177/112067210601600510] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The authors’ aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved. Methods A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989–1994, 1995–1999, and 2000–2004. Results The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7–139.0) to 13.3/100,000 (3.8–24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5–2.2) to 0.1/100,000 (CI: −0.1–0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5–5.3) to 0.7/100,000 (CI: 0.1–1.2); p<0.001. Conclusions The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.
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Disoteo O, Grimaldi F, Papini E, Attanasio R, Tonutti L, Pellegrini MA, Guglielmi R, Borretta G. State-of-the-Art Review on Diabetes Care in Italy. Ann Glob Health 2018; 81:803-13. [PMID: 27108147 DOI: 10.1016/j.aogh.2015.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Diabetes is a significant health problem in Italy as in other western countries. OBJECTIVE To review available epidemiological data and the legislative framework for diabetes care in Italy. METHODS Review of Italian Health Ministry's official documents and analysis of epidemiological data published by Italian Scientific Societies. FINDINGS Diabetes affects more than 5% of the Italian population. The expenditures for the care of people with diabetes are about €10 billion ($US 11 billion) a year and are increasing over time. Italian law regulates the clinical care of people with diabetes and creates a clinical framework involving medical organizations, prevention programs, personnel training, and legal protection. The National Health Program is structured in essential levels of assistance that can be defined differently in the various regions. In 2013, the "National Diabetes Plan," defining priority areas for intervention, was approved and represents the main regulatory tool for the management of diabetes within the Italian National Health Service. In Italy, the status of diabetes care is being monitored using the data from 2 permanent observatories: the ARNO Observatory Diabetes and the Associazione Medici Diabetologi Annals. CONCLUSIONS A comprehensive approach to diabetes is offered to all citizens, consonant with the constitutionally guaranteed right to health. However, this important effort translates into a relevant financial burden for the National Health Service.
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Affiliation(s)
- Olga Disoteo
- Diabetology Department, Niguarda Hospital, Milan, Italy
| | - Franco Grimaldi
- Division of Endocrinology, Metabolic Diseases and Clinical Nutrition, University Hospital Santa Maria della Misericordia, Udine, Italy.
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale (Rome), Italy
| | | | - Laura Tonutti
- Division of Endocrinology, Metabolic Diseases and Clinical Nutrition, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Maria Antonietta Pellegrini
- Division of Endocrinology, Metabolic Diseases and Clinical Nutrition, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale (Rome), Italy
| | - Giorgio Borretta
- Division of Endocrinology and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
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Vujosevic S, Midena E. Diabetic Retinopathy in Italy: Epidemiology Data and Telemedicine Screening Programs. J Diabetes Res 2016; 2016:3627465. [PMID: 27990441 PMCID: PMC5136623 DOI: 10.1155/2016/3627465] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/26/2016] [Accepted: 10/30/2016] [Indexed: 11/18/2022] Open
Abstract
In Italy, the number of people living with diabetes is about 3.5 million (5.5% of the population), with an increase by about 60% in the last 20 years and with 1 person out of 3 older than 65 years. The Italian Health Service system estimates that 10 billion euros is spent annually on caring for patients with diabetes, a figure that increases yearly. No national data on prevalence and incidence of legal blindness in patients with diabetes and no national registry of patients with diabetic retinopathy (DR) are currently available. However, the available epidemiological data (in several locations throughout the country) are consistent with those reported in other European countries. The use of telemedicine for the screening of DR in Italy is confined to geographically limited locations. The available data in the literature on implementation and use of telematic screening proved to be successful from patient, caregiver, and authorities point of view. This review addresses the available epidemiological data on DR and telematic screening realities in Italy and thus may help in establishing a national screening program.
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Affiliation(s)
- Stela Vujosevic
- Department of Ophthalmology, University of Padova, Padova, Italy
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padova, Italy
- Fondazione G. B. Bietti, IRCCS, Roma, Italy
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Olafsdottir E, Andersson DKG, Dedorsson I, Svärdsudd K, Jansson SPO, Stefánsson E. Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy. Acta Ophthalmol 2016; 94:232-9. [PMID: 26855250 DOI: 10.1111/aos.12954] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 11/09/2015] [Indexed: 12/12/2022]
Abstract
PURPOSE To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. METHODS A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. RESULTS Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002). CONCLUSIONS Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.
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Affiliation(s)
- Eydis Olafsdottir
- Department of Ophthalmology; The National University Hospital; Reykjavik Iceland
- University of Iceland; Reykjavik Iceland
- Department of Ophthalmology; Orebro University Hospital; Orebro Sweden
| | - Dan K. G. Andersson
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Inger Dedorsson
- Department of Ophthalmology; Orebro University Hospital; Orebro Sweden
| | - Kurt Svärdsudd
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Stefan P. O. Jansson
- Family Medicine and Preventive Medicine Section; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Family Medicine Research Centre; Orebro County Council; School of Health and Medical Sciences; Orebro University; Sweden
| | - Einar Stefánsson
- Department of Ophthalmology; The National University Hospital; Reykjavik Iceland
- University of Iceland; Reykjavik Iceland
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What the radiologist needs to know about the diabetic patient. Insights Imaging 2012; 2:193-203. [PMID: 22347947 PMCID: PMC3259362 DOI: 10.1007/s13244-011-0068-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 11/16/2010] [Accepted: 01/13/2011] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is recognised as a major health problem. Ninety-nine percent of diabetics suffer from type 2 DM and 10% from type 1 and other types of DM. The number of diabetic patients worldwide is expected to reach 380 millions over the next 15 years. The duration of diabetes is an important factor in the pathogenesis of complications, but other factors frequently coexisting with type 2 DM, such as hypertension, obesity and dyslipidaemia, also contribute to the development of diabetic angiopathy. Microvascular complications include retinopathy, nephropathy and neuropathy. Macroangiopathy mainly affects coronary arteries, carotid arteries and arteries of the lower extremities. Eighty percent of deaths in the diabetic population result from cardiovascular incidents. DM is considered an equivalent of coronary heart disease (CHD). Stroke and peripheral artery disease (PAD) are other main manifestations of diabetic macroangiopathy. Diabetic cardiomyopathy (DC) represents another chronic complication that occurs independently of CHD and hypertension. The greater susceptibility of diabetic patients to infections completes the spectrum of the main consequences of DM. The serious complications of DM make it essential for physicians to be aware of the screening guidelines, allowing for earlier patient diagnosis and treatment.
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Genz J, Scheer M, Trautner C, Zöllner I, Giani G, Icks A. Reduced incidence of blindness in relation to diabetes mellitus in southern Germany? Diabet Med 2010; 27:1138-43. [PMID: 20854381 DOI: 10.1111/j.1464-5491.2010.03081.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS We estimated the incidence of blindness in the diabetic and non-diabetic population in 2008 and compared it with results from 1990-1998 in a neighbouring region. METHODS All newly registered blindness allowance recipients in 2008 were drawn up in a German region (population 4.5 million). We estimated sex-specific, age-specific and standardized incidence rates of blindness in the diabetic and the non-diabetic population and relative and attributable risks as a result of diabetes. A comparison to the data from 1990-1998 was performed using log-linear Poisson regression. RESULTS Four-hundred and sixty-eight cases were drawn up (63% female). One-hundred and twenty-two (26.1%) had diabetes. Blindness incidence rates (per 100, 000 person-years) standardized to the 2008 German population were: men 9.1 (95% confidence interval 7.8-10.5), women 9.9 (8.8-11.1); diabetic population: men 21.8 (11.6-31.9), women 19.7 (9.2-30.1); non-diabetic population: men 8.0 (6.6-9.5), women 9.1 (7.9-10.3). Relative risk of blindness, diabetic vs. non-diabetic population: men 2.7 (1.6-4.5), women 2.2 (1.3-3.8). Attributable risk among exposed: 63% in men, 54% in women. Population attributable risk: 12% in men, 8% in women. Incidences of blindness were significantly lower than in all years of the period 1990-1998 in both the diabetic and the non-diabetic population. CONCLUSIONS We found the incidence of blindness to be approximately 2.5-fold higher in the diabetic compared with the non-diabetic population. Fifty-eight per cent of the risk to become blind in diabetic individuals and 9% of the risk to become blind in the entire population were attributable to diabetes. The decrease of the blindness incidence observed during the 1990s may have continued.
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Affiliation(s)
- J Genz
- Institute of Biometrics and Epidemiology, German Diabetes Center at the Heinrich-Heine-University Düsseldorf, Leibniz-Center for Diabetes Research, Düsseldorf, Germany
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Arun CS, Al-Bermani A, Stannard K, Taylor R. Long-term impact of retinal screening on significant diabetes-related visual impairment in the working age population. Diabet Med 2009; 26:489-92. [PMID: 19646188 DOI: 10.1111/j.1464-5491.2009.02718.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Diabetic retinopathy has long been regarded as the commonest preventable cause of blindness in the working age population. The aim was to determine if consistent annual screening for treatable retinopathy decreased the incidence of new blindness. METHODS We collated the causes of blindness for a 5-year period between 2001 and 2005 for the 16- to 64-year age group in a district that had operated systematic retinal screening in diabetes since 1986. RESULTS Diabetic retinopathy was found to be the second commonest cause of blindness, with optic atrophy being the commonest cause in Newcastle District. This differs from national data showing diabetic retinopathy to be the commonest cause. Diabetic retinopathy was also the second commonest cause of partial sightedness registrations, with stroke being the commonest cause. Overall, stroke disease accounted for 16.2% and diabetic retinopathy for 15.4% of registrations. The annual incidence of blindness was 0.22 per 1000 with diabetes and of partial sightedness 0.43 per 1000 with diabetes. CONCLUSIONS In a district that has operated retinal screening since 1986, diabetic retinopathy was not the commonest cause of blindness in the working age population, consistent with an effect of systematic annual screening.
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Affiliation(s)
- C S Arun
- Diabetes Centre, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne NE4 6BE, UK
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Retinopatía diabética y ceguera en España. Epidemiología y prevención. ACTA ACUST UNITED AC 2008; 55:459-75. [DOI: 10.1016/s1575-0922(08)75843-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 07/30/2008] [Indexed: 01/12/2023]
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Vallance JH, Wilson PJ, Leese GP, McAlpine R, MacEwen CJ, Ellis JD. Diabetic retinopathy: more patients, less laser: a longitudinal population-based study in Tayside, Scotland. Diabetes Care 2008; 31:1126-31. [PMID: 18346993 DOI: 10.2337/dc07-1498] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aim to correlate the incidence of diabetic retinopathy and maculopathy requiring laser treatment with the control of risk factors in the diabetic population of Tayside, Scotland, for the years 2001-2006. RESEARCH DESIGN AND METHODS Retinal laser treatment, retinal screening, and diabetes care databases were linked for calendar years 2001-2006. Primary end points were the numbers of patients undergoing first or any laser treatment for diabetic retinopathy or maculopathy. Mean A1C and blood pressure and retinal screening rates were followed over the study period. RESULTS Over 6 years, the number of patients with diabetes in Tayside increased from 9,694 to 15,207 (57% increase). The number of patients receiving laser treatment decreased from 222 to 138 and first laser treatments decreased from 100 (1.03% of diabetic population) to 56 (0.37%). The number of patients with type 2 diabetes treated for maculopathy decreased from 180 in 2001 to 103 in 2006 (43% reduction, P = 0.03). Mean A1C decreased for type 1 and type 2 diabetic populations (P < 0.01) and a reduction in blood pressure was observed in type 2 diabetic patients (P < 0.01). The number of patients attending annual digital photographic retinopathy screening increased from 3,012 to 11,932. CONCLUSIONS Laser treatment for diabetic maculopathy in type 2 diabetic patients has decreased in Tayside over a six-year period, despite an increased prevalence of diabetes and increased screening effort. We propose that earlier identification of type 2 diabetes and improved risk factor control has reduced the incidence of maculopathy severe enough to require laser treatment.
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Affiliation(s)
- James H Vallance
- Department of Ophthalmology, Ninewells Hospital and Medical School, Dundee, UK
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Olafsdottir E, Andersson DK, Stefánsson E. Visual acuity in a population with regular screening for type 2 diabetes mellitus and eye disease. ACTA ACUST UNITED AC 2007; 85:40-5. [PMID: 17244208 DOI: 10.1111/j.1600-0420.2006.00753.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Regular screening for both diabetes mellitus and diabetic eye disease should be the gold standard in preventing diabetic blindness. In the community of Laxå, County of Orebro, Sweden, such screening has been carried out since 1983. We evaluate visual impairment and blindness in this population. METHODS All persons in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 276) participated in the study. An age- and gender-matched control group (n = 259) was assembled. Best corrected visual acuity (BCVA) was tested in all participants, and a detailed eye examination performed by an ophthalmologist. RESULTS No significant statistical differences were seen between the diabetes and control groups regarding visual acuity (VA). In all, 2.9% of the diabetes patients and 1.2% of the controls had BCVA < or = 0.1. Only one person in the diabetes group was blind as a result of diabetic retinopathy. In both groups the leading cause of blindness was age-related macular degeneration. In a logistic regression analysis we found that in both the diabetes and the control populations, increasing age was related to worsening BCVA (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.10-1.16 versus OR 1.16, 95% CI 1.13-1.19), as was female gender in the diabetes group only (OR 2.73, 95% CI 1.69-4.40). CONCLUSIONS In a population that is carefully screened for diabetes mellitus and provided with regular screening for diabetic retinopathy, the loss of vision from diabetic retinopathy is uncommon.
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Affiliation(s)
- Eydis Olafsdottir
- Department of Ophthalmology, National University Hospital, Reykjavik, Iceland.
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Cugati S, Kifley A, Mitchell P, Wang JJ. Temporal trends in the age-specific prevalence of diabetes and diabetic retinopathy in older persons: Population-based survey findings. Diabetes Res Clin Pract 2006; 74:301-8. [PMID: 16716443 DOI: 10.1016/j.diabres.2006.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 04/06/2006] [Indexed: 01/22/2023]
Abstract
PURPOSE To compare the age-specific prevalence of diabetes and diabetic retinopathy (DR) over 6 years. METHODS The Blue Mountains Eye Study (BMES) examined 3654 residents (82.4% response) aged >49 years in BMES I (1992-1994). Survivors (n = 2335) and newly eligible residents (n = 1174) were examined in BMES II (1997-2000). Diabetes was defined by history or fasting plasma glucose > or =7.0 mmol/L. DR was graded from 6-field retinal photographs using the Airlie House Classification. Age-specific prevalence in 5-year intervals was compared, as samples of each age group were independent. RESULTS The overall diabetes prevalence increased from 7.8 to 9.9% (p = 0.002) while the age-specific prevalence increased in age groups 60-74 years, over 6 years. A slightly higher prevalence of mild levels of DR (p = 0.018) but lower prevalence of moderate-severe levels of DR (p = 0.049) was evident in BMES II compared to BMES I. Factors significantly associated with DR prevalence were diabetes duration > or =20 years (BMES I, OR 7.6 [2.9-20.5]; BMES II, OR 6.1 [2.5-15.4]) and blood glucose level (BMES I, OR 1.1 [1.0-1.2]; BMES II, OR 1.2 [1.1-1.3] per mmol/L increase). CONCLUSIONS An increased prevalence of diabetes, but decreased prevalence of severe levels of DR, was documented in two survey samples from the same region over 6 years.
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Affiliation(s)
- Sudha Cugati
- Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Westmead Hospital, Hawkesbury Rd, Westmead, NSW 2145, Australia
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Williams R, Airey M, Baxter H, Forrester J, Kennedy-Martin T, Girach A. Epidemiology of diabetic retinopathy and macular oedema: a systematic review. Eye (Lond) 2004; 18:963-83. [PMID: 15232600 DOI: 10.1038/sj.eye.6701476] [Citation(s) in RCA: 304] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AIMS To systematically review the literature on the prevalence and incidence of diabetic retinopathy (DR) and macular oedema (MO). METHODS A search of the bibliographic databases (Medline, Embase, CINAHL) was conducted up to October 2001. Selected relevant studies were scrutinized and included in the review. RESULTS A total of 359 studies were included. The studies were reported in nearly 100 different journals and in over 50 countries. The majority of the studies were US-based, with large studies such as the Wisconsin Epidemiologic Study of Diabetic Retinopathy dominating the literature. The studies were quite dated and highly heterogeneous in nature in terms of patient selection with variable inclusion criteria (age range, gender, diabetes duration and type, ethnicity, comorbidity, and DR status, assessment, and classification). CONCLUSIONS There are inconsistencies between epidemiological studies, and differences in study methods may contribute to conflicting reports of prevalence and incidence of DR and MO in diabetic populations. As new therapies for DR and its associated complications emerge, the need to capture and monitor new epidemiological data becomes increasingly important to be able to assess the impact and effectiveness of these therapies. Robust, longitudinal capture of patient data is, therefore, essential to evaluate the impact of current practice on the epidemiology of diabetic eye complications.
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Affiliation(s)
- R Williams
- The Clinical School, University of Wales Swansea, Swansea, UK.
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Dosso AA, Rungger-Brändle E, Leuenberger PM. Ultrastructural alterations in capillaries of the diabetic hypertensive rat retina: protective effects of ACE inhibition. Diabetologia 2004; 47:1196-1201. [PMID: 15243702 DOI: 10.1007/s00125-004-1442-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 04/19/2004] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS The ACE inhibitor cilazapril was administered to diabetic hypertensive rats to evaluate its ability to influence the development of retinal capillary alterations. METHODS Normotensive (strain: Wistar Kyoto) and genetically hypertensive (strain: spontaneously hypertensive) rats were rendered diabetic by intravenous injections of streptozotocin. Half of the diabetic animals received cilazapril with their daily food. At 20 weeks of diabetes, endothelial cells, pericytes and extracellular matrix were assessed by ultrastructural morphometry. Each experimental group consisted of seven animals. RESULTS Cilazapril normalised systolic arterial pressure in diabetic hypertensive rats (137+/-2 mm Hg compared with 188+/-16 mm Hg in non-medicated diabetic hypertensive rats, p<0.001). The number of endothelial intercellular junctions was reduced in untreated diabetic hypertensive rats (0.15+/-0.05, p<0.02, vs 0.47+/-0.20 in non-diabetic normotensive rats). In diabetic hypertensive animals treated with cilazapril, this loss was attenuated (0.32+/-0.16, p<0.05). The significant thickening of the basement membrane observed in the diabetic normotensive (132.8+/-19.4 nm) and diabetic hypertensive (150.3+/-20.2 nm) groups was decreased by cilazapril in the diabetic hypertensive group (116.7+/-11.0 nm, p<0.01), but was unaffected in the normotensive (131.9+/-17.3 nm) group. No protective effect of the drug was observed in either group on pericytes. CONCLUSIONS/INTERPRETATION Long-term administration of an effective antihypertensive therapy normalises endothelial alterations and basement membrane thickness in diabetic hypertensive conditions, and thus may account for the well-known improvement of the blood-retinal barrier observed during antihypertensive treatment.
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Affiliation(s)
- A A Dosso
- Laboratory of Cell Biology, University Eye Clinic, Geneva, Switzerland.
- Clinique d'Ophtalmologie, Hôpital cantonal universitaire, 22, rue Alcide Jentzer, 1211, Genève 14, Switzerland.
| | - E Rungger-Brändle
- Laboratory of Cell Biology, University Eye Clinic, Geneva, Switzerland
| | - P M Leuenberger
- Laboratory of Cell Biology, University Eye Clinic, Geneva, Switzerland
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Kawasaki S, Ito S, Satoh S, Mori Y, Saito T, Fukushima H, Kato S, Sekihara H. Use of Telemedicine in Periodic Screening of Diabetic Retinopathy. Telemed J E Health 2003; 9:235-9. [PMID: 14611690 DOI: 10.1089/153056203322502614] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telemedicine was used for taking ocular fundus images of diabetic patients, which were subsequently sent by electronic mail to experienced ophthalmologists at a university hospital. The ophthalmologists provided reports on the patients to the internists. The objective of the study was to evaluate the effectiveness of this telemedicine system. A total of 279 diabetic patients were admitted to the Third Department of Internal Medicine of Yokohama City University Hospital, School of Medicine, for blood sugar control or for education on lifestyle between April, 1999, and October, 2000. The subjects did not have eye disease nor diabetic retinopathy when evaluated by an ophthalmologist (at either Yokohama City University Hospital or other facility) within 3 months before enrollment in the study. After dilation of the pupil, fundus images were taken of each eye from four angles using a nonmydriatic fundus camera. The images were transmitted by electronic mail to the Division of Ophthalmology of Tokyo University Branch Hospital along with other patient information. The ophthalmologists there evaluated the images on the screen according to Fukuda's classification of diabetic retinopathy. They sent ophthalmologic reports to the internists at the Third Department of Internal Medicine of Yokohama City University Hospital, School of Medicine, and recommended whether the patient should be seen by his/her regular ophthalmologist earlier than the next scheduled visit. Fundus images were obtained at the time of admission, at 1, 3, and 6 months after discharge, and at every 6 months thereafter. Out of the images of 1170 eyes obtained at various time points from the 279 patients, 1076 (92.0%) were successfully evaluated by the ophthalmologists at the University of Tokyo, while 60 (5.1%) could not be evaluated and there was a communication problem for the images of 34 eyes. The ophthalmologists determined that 5 eyes of 3 patients required further evaluation by the patient's regular ophthalmologist based on the images transferred by telemedicine. No patient dropped out during the study period.
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Affiliation(s)
- Satsuki Kawasaki
- Department of Internal Medicine, Yokohama City University School of Medicine, Yokohama 236-0004, Japan.
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Lövestam-Adrian M, Agardh CD, Torffvit O, Agardh E. Type 1 diabetes patients with severe non-proliferative retinopathy may benefit from panretinal photocoagulation. ACTA OPHTHALMOLOGICA SCANDINAVICA 2003; 81:221-5. [PMID: 12780397 DOI: 10.1034/j.1600-0420.2003.00050.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine whether panretinal photocoagulation for severe non-proliferative retinopathy in type 1 diabetes patients could halt the progression of retinopathy with subsequent vitreous haemorrhages and visual impairment. METHODS During a 10-year follow-up study period of 344 type 1 diabetes patients, 81 subjects went through panretinal photocoagulation. Forty patients were treated for severe non-proliferative retinopathy (age at onset of diabetes 14 +/- 8 years, diabetes duration 18 + 10 years) and 41 for proliferative retinopathy (age at onset 15 +/- 10 years, diabetes duration 22 + 13 years). One randomly selected eye per patient forms the basis for the study. Metabolic control, systolic and diastolic blood pressure, serum creatinine and urinary albumin levels were measured and analysed yearly during the follow-up period. RESULTS A total of 35% (14/40) of eyes treated for severe non-proliferative retinopathy developed neovascularizations during a mean time of 2.9 +/- 1.5 years. Vitreous haemorrhages were more frequent in eyes with proliferative retinopathy at treatment than in eyes with severe non-proliferative retinopathy (12/41 versus 2/40; p = 0.007). The number of vitrectomies due to vitreous haemorrhages in eyes treated for severe non-proliferative retinopathy tended to be lower (1/40 versus 6/41; p = 0.052). Before photocoagulation, visual acuity (VA) was similar in eyes with severe non-proliferative retinopathy and in those with proliferative retinopathy (1.0, 0.4-1.0 versus 1.0, 0.1-1.0; median and range). Visual impairment and blindness tended to develop more often in eyes treated for proliferative retinopathy compared to those treated for severe non-proliferative retinopathy (10/40 versus 4/40; p = 0.056). Eyes with neovascularizations at follow-up were more often visually impaired (VA < 0.5) than eyes without neovascularizations (15/55 versus 1/26; p = 0.016). CONCLUSION In type 1 diabetes, panretinal photocoagulation may be beneficial even at the severe non-proliferative retinopathy stage in terms of preventing vitreous haemorrhage, subsequent vitrectomy and visual impairment.
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Trento M, Bajardi M, Borgo E, Passera P, Maurino M, Gibbins R, Owens DR, Cavallo F, Porta M. Perceptions of diabetic retinopathy and screening procedures among diabetic people. Diabet Med 2002; 19:810-3. [PMID: 12358866 DOI: 10.1046/j.1464-5491.2002.00784.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To assess how diabetic patients perceive retinopathy, screening for sight-threatening lesions and their own role in preventing blindness. METHODS A questionnaire was administered to 258 consecutive patients after screening for retinopathy, according to the European Field Guide-Book procedure, in Turin (n = 130) and Wales (n = 128, W). All Welsh patients and 70 in Turin (T1) were on standard diabetes care at their clinic or general practitioner, whereas 60 in Turin (T2) were on permanent group education. RESULTS According to 65%, 84% and 100% of patients in W, T1 and T2, respectively, diabetes may damage the eyes. Retinopathy had been heard of by 48% (W), 67% (T1) and 100% (T2). In T2, 82% of patients could give a meaningful description of retinopathy but only 17% could use correctly the word 'retina'. In W and T1, 16% and 19% could describe retinopathy but none could describe the retina. In W and T1, 47% and 57% believed they could not help with eye care, whereas 78% in T2 replied that they should control diabetes and 20% that eyes should be checked regularly. Regarding reasons for screening, 100% of patients in T2 answered 'prevention and checks', against 61% in T1 and only 9% in W. In T1 and W, 33% and 37% did not know why they were being screened. CONCLUSIONS Patients' health perceptions and internal control mechanisms may be insufficiently developed for optimal participation in retinopathy screening. Diabetes care by long-term group education may address this problem.
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Affiliation(s)
- M Trento
- Centro Retinopatia Diabetica, Department of Internal Medicine, University of Turin, Turin, Italy.
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Hansson-Lundblad C, Holm K, Agardh CD, Agardh E. A small number of older type 2 diabetic patients end up visually impaired despite regular photographic screening and laser treatment for diabetic retinopathy. ACTA OPHTHALMOLOGICA SCANDINAVICA 2002; 80:310-5. [PMID: 12059872 DOI: 10.1034/j.1600-0420.2002.800315.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE The present study describes the prevalence of visual impairment and blindness in a geographically defined population 8 years after the introduction of a screening programme in 1987 for early detection of sight-threatening diabetic retinopathy. METHODS Of 374 patients with diabetes, comprising 2.6% of the population in the study community, 72% were examined with fundus photography or biomicroscopy during 1994-95. These patients form the basis of this study. The screening programme was fulfilled by 93% of subjects, all of whom underwent ophthalmic examinations at least every other year. A total of 79 eyes in 52 patients received photocoagulation for macular oedema alone or in combination with severe non-proliferative or proliferative retinopathy. RESULTS Eight years after the implementation of the programme, only three patients, all with type 2 diabetes (diabetes diagnosed at or after 30 years of age), had visual acuity < or = 0.1. The total number of eyes with visual acuity < or = 0.5 was higher in insulin-treated type 2 diabetic patients (n = 20) than in those on oral treatment (n = 5) or diet treatment only (n = 1) (p = 0.006 in both cases). The only independent risk factor for visual impairment in eyes with sight-threatening retinopathy was age. CONCLUSION A small number of older type 2 diabetic patients end up with visual impairment due to unsuccessful photocoagulation of macular oedema.
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Munier A, Gunning T, Kenny D, O'Keefe M. Causes of blindness in the adult population of the Republic of Ireland. Br J Ophthalmol 1998; 82:630-3. [PMID: 9797662 PMCID: PMC1722638 DOI: 10.1136/bjo.82.6.630] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Blindness in the developed countries affects 3.5 million people. This study was conducted on the causes of blindness in the Republic of Ireland based on the register of the National Council for the Blind of Ireland. The aim was to determine the prevalence of potentially avoidable blindness and to identify its causes. METHOD Criteria for registration as blind are in Ireland: best corrected visual acuity of 6/60 (0.1) or less in the better eye or a visual field restricted to 20 degrees or less. Data on 5002 adults 16 years an older registered as blind were analysed. The causes of blindness are classified in 17 diagnostic categories. RESULTS The leading causes of blindness are macular degeneration and glaucoma, each accounting for 16% (812 and 795). Cataract accounted for 11% (561), a third of these had an associated cause of blindness and one tenth had a cognitive deficit. Diabetic retinopathy ranked as the 11th cause of blindness and accounted for 3% (147). More than half of the patients were 65 years and older. CONCLUSION 25% of blindness was potentially avoidable. The treatable causes were glaucoma and diabetic retinopathy in the working population and glaucoma and cataract over 65 years of age. Glaucoma is the most important, which raises the question of a screening programme. The prevalence of blindness of 3% due to diabetic retinopathy is lower than in most other series.
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Affiliation(s)
- A Munier
- National Council for the Blind of Ireland, Dublin, Ireland
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