Communications between intraretinal and subretinal space on optical coherence tomography of neurosensory retinal detachment in diabetic macular edema

The pathogenesis of development and progression of neurosensory retinal detachment [NSD] in diabetic macular edema [DME] is not yet fully understood. The purpose of this study is to describe the spectral domain optical coherence tomography [SD-OCT] morphological characteristics of NSD associated with DME in the form of outer retinal communications and to assess the correlation between the size of communications and various factors. This was an observational retrospective nonconsecutive case series in a tertiary care eye institute. We imaged NSD and outer retinal communications in 17 eyes of 16 patients having NSD associated with DME using SD-OCT. We measured manually the size of the outer openings of these communications and studied its correlation with various factors. Statistical analysis [correlation test] was performed using the Statistical Package for Social Sciences [SPSS] software [version 14.0]. The main outcome measures were correlation of the size of communications with dimensions of NSD, presence of subretinal hyper-reflective dots, and best-corrected visual acuity [BCVA]. The communications were seen as focal defects of the outer layers of elevated retina. With increasing size of communication, there was increase in height of NSD [r = 0.701, P = 0.002], horizontal diameter of NSD [r = 0.695, P = 0.002], and the number of hyper-reflective dots in the subretinal space [r = 0.729, P = 0.002]. The minimum angle of resolution [logMAR] BCVA increased with the increasing size of communications [r = 0.827, P< 0.0001]. Outer retinal communications between intra and subretinal space were noted in eyes having NSD associated with DME. The size of communications correlated positively with the size of NSD and subretinal detachment space hyper-reflective dots, and inversely with BCVA

Prevalence of visual impairment and associated risk factors in subjects with type II diabetes mellitus: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study [SN-DREAMS, report 16]

To report the prevalence of visual impairment [VI] and the associated risk factors in type II diabetic subjects. The study included type II diabetes mellitus subjects who were enrolled from a cross-sectional study. Participants underwent biochemical testing and comprehensive ocular examination including stereo fundus photography. The VI was defined based on the World Health Organization criteria. The prevalence of VI was 4% in the cohort. The risk factors associated with the presence of VI included a female gender, age greater than 60 years, low socio-economic status, hypertension, microalbuminuria, macroalbuminuria, neuropathy, use of insulin and alcohol. Various ocular risk factors are nuclear sclerosis, subjects who have undergone cataract surgery, myopia and sight-threatening diabetic retinopathy [STDR]. After adjusting for the factors using stepwise logistic regression analysis, hypertension, use of alcohol, post-cataract surgery and myopia were not risk factors. Stepwise logistic regression analysis indicated that VI was higher among subjects older than 60 years [odds ratio [OR]: 4.95 [2.67-9.15]] and those who belonged to a low socio-economic status [OR: 2.91 [1.24-6.85]]. The systemic risk factors for VI included microalbuminuria [OR: 2.91 [1.59-5.33]], macroalbuminuria [OR: 4.65 [1.57-13.77]] and presence of neuropathy [OR: 1.97 [1.09-3.59]] among subjects. Subjects with nuclear sclerosis [OR: 36.82 [11.12-112.36]] and presence of STDR [OR: 4.17 [1.54-11.29]] were at a higher risk of VI. Cataract was the most common cause of VI in the cohort. Visual impairment, among type II diabetic subjects [4%], is a major public health problem that needs to be addressed. Cataract is the most common reversible cause of vision impairment in this population

Prevalence of myopia and its association with diabetic retinopathy in subjects with type II diabetes mellitus: a population-based study

To report the prevalence of myopia and its association with diabetic retinopathy in subjects with type II diabetes mellitus and compare the diabetic retinopathy status in the myopic group vs the emmetropic group. Population-based study. The population-based study estimated the prevalence of myopia from 1058 subjects, who were more than 40 years old and had type II diabetes mellitus; the patients were enrolled from a cross-sectional study. Participants answered a detailed questionnaire and underwent biochemical, physical and comprehensive ocular examination which included grading of nuclear sclerosis by lens opacities classification system III [LOCS III], seven field fundus photography and ultrasonography. Diabetic retinopathy and diabetic maculopathy were graded using the Klein's classification and early treatment diabetic retinopathy study [ETDRS] criteria respectively. The prevalence of mild, moderate and high myopia in type 2 diabetes was 15.9, 2.1 and 1.9% respectively. The prevalence of any myopia was found to be 19.9% in our study population. After adjusting the age, gender, duration of diabetes, hemoglobin A1c and other factors, increasing age was associated with mild and moderate myopia [OR 1.11 [95% CI 1.05 - 1.18]]. Compared to emmetropia, complete posterior vitreous detachment [CPVD] was associated with high myopia [50% Vs 12.2%, P < 0.0001]. Myopia had no association with diabetic retinopathy. The prevalence of myopia and high myopia was found to be 19.9 and 1.9% respectively among subjects with type II diabetes. Myopia was not associated with diabetic retinopathy, thereby, suggesting the need for a longitudinal study

Effect of Illumination on Colour Vision Testing with Farnsworth-Munsell 100 Hue Test: Customized Colour Vision Booth versus Room Illumination

PURPOSE: To evaluate a customized, portable Farnsworth-Munsell 100 (FM 100) hue viewing booth for compliance with colour vision testing standards and to compare it with room illumination in subjects with normal colour vision (trichromats), subjects with acquired colour vision defects (secondary to diabetes mellitus), and subjects with congenital colour vision defects (dichromats). METHODS: Discrete wavelengths of the tube in the customized booth were measured using a spectrometer using the normal incident method and were compared with the spectral distribution of sunlight. Forty-eight subjects were recruited for the study and were divided into 3 groups: Group 1, Normal Trichromats (30 eyes); Group 2, Congenital Colour Vision Defects (16 eyes); and Group 3, Diabetes Mellitus (20 eyes). The FM 100 hue test performance was compared using two illumination conditions, booth illumination and room illumination. RESULTS: Total error scores of the classical method in Group 2 as mean+/-SD for room and booth illumination was 243.05+/-85.96 and 149.85+/-54.50 respectively (p=0.0001). Group 2 demonstrated lesser correlation (r=0.50, 0.55), lesser reliability (Cronbach's alpha, 0.625, 0.662) and greater variability (Bland & Altman value, 10.5) in total error scores for the classical method and the moment of inertia method between the two illumination conditions when compared to the other two groups. CONCLUSIONS: The customized booth demonstrated illumination meeting CIE standards. The total error scores were overestimated by the classical and moment of inertia methods in all groups for room illumination compared with booth illumination, however overestimation was more significant in the diabetes group.