RETIDIAB®: assessment of a continuing medical education website for the improvement of diabetic retinopathy management.

AIM: The aim of this study was to evaluate the efficacy of a continuing medical education (CME) website to improve ophthalmological management of diabetic retinopathy (DR). METHODS: A worldwide website called RETIDIAB® was created in which, to log on for first time, users had to take a preliminary test to evaluate their baseline level of knowledge. This allowed them free access to the entire website at any time with no time obligation. The website comprised a course of theoretical concepts and different types of training, including multiple-choice questionnaires (MCQ) focused on the course content, interpretation of diabetic fundus photographs and case reports. After perusing the entire RETIDIAB® website, users could take a second assessment test. Finally, they were asked to fill in a questionnaire evaluating the entire programme. RESULTS: A total of 137 users were registered and, of these, 109 took only the preliminary test, while 28 took the second test and evaluated the entire website; of the latter, 75% were residents and 25% were practising physicians, and 15 were male and 13 were female, ranging in age from 26 to 42 (30.2 ± 3) years. Statistically significant progress was seen between the first and second evaluations (37.3 ± 14% correct answers vs 64 ± 10%, respectively), and the average time interval between the first and second evaluations was 40 ± 20 days. In addition, users expressed a high level of overall satisfaction with the site. CONCLUSION: This pilot study demonstrated the value and effectiveness of RETIDIAB®, a new CME website exclusively devoted to DR management.

[Diabetic retinopathy in children and adolescents]. / La rétinopathie diabétique du sujet jeune: l'enfant et l'adolescent.

Diabetic retinopathy rarely occurs before puberty and is never proliferative in prepubescent children. On the opposite, puberty and adolescence are high-risk periods for diabetic retinopathy progression, and call for strict ophthalmologic monitoring. The period between 16 and 18 years of age is particularly critical. Progression towards florid diabetic retinopathy is to be especially feared and should be prevented in the course of adolescence, as this form can be severe and can lead to blindness. Risk factors are probably many, including diabetes duration, difficulties in achieving glycemic control due to increase in insulin requirements, low compliance to treatment, and hormonal changes related to puberty (abnormalities of the growth hormone (GH)/insulin-like growth factor-I (IGF-1) axis). Systematical diabetic retinopathy screening should be performed in adolescents, notably by non-mydriatic fundus photographs. Furthermore, the anticipation of the switch from pediatric to adult structures, together with the careful information and education of parents and children may improve visual prognosis of young diabetic patients, whose life expectancy is high.

Evaluation of a new non-mydriatic digital camera for detection of diabetic retinopathy.

AIMS: To compare the results of fundus photography using a new non-mydriatic digital camera with the results of reference standard of Early Treatment Diabetic Retinopathy Study (ETDRS) retinal photographs, for the detection of diabetic retinopathy (DR). METHODS: Fundus colour photographs were taken with a Topcon non-mydriatic camera of 147 eyes of 74 diabetic patients, without pupillary dilation (five overlapping fields of 45 degrees; posterior pole, nasal, temporal, superior and inferior). Three retinal specialists classified the photographs in a masked fashion, as showing no DR or mild non-proliferative DR (NPDR) not requiring referral, moderate or more severe NPDR and/or macular oedema, or as non-gradable image requiring referral. ETDRS 35-mm colour slides served as reference images for DR detection. RESULTS: For moderately severe to severe DR, the sensitivities of detection reported by the three observers were 92, 100 and 92%, respectively, and the specificities, 87, 85, and 88%. For four levels of DR severity (none or mild NPDR, moderate NPDR, severe NPDR and proliferative DR), the percentages of exact agreement between the three observers on the retinopathy grades assigned to the non-mydriatic photographs and to the ETDRS reference slides were 94.6, 93 and 87.6%, respectively (kappa 0.60-0.80). Sixteen eyes of nine patients (11%) were judged ungradable by at least one observer. In a second series of 110 patients, evaluated in the setting of a screening procedure, fewer photographs were ungradable (< 6%). CONCLUSION: These results suggest that fundus photographs taken by the Topcon TRC-NW6S non-mydriatic camera, without pupillary dilation, are suitable for DR screening.

[Management of diabetic complications during pregnancy using diabetic retinopathy as an example]. / Prise en charge des complications du diabète au cours de la grossesse exemple de la rétinopathie diabétique.

Pregnancy may adversely affect the natural course of diabetic retinopathy (DR). Reported rates of new cases or progression of DR during pregnancy range from 10% to 70%. Regression of some of the nonproliferative vascular changes have been reported after delivery. Several risk factors contribute to the aggravation of DR, such as pregnancy itself, duration of the diabetes, elevated glycohemoglobin level, degree of retinopathy at the beginning of the pregnancy, rapid normalization of blood glucose level. The mechanisms by which pregnancy may alter the course of DR is not elucidated: worsening of DR may be due to modifications of retinal blood flow, or to increase in circulating growth factors levels. Careful ophthalmologic monitoring during pregnancy is required. Fundus examination should be performed before pregnancy or at the beginning of it. In patients with no retinopathy, fundus examination should be performed every three months. In those with diabetic retinopathy, fundus examination should be repeated every month. In eyes with proliferative DR or severe nonproliferative DR before pregnancy or at its beginning, laser photocoagulation should be performed promptly.

[Bilateral macular pseudocoloboma associated with chronic renal insufficiency in two sisters]. / Pseudocolobome maculaire bilatéral associé à une insuffisance rénale chronique chez deux soeurs.

We report Meier's syndrome in two sisters, with combined macular pseudocoloboma and end-stage renal failure. The two sisters, aged 12 and 17 years, presented with a bilateral macular coloboma and slight myopic shift reducing visual acuity to 20/60 in one sibling and 20/100 in the other sibling. No other ocular abnormalities were present. The electroretinograms were normal. In both patients renal grafts were performed with good results. The mother and the 4 other siblings were unaffected. This observation underlines the need to check kidney function in case of bilateral pseudocoloboma.