Learning ensemble classifiers for diabetic retinopathy assessment.

Diabetic retinopathy is one of the most common comorbidities of diabetes. Unfortunately, the recommended annual screening of the eye fundus of diabetic patients is too resource-consuming. Therefore, it is necessary to develop tools that may help doctors to determine the risk of each patient to attain this condition, so that patients with a low risk may be screened less frequently and the use of resources can be improved. This paper explores the use of two kinds of ensemble classifiers learned from data: fuzzy random forest and dominance-based rough set balanced rule ensemble. These classifiers use a small set of attributes which represent main risk factors to determine whether a patient is in risk of developing diabetic retinopathy. The levels of specificity and sensitivity obtained in the presented study are over 80%. This study is thus a first successful step towards the construction of a personalized decision support system that could help physicians in daily clinical practice.

Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up.

BACKGROUND: Prospective, population-based study of an 8-year follow up. To determine the direct cost of diabetic retinopathy [DR], evaluating our screening programme and the cost of treating DR, focusing on diabetic macular oedema [DMO] after anti-vascular endothelial growth factor [anti-VEGF] treatment. METHODS: A total of 15,396 diabetes mellitus [DM] patients were studied. We determined the cost-effectiveness of our screening programme against an annual programme by applying the Markov simulation model. We also compared the cost-effectiveness of anti-VEGF treatment to laser treatment for screened patients with DMO. RESULTS: The cost of our 2.5-year screening programme was as follows: per patient with any-DR, €482.85 ± 35.14; per sight-threatening diabetic retinopathy [STDR] patient, €1528.26 ± 114.94; and €1826.98 ± 108.26 per DMO patient. Comparatively, an annual screening programme would result in increases as follows: 0.77 in QALY per patient with any-DR and 0.6 and 0.44 per patient with STDR or DMO, respectively, with an incremental cost-effective ratio [ICER] of €1096.88 for any-DR, €4571.2 for STDR and €7443.28 per DMO patient. Regarding diagnosis and treatment, the mean annual total cost per patient with DMO was €777.09 ± 49.45 for the laser treated group and €7153.62 ± 212.15 for the anti-VEGF group, with a QALY gain of 0.21, the yearly mean cost was €7153.62 ± 212.15 per patient, and the ICER was €30,361. CONCLUSIONS: Screening for diabetic retinopathy every 2.5 years is cost-effective, but should be adjusted to a patient's personal risk factors. Treatment with anti-VEGF for DMO has increased costs, but the cost-utility increases to 0.21 QALY per patient.

Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population.

BACKGROUND/AIMS: To determine the changes in the incidence of diabetic retinopathy (DR), diabetic macular oedema (DMO) and their risk factors in a population-based study of patients with diabetes mellitus (DM) referred to our 16 Primary Health Care Areas (HCAs). METHODS: Prospective population-based study of a total of 15 396 Caucasian patients with DM, who represent 86.53% of the total patients with DM in our HCAs, were studied over an 8-year follow-up period. All patients were screened with a mean follow-up of 3.18±1.11 times for each patient over the 8 years. RESULTS: The yearly mean value of any DR was 8.37±2.19% (8.09%-8.99%); of advanced DR yearly mean value of 0.46±0.22% (0.03-0.78); and of DMO a yearly mean value of 2.19±0.18% (2%-2.49%). A clear increase was observed in the last 3 years, any DR increased from 8.09% in 2007 to 8.99% in 2014, and DMO from 2% in 2007 to 2.49% in 2014. These increases were more evident in some age groups. For patients with any DR aged 41-50 and 51-60 and for patients with advanced DR aged 41-50, 51-60 and 61-70, the increase was more marked, related to an increase in HbA1c values or to patients treated with insulin. CONCLUSIONS: An increase in the incidence of DR and DMO was observed, especially in the younger patients aged between 31 and 70 years. This is linked to bad metabolic control of DM. Our results suggest a greater number of ocular complications in the near future, such as neovascular glaucoma, if these current findings are not addressed.