Early diabetic eye damage: Comparing detection methods using diagnostic power.

It is now clear that retinal neuropathy precedes classical microvascular retinopathy in diabetes. Therefore, tests that underpin useful new endpoints must provide high diagnostic power well before the onset of moderate diabetic retinopathy. Hence, we compare detection methods of early diabetic eye damage. We reviewed data from a range of functional and structural studies of early diabetic eye disease and computed standardized effect size as a measure of diagnostic power, allowing the studies to be compared quantitatively. We then derived minimum performance criteria for tests to provide useful clinical endpoints. This included the criteria that tests should be rapid and easy so that children with type 1 diabetes can be followed into adulthood with the same tests. We also defined attributes that lend test data to further improve performance using Machine/Deep Learning. Data from a new form of objective perimetry suggested that the criteria are achievable.

Analysis of retinal and choroidal characteristics in patients with early diabetic retinopathy using WSS-OCTA.

Introduction: Diabetic retinopathy (DR) is one of the most common and destructive microvascular complications of DM, and has become a major cause of irreversible visual impairment. The purpose of this study was to evaluate the changes in fundus microcirculation in non-diabetic retinopathy (NDR) and mild non-proliferative diabetic retinopathy (NPDR) in patients with type 2 diabetic mellitus (T2DM) using widefield swept-source optical coherence tomography angiography (WSSOCTA), and to investigate the correlation with laboratory indices of T2DM. Methods: Eighty nine, 58 and 28 eyes were included in the NDR, NPDR and Control groups, respectively, were enrolled in this study. The 12mm×12mm fundus images obtained by WSS-OCTA were divided into 9 regions (supratemporal, ST; temporal, T; inferotemporal, IT; superior, S; central macular area, C; inferior, I; supranasal, SN; nasal, N; inferonasal, IN) to evaluate changes in vessel density (VD) of the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and mid-large choroidal vessel (MLCV), as well as changes in inner retinal thickness (IRT), outer retinal thickness (ORT), and choroidal thickness (CT). Results: Compared with control group, MLCV VD (I, N, IN) was significantly decreased in NDR group, SCP VD (IT, C, I) and DCP VD (T, IT, I) were significantly decreased in NPDR group. In NPDR group, DCP VD (IT) was significantly decreased compared with that in NDR group. Compared with control group, CT (ST, T, IT, S, SN, IN) was significantly declined in NDR group, and IRT (ST, IT) and ORT (ST, N) were significantly increased in NPDR group. In NPDR group, IRT (ST) and ORT (T, S) were significantly increased compared with NDR group. Correlation analysis showed that age, body mass index, fasting blood glucose, fasting insulin, fasting C-peptide, and estimated glomerular filtration rate in T2DM patients were statistically correlated with retinal and choroidal thickness/VD. Discussion: Structural and blood flow changes in the choroid occur before the onset of DR and precede changes in the retinal microcirculation, and MLCV thickness/VD is a more sensitive imaging biomarker for the clinical detection of DR. WSS-OCTA enables large-scale non-invasive visual screening and follow-up of the retinal and choroidal vasculature in DR patients, providing a new strategy for the prevention and monitoring of DR in patients with T2DM.

Early diagnosis of retinal neurovascular injury in diabetic patients without retinopathy by quantitative analysis of OCT and OCTA.

AIMS: To quantitatively analyze and compare the differences in retinal neurovascular units (NVUs) between healthy individuals and patients with type 2 diabetes mellitus (DM) by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) techniques and to determine the value of this technique for the early diagnosis of retinal neurovascular damage in patients with diabetes mellitus without retinopathy (NDR). METHODS: This observational case‒control study was conducted from July 1, 2022, to November 30, 2022, at the outpatient ophthalmology clinic of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine. All subjects underwent baseline data entry and mean thickness of the peripapillary retinal nerve fiber layer (pRNFL), the thickness of each retinal layer in the macula 3 × 3 mm, and vascular density (VD) examination. RESULTS: The study included 35 healthy individuals and 48 patients with DM. The retinal VD as well as partial pRNFL, macular nerve fiber layer (NFL), and macular ganglion cell layer (GCL) thickness in DM patients exhibited significantly lower VD in the DM group than in the control group (p < 0.05). Age and disease duration of DM patients showed a negative trend with pRNFL thickness, macular NFL thickness, macular GCL thickness, and VD. However, a positive trend was observed between DM duration and partial inner nuclear layer (INL) thickness. Moreover, there was a positive correlation between macular NFL and GCL thickness and VD for the most part, while a negative correlation was shown between INL temporal thickness and DVC-VD. pRNFL-TI and GCL-superior thickness were screened as two variables in the analysis of the predictors of retinal damage in DM according to the presence or absence of DM. The AUCs were 0.765 and 0.673, respectively. By combining the two indicators for diagnosis, the model predicted prognosis with an AUC of 0.831. In the analysis of retinal damage indicators associated with the duration of DM, after regression logistic analysis according to the duration of DM within 5 years and more than 5 years, the model incorporated two indicators, DVC-VD and pRNFL-N thickness, and the AUCs were 0.764 and 0.852, respectively. Combining the two indicators for diagnosis, the AUC reached 0.925. CONCLUSIONS: Retinal NVU may have been compromised in patients with DM without retinopathy. Basic clinical information and rapid noninvasive OCT and OCTA techniques are useful for the quantitative assessment of retinal NVU prognosis in patients with DM without retinopathy.

Early diabetic retinopathy diagnosis based on local retinal blood vessel analysis in optical coherence tomography angiography (OCTA) images.

PURPOSE: This paper introduces a new computer-aided diagnosis (CAD) system for detecting early-stage diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA) images. METHODS: The proposed DR-CAD system is based on the analysis of new local features that describe both the appearance and retinal structure in OCTA images. It starts with a new segmentation approach that has the ability to extract the blood vessels from superficial and deep retinal OCTA maps. The high capability of our segmentation approach stems from using a joint Markov-Gibbs random field stochastic model integrating a 3D spatial statistical model with a first-order appearance model of the blood vessels. Following the segmentation step, three new local features are estimated from the segmented vessels and the foveal avascular zone (FAZ): (a) vessels density, (b) blood vessel calibre, and (c) width of the FAZ. To distinguish mild DR patients from normal cases, the estimated three features are used to train and test a support vector machine (SVM) classifier with the radial basis function (RBF) kernel. RESULTS: On a cohort of 105 subjects, the presented DR-CAD system demonstrated an overall accuracy (ACC) of 94.3%, a sensitivity of 97.9%, a specificity of 87.0%, the area under the curve (AUC) of 92.4%, and a Dice similarity coefficient (DSC) of 95.8%. This in turn demonstrates the promise of the proposed CAD system as a supplemental tool for early detection of DR. CONCLUSION: We developed a new DR-CAD system that is capable of diagnosing DR in its early stage. The proposed system is based on extracting three different features from the segmented OCTA images, which reflect the changes in the retinal vasculature network.

Detection of serum cytokines in patients with early diabetic retinopathy / 上海第二医科大学学报

Objective To determine serum cytokine profiles and levels in patients with early diabetic retinopathy(DR)by using antibody array technology and analyze their clinical significances.Methods Among 32 patients with type 2 diabetes mellitus,16 patients with mild to moderate non-proliferative DR were as DR group;and 16 patients without retinopathy,as diabetic control group.Eight healthy subjects were selected as normal control group.The profiles of 42 cytokines were detected by human cytokines antibody array(Raybiotech).Results Compared with diabetic control group,in DR group,levels of epithelial neutrophil-activating peptide-78(ENA-78),growth related gene(GRO),regulated upon activation normal T cell expressed and secreted(RANTES),angiogenin,vascular endothelial growth factor(VEGF)and platelet-derived growth factor(PDGF)increased significantly(P