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Diabetic Retinopathy Pictures

Diabetic Retinopathy

Diabetic Retinopathy

What is Diabetic Retinopathy? Diabetic Retinopathy is a chronic and progressive disease of the retinal microvasculature as a result of complication from Diabetes. It is a common complication and manifestation of prolonged diabetes or for those patients suffering from Diabetes for more than 10 years. Diabetic retinopathy is characterized by damage in the blood vessel of the retina or the light sensitive tissue found at the rear of the eye. It is regarded as the leading cause of blindness among people 27 to 74 years of age and is commonly associated with diabetes type 1 and type 2. Patients suffering from long-term diabetes are especially at high risk for diabetic retinopathy. In type 1 diabetes the onset of diabetic retina is mild and is usually recognized in the 7th year on the average from the onset of diabetes. Type 2 diabetes is the more common type of diabetes where the onset is rather gradual in which the retinal changes may have taken place right before the diagnosis of diabetes. Diabetes is a metabolic disease described with high levels of blood glucose as a consequence of the inability of the pancreas to produce sufficient amount of insulin in the body or as a result of dysfunction of the pancreas. This metabolic disease is divided into two main types known as diabetes mellitus type 1 and diabetes type 2. Type 1 of diabetes mellitus is also known as juvenile onset diabetes and formerly known as insulin dependent diabetes. It is an autoimmune disease where the pancreas is mistakenly being attacked by the autoimmunity itself leading the pancreas to the inability to produce insulin. Type 2 diabetes on the other hand is known as adult onset diabetes mellitus or the non-insulin dependent diabetes. This type of diabetes is characterized by an overproduction of insulin Continue reading >>

Retinopathy

Retinopathy

Definition Retinopathy is a noninflammatory disease of the retina. There are many causes and types of retinopathy. Description The retina is the thin membrane that lines the back of the eye and contains light-sensitive cells (photoreceptors). Light enters the eye and is focused onto the retina. The photoreceptors send a message to the brain via the optic nerve. The brain then interprets the electrical message sent to it, resulting in vision. The macula is a specific area of the retina responsible for central vision. The fovea is about 1.5 mm in size and is located in the macula. The fovea is responsible for sharp vision. When looking at something, the fovea should be directed at the object. Retinopathy, or damage to the retina, has various causes. A hardening or thickening of the retinal arteries is called arteriosclerotic retinopathy. High blood pressure in the arteries of the body can damage the retinal arteries and is called hypertensive retinopathy. Diabetes damages the retinal vessels resulting in a condition called diabetic retinopathy. Sickle cell anemia also affects the blood vessels in the retina. Exposure to the sun (or looking at the sun during an eclipse) can cause damage (solar retinopathy), as well as certain drugs (for example, chloroquine, thioridazine, and large doses of tamoxifen). The arteries and veins can become blocked, resulting in a retinal artery or vein occlusion. These are just some of the causes of the various retinopathies. Retinopathies are divided into two broad categories: simple or nonproliferative retinopathies and proliferative retinopathies. The simple retinopathies include the defects identified by bulging of the vessel walls, bleeding into the eye, small clumps of dead retinal cells called cotton wool exudates, and closed vessels. T Continue reading >>

Diabetic Retinopathy: Classification And Clinical Features

Diabetic Retinopathy: Classification And Clinical Features

INTRODUCTION Diabetic retinopathy (DR) is one of the most important causes of visual loss worldwide and is the principal cause of impaired vision in patients between 25 and 74 years of age. Visual loss from DR may be secondary to macular edema (ME; retinal thickening and edema involving the macula), hemorrhage from new vessels, retinal detachment, or neovascular glaucoma. The vast majority of patients who develop DR have no symptoms until the very late stages. Because the rate of progression may be rapid and therapy can be beneficial for both symptom amelioration and reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease. The classification, clinical features, and natural history of DR will be reviewed here. The pathogenesis, screening, and treatment of DR are discussed elsewhere (see "Diabetic retinopathy: Pathogenesis" and "Diabetic retinopathy: Screening" and "Diabetic retinopathy: Prevention and treatment"). Cataracts associated with diabetes are also a major cause of visual impairment, especially in type 2 diabetes. Cataracts are reviewed separately. (See "Cataract in adults".) CLASSIFICATION DR is divided into two major forms: nonproliferative and proliferative, named for the absence or presence of abnormal new blood vessels emanating from the retina. DR can be further classified by severity (table 1 and picture 1 and picture 2). These stratifications have been useful for analysis of treatment efficacy in the literature and general indicators for treatment strategies. However, each patient with DR has a unique combination of findings, symptoms, and rate of progression, which necessarily requires an individualized approach to treatment in the effort to preserve vision. Nonproli Continue reading >>

Deep Learning For Detection Of Diabetic Eye Disease

Deep Learning For Detection Of Diabetic Eye Disease

Posted by Lily Peng MD PhD, Product Manager and Varun Gulshan PhD, Research Engineer Diabetic retinopathy (DR) is the fastest growing cause of blindness, with nearly 415 million diabetic patients at risk worldwide. If caught early, the disease can be treated; if not, it can lead to irreversible blindness. Unfortunately, medical specialists capable of detecting the disease are not available in many parts of the world where diabetes is prevalent. We believe that Machine Learning can help doctors identify patients in need, particularly among underserved populations. A few years ago, several of us began wondering if there was a way Google technologies could improve the DR screening process, specifically by taking advantage of recent advances in Machine Learning and Computer Vision. In "Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs", published today in JAMA, we present a deep learning algorithm capable of interpreting signs of DR in retinal photographs, potentially helping doctors screen more patients in settings with limited resources. One of the most common ways to detect diabetic eye disease is to have a specialist examine pictures of the back of the eye (Figure 1) and rate them for disease presence and severity. Severity is determined by the type of lesions present (e.g. microaneurysms, hemorrhages, hard exudates, etc), which are indicative of bleeding and fluid leakage in the eye. Interpreting these photographs requires specialized training, and in many regions of the world there aren’t enough qualified graders to screen everyone who is at risk. Working closely with doctors both in India and the US, we created a development dataset of 128,000 images which were each evaluated by 3-7 ophthalmo Continue reading >>

Oct Angiography Provides Vivid Pictures Of Nonproliferative Diabetic Retinopathy Severity

Oct Angiography Provides Vivid Pictures Of Nonproliferative Diabetic Retinopathy Severity

Test all patients for evidence of current or prior hepatitis B virus (HBV) infection before initiating treatment with HARVONI or EPCLUSA. HBV reactivation has been reported in HCV/HBV coinfected patients who were undergoing or had completed treatment with HCV direct acting antivirals (DAAs) and were not receiving HBV antiviral therapy. Some cases have resulted in fulminant hepatitis, hepatic failure, and death. Cases have been reported in patients who are HBsAg positive, in patients with serologic evidence of resolved HBV, and also in patients receiving certain immunosuppressant or chemotherapeutic agents; the risk of HBV reactivation associated with treatment with HCV DAAs may be increased in patients taking these other agents. Monitor HCV/HBV coinfected patients for hepatitis flare or HBV reactivation during HCV treatment and post-treatment follow-up. Initiate appropriate patient management for HBV infection as clinically indicated. If HARVONI or EPCLUSA is used in combination with ribavirin (RBV), all contraindications, warnings and precautions, in particular pregnancy avoidance, and adverse reactions to RBV also apply. Refer to RBV prescribing information. Serious Symptomatic Bradycardia When Coadministered with Amiodarone: Amiodarone is not recommended for use with HARVONI or EPCLUSA due to the risk of symptomatic bradycardia, particularly in patients also taking beta blockers or with underlying cardiac comorbidities and/or with advanced liver disease. A fatal cardiac arrest was reported in a patient taking amiodarone who was coadministered a sofosbuvir containing regimen. In patients without alternative, viable treatment options, cardiac monitoring is recommended. Patients should seek immediate medical evaluation if they develop signs or symptoms of bradycardia. R Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

- Did you know that diabetes is the most common cause of blindness in individuals from the ages of 25 to 65? And blindness can be caused by multiple different complications associated with diabetes including glaucoma and cataracts, however in this tutorial, let's discuss the most common cause of blindness due to diabetes which is a condition known as diabetic retinopathy. And if we break down the term, we can receive generally, an understanding of what this disease is, so you have retino here meaning the retina, and pathy meaning disease. So, diabetic retinopathy is a disease of the retina that's caused by diabetes. And to describe what the retina is, let's bring in a diagram of the eye and go through some of the structures as it will help us as we learn more about this condition. Over here on the left, we have a cross-section of the eye and there's a few important structures to note. So this is the front of the eye here, and this is the back of the eye, and this part right here is known as the cornea. And it is where light initially passes through as it goes through the eye, and then it hits this structure right here, which is known as the lens. And the lens focuses the light on this structure in the back of the eye, this kind of brownish structure, and this is the retina. And then exiting the back of the eye here, this is the optic nerve. Then, you can also see all of these blood vessels that are traveling through the retina and then exit the back of the eye in the middle of the optic nerve. So if you look over here on the right, this is a front view of the eye. So this is kind of what it looks like when a doctor looks in to your eye. So here, right here we have what's called the optic disc, and the optic disc is really just the convergence of the retina and where it Continue reading >>

Diabetic Retinopathy Clinical Presentation

Diabetic Retinopathy Clinical Presentation

In the initial stages of diabetic retinopathy, patients are generally asymptomatic; in the more advanced stages of the disease, however, patients may experience symptoms that include floaters, blurred vision, distortion, and progressive visual acuity loss. Continue reading >>

Detecting Diabetic Retinopathy In Eye Images

Detecting Diabetic Retinopathy In Eye Images

The past almost four months I have been competing in a Kaggle competition about diabetic retinopathy grading based on high-resolution eye images. In this post I try to reconstruct my progression through the competition; the challenges I had, the things I tried, what worked and what didn’t. This is not meant as a complete documentation but, nevertheless, some more concrete examples can be found at the end and certainly in the code. In the end I finished fifth of the almost 700 competing teams. Update 02/08/2015: Code and models (with parameters) added. Introduction Introduction Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population of the developed world and is estimated to affect over 93 million people. (From the competition description where some more background information can be found.) The grading process consists of recognising very fine details, such as microaneurysms, to some bigger features, such as exudates, and sometimes their position relative to each other on images of the eye. (This is not an exhaustive list, you can look at, for example, the long list of criteria used in the UK to grade DR (pdf).) Some annotated examples from the literature to get an idea of what this really looks like (the medical details/terminology are not very important for the rest of this post): Example of non-proliferative diabetic retinopathy (NPDR): Thin arrows: hard exudates; Thick arrow: blot intra-retinal hemorrhage; Triangle: microaneurysm. (Click on image for source.) Now let’s look at it as someone who simply wants to try to model this problem. You have 35126 images in the training set that look like this annotated by a patient id and “left” or “right” (each patient has two images, one per eye) and divided into 5 fairly unbalanc Continue reading >>

Picture Review Of Diabetic Retinopathy

Picture Review Of Diabetic Retinopathy

Unfortunately, Americans are being diagnosed with diabetes at record rates, which means that eye examinations mean a lot more than just screening for glasses. I am often asked what diabetic changes in the eye look like, so below are a few pictures of some of my most advanced diabetic changes. An eye exam is a crucial part of your diabetic care because the eye is the only part of the body where blood vessels can be seen. If you have bleeding from damaged blood vessels in your eye, there are likely changes going on throughout your body. I always send a letter to my patient's primary care doctors when they have been diagnosed with diabetes, reporting any ocular findings. If we all work together (patients, and all doctors!) we can help prevent severe damage from occurring! Diabetic retinal (internal eye) findings can be as mild as a small spot of blood, which may just require yearly examination. The three pictures below are actual patients where things have gotten a lot more advanced. This photo shows bleeding or hemorrhaging throughout the retina, but you also see exudate which is the yellow changes you see above the central vision spot (the macula). Exudate is evidence of swelling, which means that the blood vessels have been actively leaking in the area. This patient's central vision was reduced because the swelling was so close to her macula. She was seen by an ophthalmologist, who is monitoring closely for resolution. The 2 photos above are from the same patient who has even more advanced damage. At the bottom of both photographs you can see small, "squiggly" spider-web like blood vessels. I know these pictures might not appear as severe as the first, but these new blood vessels (or neovascularization) are evidence of advanced changes. These lacy and thin blood vessels Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy (pronounced ret in OP uh thee) is a complication of diabetes that causes damage to the blood vessels of the retina— the light-sensitive tissue that lines the back part of the eye, allowing you to see fine detail. Diabetic retinopathy is the most common cause of irreversible blindness in working-age Americans. As many people with type 1 diabetes suffer blindness as those with the more common type 2 disease. Diabetic retinopathy occurs in more than half of the people who develop diabetes. Video: Vision Treatment Breakthrough: People With Diabetic Eye Disease Have a New Option That Could Preserve or Improve Their Vision Symptoms It is possible to have diabetic retinopathy for a long time without noticing symptoms until substantial damage has occurred. Symptoms of diabetic retinopathy may occur in one or both eyes. Symptoms may include: Blurred or double vision Difficulty reading The appearance of spots— commonly called “floaters”— in your vision A shadow across the field of vision Eye pain or pressure Difficulty with color perception Causes The primary cause of diabetic retinopathy is diabetes—a condition in which the levels of glucose (sugar) in the blood are too high. Elevated sugar levels from diabetes can damage the small blood vessels that nourish the retina and may, in some cases, block them completely. When damaged blood vessels leak fluid into the retina it results in a condition known as diabetic macular edema which causes swelling in the center part of the eye (macula) that provides the sharp vision needed for reading and recognizing faces. Prolonged damage to the small blood vessels in the retina results in poor circulation to the retina and macula prompting the development of growth factors that cause new abnormal blood vessels Continue reading >>

What Is Proliferative Retinopathy?

What Is Proliferative Retinopathy?

Enlarge side view: in proliferative retinopathy 'new blood vessels' grow on the surface of the retina and can bleed. In this condition very small blood vessels grow from the surface of the retina. The retina is the film at the back of your eye , and the tiny blood vessels are capillaries. These growing blood vessels are very delicate and bleed easily. Without laser treatment, the bleeding causes scar tissue that starts to shrink and pull the retina off, and the eye becomes blind. Laser treatment prevents blindness, but often some vision is lost. If you have had diabetes for years your retinae may develop this condition. As the retina is damaged by diabetes, the diseased retina releases special growth chemicals. These chemicals make tiny blood vessels grow: these are called 'new blood vessels'. See Animation, case with obvious new vessels, photo , photo Some details The new vessel growth in diabetes only occurs in the retina, nowhere else in the body. When a retina becomes damaged by a higher than normal sugar, over many years, it seems to release special growth hormones. VEGF is one of the main growth hormones; VEGF stands for Vascular Endothelial Cell Growth Factor. It seems to be manufactured and released by 'sick' retinal capillaries, and in turn makes other capillaries grow. This seems to be an exaggeration of one of the body's normal responses.... the retina becomes starved of nutrients, and then the retina makes chemicals that make new blood vessels grow to deliver more nutrients. There are other growth factors and processes involved. Description of events in proliferative retinopathy the mechanism of proliferative retinopathy (start at top) with laser treatment diabetes for years ^ retinal damage ^ retina releases growth chemicals ^ 'new vessels' grow ^ anti-VEGF Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy, also known as diabetic eye disease, is a medical condition in which damage occurs to the retina due to diabetes and is a leading cause of blindness.[1] It affects up to 80 percent of people who have had diabetes for 20 years or more.[2] At least 90% of new cases could be reduced if there were proper treatment and monitoring of the eyes.[3] The longer a person has diabetes, the higher his or her chances of developing diabetic retinopathy.[4] Each year in the United States, diabetic retinopathy accounts for 12% of all new cases of blindness. It is also the leading cause of blindness for people aged 20 to 64 years.[5] Signs and symptoms[edit] Normal vision The same view with diabetic retinopathy. Emptied retinal venules due to arterial branch occlusion in diabetic retinopathy (fluorescein angiography) Diabetic retinopathy often has no early warning signs. Even macular edema, which can cause rapid vision loss, may not have any warning signs for some time. In general, however, a person with macular edema is likely to have blurred vision, making it hard to do things like read or drive. In some cases, the vision will get better or worse during the day. In the first stage which is called non-proliferative diabetic retinopathy (NPDR) there are no symptoms, the signs are not visible to the eye and patients will have 20/20 vision. The only way to detect NPDR is by fundus photography, in which microaneurysms (microscopic blood-filled bulges in the artery walls) can be seen. If there is reduced vision, fluorescein angiography can be done to see the back of the eye. Narrowing or blocked retinal blood vessels can be seen clearly and this is called retinal ischemia (lack of blood flow). Macular edema in which blood vessels leak their contents into the macular regi Continue reading >>

Detecting Diabetic Eye Disease With Machine Learning

Detecting Diabetic Eye Disease With Machine Learning

Diabetic retinopathy — an eye condition that affects people with diabetes — is the fastest growing cause of blindness, with nearly 415 million diabetic patients at risk worldwide. The disease can be treated if detected early, but if not, it can lead to irreversible blindness. One of the most common ways to detect diabetic eye disease is to have a specialist examine pictures of the back of the eye and determine whether there are signs of the disease, and if so, how severe it is. While annual screening is recommended for all patients with diabetes, many people live in areas without easy access to specialist care. That means millions of people aren’t getting the care they need to prevent loss of vision. A few years ago, a Google research team began studying whether machine learning could be used to screen for diabetic retinopathy (DR). Today, in the Journal of the American Medical Association, we’ve published our results: a deep learning algorithm capable of interpreting signs of DR in retinal photographs, potentially helping doctors screen more patients, especially in underserved communities with limited resources. Working with a team of doctors in India and the U.S., we created a dataset of 128,000 images and used them to train a deep neural network to detect diabetic retinopathy. We then compared our algorithm’s performance to another set of images examined by a panel of board-certified ophthalmologists. Our algorithm performs on par with the ophthalmologists, achieving both high sensitivity and specificity. For more details, see our post on the Research blog. We’re excited by the results, but there’s a lot more to do before an algorithm like this can be used widely. For example, interpretation of a 2D retinal photograph is only one step in the process of Continue reading >>

Slideshow: Diabetes Complications -- Eye Problems And Blindness

Slideshow: Diabetes Complications -- Eye Problems And Blindness

Diabetes can make you more likely to have eye problems. Your blood sugar (glucose) levels may be high because your body can't make or use insulin properly. Too much blood sugar can build up and harm your nerves and blood vessels. Damage to the blood vessels in your eyes can lead to vision loss or blindness. Anyone with diabetes is at risk, so it’s important to get yearly eye exams. Diabetes can affect your eyes in different ways. When your blood sugar is high or when you start insulin treatment, you may have blurry vision or other problems. But your eyes can be damaged even if you don’t notice any changes. Don’t wait for symptoms to arise to get your vision checked. Diabetic Retinopathy The retina senses light coming into your eye, and it sends messages to your brain about the things you see. Damage to blood vessels inside the retina from blood sugar buildup is called diabetic retinopathy. You might not notice changes at first, but over time the walls of your blood vessels may leak fluid. When you’ve had diabetes for a while, blood vessels can form scar tissue and pull the retina away from the back of your eye. This can lead to severe vision loss and even blindness. Your doctor can diagnose retinopathy during a thorough eye exam. He’ll use a special dye to find leaking blood vessels. In the early stages, diabetic retinopathy often can be treated with laser surgery called photocoagulation. The laser seals the blood vessels and stops them from leaking and growing. The procedure can't restore lost vision. Combined with follow-up care, though, it can lower your chances of blindness by as much as 90%. In the late stages of diabetic retinopathy -- if the retina has detached or a lot of blood has leaked into your eye -- your doctor may suggest vitrectomy. This surger Continue reading >>

Diabetic Retinopathy

Diabetic Retinopathy

Diabetic retinopathy is damage to the retina at the back of the eye from long-term high blood sugar levels in people with diabetes. Left untreated, diabetic retinopathy can affect a person's vision and can lead to blindness. Everyone with diabetes should attend annual NHS eye screening to check for signs of damage to the retina. This is done using a special camera to take pictures of the back of the eye. The retina and diabetes Too much blood sugar can damage the blood vessels in the back of the eye, preventing the retina from receiving the appropriate amount of nutrients it needs to maintain vision. The retina is light-sensitive nerve tissue at the back of the eye. As light enters the front of the eye, the retina converts the light rays into electrical impulses that travel along the optic nerve to part of the brain called the visual cortex. The brain then combines images sent from both eyes to interpret them as a single, three-dimensional image. This allows us to perceive depth and distance. Without the retina, the eye cannot communicate with the brain, making vision impossible. Diabetic retinopathy occurs when diabetes damages the tiny blood vessels in the retina. In the early stages of diabetic retinopathy, called non-proliferative retinopathy, these blood vessels leak fluid and distort sight. In the more advanced stage of diabetic retinopathy, called proliferative retinopathy, fragile new blood vessels grow around the retina and in the vitreous humour - a clear substance that fills the eye. If left untreated, these blood vessels may bleed, clouding vision or detaching the retina. Anyone with diabetes - either type 1 or type 2 diabetes - is at risk of developing diabetic retinopathy. However, the type of diabetes a person has, how often their blood sugar fluctuates, Continue reading >>

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