Diabetic Eye Disease: Diagnosis, Causes, And Symptoms
By Debra A. Sokol-McKay, MS, CVRT, CDE, CLVT, OTR/L, SCLV Diagnosing Diabetic Eye Disease How Diabetes Affects the Eyes and Vision: Diabetic Retinopathy Eye Examination Guidelines Diagnosing Diabetic Eye Disease Diabetic retinopathy usually has no early warning signs. It can be detected only through a comprehensive eye examination that looks for early signs of the disease, including: Leaking blood vessels Macular edema (swelling) Pale, fatty deposits on the retina Damaged nerve tissue Any changes to the retinal blood vessels To diagnose diabetic eye disease effectively, eye care specialists recommend a comprehensive diabetic eye examination that includes the following procedures: Distance and near vision acuity tests A dilated eye (or fundus) examination, which includes the use of an ophthalmoscope. In a dilated eye examination, it is the pupil that is dilated—not the entire eye. This allows the examiner to see through the pupil to the retina. Visual acuity tests alone are not sufficient to detect diabetic retinopathy in its early stages. A tonometry test to measure fluid pressure inside the eye. A fluorescein angiography test, if more serious retinal changes, such as macular edema, are suspected. Fluorescein angiography is an eye test that uses a special dye and camera to look at blood flow in the retina. Optical coherence tomography (OCT) testing may be used to gain a clearer picture of the retina and its supporting layers. OCT is a type of medical imaging technology that produces high-resolution cross-sectional and three-dimensional images of the eye. Also, an Amsler Grid test can detect early and sometimes subtle visual changes in a variety of macular diseases, including diabetic macular edema. The first image below shows an Amsler Grid as seen with unimpaired vis Continue reading >>
Exudate Detection In Color Retinal Images For Mass Screening Of Diabetic Retinopathy
Volume 18, Issue 7 , October 2014, Pages 1026-1043 Exudate detection in color retinal images for mass screening of diabetic retinopathy Author links open overlay panel XiweiZhanga We introduce a new database, e-ophtha EX, with precisely manually contoured exudates. We propose a new exudate segmentation method based on mathematical morphology. The method preforms normalization, denoising and detecting reflections and artifacts. New contextual features are used to train a random forest for the classification. The method achieves an area under ROC curve of 0.95 on e-ophtha EX database. The automatic detection of exudates in color eye fundus images is an important task in applications such as diabetic retinopathy screening. The presented work has been undertaken in the framework of the TeleOphta project, whose main objective is to automatically detect normal exams in a tele-ophthalmology network, thus reducing the burden on the readers. A new clinical database, e-ophtha EX, containing precisely manually contoured exudates, is introduced. As opposed to previously available databases, e-ophtha EX is very heterogeneous. It contains images gathered within the OPHDIAT telemedicine network for diabetic retinopathy screening. Image definition, quality, as well as patients condition or the retinograph used for the acquisition, for example, are subject to important changes between different examinations. The proposed exudate detection method has been designed for this complex situation. We propose new preprocessing methods, which perform not only normalization and denoising tasks, but also detect reflections and artifacts in the image. A new candidates segmentation method, based on mathematical morphology, is proposed. These candidates are characterized using classical features, bu Continue reading >>
Enhancing Eye Fundus Images For Diabetic Retinopathy Screening
Enhancing Eye Fundus Images for Diabetic Retinopathy Screening (15, chemin du Saquin, 69130 Ecully - France) (18 rue du Professeur Lauras 42000 SAINT-ETIENNE - France) (10 rue Trfilerie - 42100 Saint-tienne - France) (Singleton ParkSwanseaSA2 8PP Wales - Royaume-Uni) (1 Fairway CourtTonteg RoadUpper BoatTreforestPontypridd CF37 5UAWales, UK - Royaume-Uni) (16 Richmond Street, Glasgow G1 1XQ, Scotland, UK - Royaume-Uni) Abstract : Many eye fundus images present strong variations of contrast which can be a limitation to the diagnosis of the retinopathy. Either some lesions are not taken into account or only a limited part of the domain of the image can be read. Graders have to manually adjust the contrast, which is tedious and not easily reproducible. We have developed an automatic system, which standardises the colour contrast across the whole domain of the image. The method is consistent with the physical principles or image formation and ensures that the colour aspect of lesions such as micro-aneurysms or anatomical structures such as veins are similar. It is more powerful than the existing grey level methods. We have tested our approach on several thousand images acquired in good or in harsher conditions. Some were bright while others were dark. Expert graders have checked the enhanced images. Diagnosis becomes more obvious and the grading more comfortable. Another limitation for the diagnosis is that images of the same patient acquired for different examinations cannot be directly superimposed. Indeed, the eye of the patient is never in the exact same position, the image is a projection of a 3D scene into the plane of the sensor, the optics of the camera creates a radial deformation and the colour of the image may have changed. We have developed an automatic method Continue reading >>
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 >>
Retinal Imaging Techniques For Diabetic Retinopathy Screening.
1. J Diabetes Sci Technol. 2016 Feb 1;10(2):282-94. doi: 10.1177/1932296816629491. Retinal Imaging Techniques for Diabetic Retinopathy Screening. Goh JK(1), Cheung CY(2), Sim SS(3), Tan PC(3), Tan GS(3), Wong TY(4). (1)Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Duke-NUS Graduate Medical School, Singapore. (2)Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong. (3)Singapore Eye Research Institute, Singapore National Eye Centre, Singapore. (4)Singapore Eye Research Institute, Singapore National Eye Centre, Singapore Duke-NUS Graduate Medical School, Singapore Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore [email protected] Due to the increasing prevalence of diabetes mellitus, demand for diabeticretinopathy (DR) screening platforms is steeply increasing. Early detection andtreatment of DR are key public health interventions that can greatly reduce thelikelihood of vision loss. Current DR screening programs typically employ retinalfundus photography, which relies on skilled readers for manual DR assessment.However, this is labor-intensive and suffers from inconsistency across sites.Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively.Furthermore, current screening programs based on 2-dimensional fundus photographydo not effectively screen for diabetic macular edema (DME). Optical coherencetomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improvingDME detection in large-scale DR screening programs. Cu Continue reading >>
Ocular Imaging In Diabetic Retinopathy Mohamed Qa - Egypt Retina J
Imaging of the fundus has revolutionized our understanding of the pathogenesis of diabetic retinopathy (DR), allowed standardized grading and follow-up with the ability to evaluate treatments in randomized clinical studies. Ocular imaging provides the tools for screening of diabetic individuals to detect and treat changes before vision loss. Modern instruments allow rapid in vivo imaging of the diabetic fundus using multiple modalities with higher resolution. Images can be transmitted, manipulated, analyzed, and graded with increasing ease. These imaging techniques are now entwined in the paradigms for newer treatments for DR. This paper aimed to provide a brief overview of current imaging modalities including conventional and digital fundus imaging, scanning laser ophthalmoscopy, fluorescein angiography, wide-field retinal imaging, and optical coherence tomography. Future developments in these imaging techniques are discussed. Keywords:Confocal scanning ophthalmoscopy, diabetic macular edema, diabetic retinopathy, fluorescein angiography, imaging, optical coherence tomography, wide field imaging Mohamed QA. Ocular imaging in diabetic retinopathy. Egypt Retina J 2014;2:19-25 Mohamed QA. Ocular imaging in diabetic retinopathy. Egypt Retina J [serial online] 2014 [cited2018 Apr 9];2:19-25. Available from: It is estimated that almost one in ten individuals in the world will be diabetic by 2030. [1] The rising tide of diabetes and its associated complications is one of the major healthcare challenges in countries rich and poor. Diabetic retinopathy (DR), a specific microvascular complication of diabetes is the commonest cause of blindness in working age adult's worldwide. [1] Although the prevalence of diabetes continues to increase, the proportion of diabetics with sight Continue reading >>
Wide-field Megahertz Oct Imaging Of Patients With Diabetic Retinopathy
Wide-Field Megahertz OCT Imaging of Patients with Diabetic Retinopathy 1Department of Ophthalmology, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany 2Institute for Biomolecular Optics, Ludwig Maximilians University, Oettingenstrasse 67, 80538 Munich, Germany 3Institute of Biomedical Optics, University of Lbeck, Peter-Monnik-Weg 4, 23562 Lbeck, Germany 4Department of Ophthalmology, Ludwig Maximilians University, Mathildenstrasse 8, 80336 Munich, Germany Received 31 March 2015; Accepted 30 June 2015 Copyright 2015 Lukas Reznicek et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate the feasibility of wide-field Megahertz (MHz) OCT imaging in patients with diabetic retinopathy. Methods. A consecutive series of 15 eyes of 15 patients with diagnosed diabetic retinopathy were included. All patients underwent Megahertz OCT imaging, a close clinical examination, slit lamp biomicroscopy, and funduscopic evaluation. To acquire densely sampled, wide-field volumetric datasets, an ophthalmic 1050 nm OCT prototype system based on a Fourier-domain mode-locked (FDML) laser source with 1.68 MHz A-scan rate was employed. Results. We were able to obtain OCT volume scans from all included 15 patients. Acquisition time was 1.8 seconds. Obtained volume datasets consisted of 2088 1044 A-scans of 60 of view. Thus, reconstructed en face images had a resolution of 34.8 pixels per degree in x-axis and 17.4 pixels per degree. Due to the densely sampled OCT volume dataset, postprocessed customized cross-sectional B-frames through pathologic changes such as an individual microaneurys Continue reading >>
Diabetic Retinopathy - Optical Coherence Tomography Scans
Diabetic retinopathy can lead to severe vision loss secondary to diabetic macular edema, tractional retinal detachment from fibrovascular proliferation, macular ischemia and complications from neovascular glaucoma. OCT has increased the sensitivity to detect diabetic macular edema and track progression of treatment from focal/grid laser and anti-VEGF therapies. The RISE/RIDE studies on treatment of diabetic macular edema with Lucentis was one of the initial studies to incorporate time-domain OCT. The definition of clinically significant macular edema (CSME) is based on a clinical assessment of diabetic macular edema with a specific criterias defined by the ETDRS in report 1 prior to the development of OCT. Figure 1: Diabetic macular edema with intraretinal edema secondary to leakage from the microaneurysm located in the center of the cyst. Figure 2: Diabetic macular edema with intraretinal edema/cysts and subretinal retinal fluid. Leakage can occur from microaneurysms located in the intraretinal layers and leak into the subretinal space causing a serous detachment. Figure 3: Diabetic macular edema with large intraretinal cysts located in multiple retinal layers, especially the outer nuclear layer (ONL). Temporal to the fovea, there is RPE disruption and loss of the COST and EPIS lines secondary to s/p panretinal photocoagulation (PRP) laser treatment. A window defect is seen from the disrupted RPE allowing the OCT scans to penetrate deeper into the choroid. In diabetic retinopathy, hard exudates with associated retinal thickening located within 500 microns of the center of the fovea is referred to as clinically significant macular edema (CSME). The ETDRS report 22 found an association of hard exudates with elevated serum lipid levels. Figure 4: Retinal hard exudates lo Continue reading >>
Imaging In Diabetic Retinopathy
Go to: Abstract While the primary method for evaluating diabetic retinopathy involves direct and indirect ophthalmoscopy, various imaging modalities are of significant utility in the screening, evaluation, diagnosis, and treatment of different presentations and manifestations of this disease. This manuscript is a review of the important imaging modalities that are used in diabetic retinopathy, including color fundus photography, fluorescein angiography, B-scan ultrasonography, and optical coherence tomography. The article will provide an overview of these different imaging techniques and how they can be most effectively used in current practice. Keywords: B-scan Ultrasonography, Color Fundus Photography, Diabetic Retinopathy, Fluorescein Angiography, Optical Coherence Tomography, Retinal Imaging Go to: INTRODUCTION While the primary method for evaluating diabetic retinopathy involves direct and indirect ophthalmoscopy, various imaging modalities are of significant utility in the screening, evaluation, diagnosis, and treatment of the different presentations of this disease. Many imaging techniques can be useful depending on the manifestation of diabetic retinopathy. Important imaging techniques to be familiar with include color fundus photography, fluorescein angiography (FA), B-scan ultrasonography, and optical coherence tomography (OCT). This manuscript is meant to provide an overview of these different imaging techniques and how they relate to the management of diabetic retinopathy. Go to: FUNDUS PHOTOGRAPHY Color fundus photography is a useful tool in the management of diabetic eye disease. Traditionally, fundus photography has been performed using film, but more recently, digital fundus photography has become widely adopted. Digital images enable easy and immediate Continue reading >>
Picture Of Diabetic Retinopathy
PREV Next Image: Picture of Strabismus (Crossed Eyes) NEXT Diabetic retinopathy, a common complication of diabetes, affects the blood vessels in the retina (the thin light-sensitive membrane that covers the back of the eye). It is due to the retina not receiving enough oxygen. If untreated, it may lead to blindness. If diagnosed and treated promptly, blindness is usually preventable. There are two types: nonproliferative and proliferative retinopathy. Nonproliferative retinopathy is the less severe type in which there may be hemorrhages (bleeding) in the retina and leakage of blood or serum causing a "wet retina." As a consequence vision may be diminished. Proliferative retinopathy is a more severe type of diabetic retinopathy. New abnormal fragile vessels develop on the surface of the retina and may grow toward the center of the eye. These vessels frequently bleed into the vitreous (the clear jelly in the center of the eye). Such bleeding episodes cause severe visual problems. Treatment is by laser surgery or surgery on the vitreous. These techniques can slow the progression of diabetic retinopathy and sometimes will reverse visual loss. However, damage done may be permanent. Diabetic retinopathy can often be prevented by lifestyle modification, including weight loss, dietary changes, and exercise. In addition, better control of high blood sugar decreases the incidence and the progression of diabetic retinopathy. Reviewed by Andrew A. Dahl, MD, FACS on September 17, 2009 Image Source: Dr. Andrew A. Dahl, M.D., F.A.C.S. Text: eMedicineHealth - Corneal Ulcer, WebMD - Corneal Ulcer Continue reading >>
Advances In Retinal Imaging For Diabetic Retinopathy And Diabetic Macular Edema
Advances in retinal imaging for diabetic retinopathy and diabetic macular edema 1Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 2Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore 1Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 2Fundus Image Reading Center, National Healthcare Group Eye Institute, Singapore 3Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, CA, USA Correspondence to: Dr. Srinivas R Sadda, Doheny Eye Institute, DEI 3623, 1450 San Pablo Street, Los Angeles, CA 90033, USA. E-mail: [email protected] Received 2015 Oct 1; Accepted 2015 Dec 31. Copyright : 2016 Indian Journal of Ophthalmology This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. This article has been cited by other articles in PMC. Diabetic retinopathy and diabetic macular edema (DME) are leading causes of blindness throughout the world, and cause significant visual morbidity. Ocular imaging has played a significant role in the management of diabetic eye disease, and the advent of advanced imaging modalities will be of great value as our understanding of diabetic eye diseases increase, and the management options become increasingly varied and complex. Color fundus photography has established roles in screening for diabetic eye disease, early detection of progression, and monitoring of treatment response. Fluorescein angiography (FA) detects areas of capillary nonp Continue reading >>
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 >>
Teleretinal Imaging For Diabetic Retinopathy
Teleretinal Imaging for Diabetic Retinopathy Think remote screening doesnt apply to your practice? Think again. By Richard J. Zimbalist, OD, and Amber R. Scharnweber, OD Its safe to assume the majority of you are thinking about skipping this article, believing it has absolutely nothing to do with the way you practice. Well, think again. Lets take a step back for a moment and reflect on some of the technological changes to eye care over the past several years. Optical coherence tomography (OCT) came to the market in the early 2000s and quickly changed the way we diagnose and manage glaucoma and retinal conditions.1,2 The mid-2000s brought the ever-growing popularity of 1-800-CONTACTS. In 2007, Zenni Optical drastically changed the optical world when it started marketing online glasses at a fraction of the price. Skip ahead to 2013 and Opternative offers online refractive exams that it markets as being as accurate as a traditional refractive exam performed by an optometrist or ophthalmologist using a phoropter.3 As the landscape of medicine continues to evolve, telehealth is at the forefront. It is not inconceivable to envision a time when telemedicine becomes the norm. In 2015, Kaiser Permanente performed 14 million virtual visits.4 They predict that virtual visits will actually outnumber traditional in-person visits by 2018.4 As technology advances and the infrastructure for such examination modalities expands, one can only expect patients to continue to embrace this concept. This patients last reported eye exam was in July 2014 at an unknown location. Teleretinal imaging was performed in November 2014 and revealed severe nonproliferative diabetic retinopathy with probable clinically significant macular edema (CSME) in both eyes.Click image to enlarge. Telehealth appoi Continue reading >>
Spotting Diabetic Retinopathy By Analyzing Medical Images Pixel By Pixel
Posted in: Healthcare , IBM Research-Australia Spotting Diabetic Retinopathy by analyzing medical images pixel by pixel Medical images are a rich source of data for clinicians in their diagnosis and treatment of diseases. In fact, specialized fundus photography can help pinpoint tiny pathologies in the eyes of diabetics, revealing signs of diabetic retinopathy (DR), one of the worlds leading causes of blindness. In the vast majority of these cases, early detection is the key to a patients survival and treatment outcome. Yet it is estimated that half of Australians with diabetes do not undergo the recommended frequency of screening. even though early intervention can reduce the risk of blindness by 95 percent ( CERA ). And this is not only a challenge in Australia. Eighty percent of blindness worldwide is preventable if detected and treated early ( WHO ). While education is a major part of encouraging regular screening, ensuring easy access for all Australians is also a key factor. Picking up subtle signs of DR in images is often a manual and subjective process for clinicians. Accuracy of the diagnosis heavily depends on their level of expertise, which can be hard to come by, particularly in rural or remote communities. We believe we can help with this challenge. Scientists at IBM Research -Australia are studying how new cognitive technologies could support clinicians in streamlining their analysis of images, as well as enable greater access to health services for everyone, regardless of their location. Last week, my team and I presented new research findings at the 2017 IEEE International Symposium on Biomedical Imaging (ISBI) , using deep learning and visual analytics technology for the early detection of DR. Our new method uses deep learning algorithms combined with Continue reading >>
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 >>
