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Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the leading causes of vision loss worldwide. Early detection and timely intervention are crucial in decreasing the risk of vision impairment worldwide. Optical Coherence Tomography Angiography (OCTA) is an emerging imaging modality that has advantages to the current standard for assessing retinal microvascular changes in diabetic eye diseases. This study aims to evaluate the cost-effectiveness of different screening strategies incorporating OCTA for the detection and management of DR and DME. A decision tree model (Figure 2) was created to estimate the cost consequences of different screening strategies for clinically significant macular edema (CSME) and severe DR in the United States. The model can be used to compare two screening arms: A) standard fluorescein angiography (FA) and optical coherence tomography (OCT) scans with standard of care follow-up.; and B) Universal OCTA imaging with FA and OCT scans with standard of care follow-up. In both strategies, screening will start with the most sensitive imaging (OCTA > OCT > FA) that is available. Strategy A will serve as the control with the current standard image screening protocol for DME and DR diagnosis, which is based on the National Institute of Clinical Excellence (NICE) guidelines used in both the U.S. and U.K. These guidelines include FA imaging and a visual acuity test within 3 months of diagnosis of diabetes. In accordance with the guidelines, if DR or CSME is identified the participant will subsequently be referred to an ophthalmologist at which point OCT will also be obtained at this visit. If no DR or CSME is identified during imaging, the guidelines state that follow-up imaging should be conducted every 6 months. Strategy B will involve universal OCTA Imaging, FA imaging, OCT scans and a visual acuity test. Screening with OCTA imaging should be conducted before proceeding to screen the FA images taken. If criteria for CSME or severe DR is met, then the participant will be referred to an ophthalmologist. If criteria for CSME or severe DR is not met, then the participant will receive follow up imaging every 6 months.

A non-experimental quantitative, descriptive and contextual study which sought to examine the level of awareness about Diabetic Retinopathy (DR), and how aware female diabetic patients were about retinal screening as a preventative measure to eye complications and blindness was conducted. The objective of the study was to explore and describe the variables related to the awareness level of female diabetic patients about Diabetic Retinopathy and diabetic retinal screening. A convenient sample of 149 respondents was obtained. A questionnaire was used to collect data. Data was analysed using the Statistical Package for Social Sciences (SPSS), 13.0 computer software program. Results evidenced a good level of awareness about DR. Recommendations based on the findings were made for consideration in clinical practice, education and research. / Health Studies / M.P.H.

Bakgrund: Diabetesretinopati är den vanligaste ögonsjukdomen hos personer med diabetes och är en ledande orsak till synnedsättning och blindhet världen över. Patienter som har diabetesretinopati kan vara symptomfria och patienten märker inte att han/hon är drabbad. Det är därför viktigt att patienter som har diabetes screenas regelbundet för att synhotande diabetesretinopati ska upptäckas i ett tidigt stadium så att rätt behandling kan sättas in för att undvika synnedsättning. Syfte: Syftet med studien var att belysa ögonsjuksköterskans uppfattning av olika faktorer som påverkar diabetespatientens följsamhet till ögonbottenfotografering. Metod: En kvalitativ metod med en fenomenografisk ansats användes i studien. Studien har genomförts genom åtta intervjuer med ögonsjuksköterskor på två olika ögonmottagningar i södra Sverige. Resultat: Dataanalysen mynnade ut i fyra olika beskrivningskategorier: Patientens förståelse för sjukdomen, Patientens hälsa och syn, Ögonsjuksköterskans tid med patienten samt Generella hinder. Slutsats: Under studien framkom flera olika faktorer som påverkade patienten att delta eller inte delta vid ögonbottenfotografering. Utifrån resultatet i denna studie drog vi slutsatsen att en ögonsjuksköterska framförallt behöver mer tid tillsammans med varje enskild patient för att kunna informera patienten om diabetes och diabetesretinopati samt motivera till deltagande vid regelbunden ögonbottenscreening. / Background: Diabetic retinopathy is the most common eye disease among people with diabetes and it is a leading cause for sight impairment and blindness all over the world. Patients with diabetic retinopathy can be asymptomatic and the patient can´t tell that he/she is affected. Because of this, it is important that patients with diabetes regularly are screened so that sight threatening retinopathy can be detected in an early state so the proper treatment can be inserted to prevent a sight impairment. Aim: The aim of the study was to illuminate the ophthalmic nurse’s perception of different factors influencing the diabetic patient´s compliance to fundus photography. Method: A qualitative method with a phenomenographic onset has been used in the study. The study has been conducted through eight interviews with ophthalmic nurses working in two different eye clinics in the south of Sweden. Results: The data analysis resulted in four different categories: The patient´s understanding of the disease, The patient´s health and vision, The ophthalmic nurse´s time with the patient and General obstacles. Conclusion: During the study several different factors which influenced the patient to participate or not to participate in fundus photography were found. Based on the result of this study we concluded that an ophthalmic nurse especially needs more time with each patient to be able to inform the patient about diabetes and diabetic retinopathy and to motivate the patient to participate in regular diabetic retinopathy screening.

Objetivo: Avaliação funcional (acuidade visual e sensibilidade ao contraste) e morfológica da retina de pacientes com edema macular diabético (EMD) tratados com bevacizumabe intravítreo e controle glicêmico optimizado durante 24 semanas de acompanhamento. Projeto: Estudo prospectivo intervencionista, randomizado e controlado. Métodos: Quarenta e um olhos de 34 pacientes com diabetes mellitus tipo 2 e EMD com Hemoglobina glicada (HbA1c) <= 11% receberam injeções de bevacizumabe intravítreo (BIV) com controle glicêmico optimizado nas semanas 0, 6, 12 e 18 (grupo 1; n=21); ou receberam simulação de BIV com controle glicêmico optimizado na semana 0 e 6 e, posteriormente, BIV com controle glicêmico optimizado na semana 12 e 18 (Grupo 2; n=20). Mudanças na sensibilidade ao contraste (SC), na acuidade visual (AV) e na espessura foveal (EF) medida por Tomografia de coerência óptica (TCO) foram comparadas antes do início do tratamento e nas semanas 2, 6, 12, 14, 18 e 24. A análise laboratorial do controle sistêmico foi comparada também no início e nas semanas 12 e 24. Resultados: O estudo mostrou AV e EF significativamente melhores em 24 semanas em ambos os grupos. Na 24ª semana, a média da SC melhorou no grupo 1 de 1,14±0,36logCS para 1,33±0,24logCS (P=0,002) e, também, no grupo 2 de 1,11±0,29 para 1,26±0,23logCS (P = 0,004) em 24 semanas, sem diferença significativa entre eles (P = 0,52). Houve uma redução média de 0,78% nos níveis de HbA1c (8,28±1,29% para 7,5±1,20%; P < 0,001) em 24 semanas. As maiores diferenças entre os grupos foram detectadas entre o pré-tratamento e a segunda semana, onde a EF diminuiu rapidamente no grupo 1 em comparação ao grupo 2 (116±115 vs. 17±71?m, respectivamente; P < 0,01). Em 12 semanas, as medidas já não foram estatisticamente significativas (variação da EF = grupo 1 91±184?m vs. grupo 2 62±152?m; P = 0.72). No pré-tratamento, houve correlação significativa entre SC e AV (r = -0,70; P < 0,001) e também entre SC e EF (r = -0,63; P < 0,001) que se manteve em 24 semanas. Conclusão: O uso do bevacizumabe intravítreo associado ao controle glicêmico optimizado melhorou significativamente a função visual, incluindo a sensibilidade ao contraste dos olhos com EMD. No entanto, o controle glicêmico optimizado isolado também se mostrou eficiente durante 12 semanas / Purpose: Functional (visual acuity and contrast sensitivity) and morphological evaluation of the retina of patients with diabetic macular edema (DME) treated with intravitreal bevacizumab and optimized glycemic control on 24-week followup. Project: Prospective, interventional, randomized controlled trial. Methods: Forty-one eyes of 34 patients with type 2 diabetes mellitus and DME with hemoglobin A1c (HbA1c) <= 11% received injections of intravitreal bevacizumab (IVB) with optimized glycemic control (group 1; n=21) at week 0, 6, 12 and 18; or received IVB simulation with optimized glycemic control at week 0 and 6 and, after three months, IVB with optimized glycemic control at week 12 and 18 (Group 2; n=20). Mean Change in contrast sensitivity (CS), best corrected visual acuity (BCVA) and central foveal thickness (CFT) - as measured by optical coherence tomography (OCT) were compared at baseline, and at weeks 2, 6, 12, 14, 18 and 24. A laboratory analysis of systemic control was also compared at baseline and at weeks 12 and 24. Results: The study showed that BCVA and CFT were significantly better in both groups at 24 weeks. Mean CS also improved significantly in group 1 from 1.14±0.36 to 1.33±0,24logCS (P=0,002) and also in group 2 from 1.11±0.29 to 1.26±0.23logCS (P=0,004) at 24 weeks, with no significant difference between them (P = 0.52). There was a mean reduction of 0.78% in HbA1c levels (8,28±1,29 to 7,5±1,20%; P < 0,001) at 24 weeks. The major differences between both groups were detected between the baseline and the second week, whem CFT promptly decreased in group 1 compared to group 2 (116±115 ?m vs. 17±71 ?m; P < 0,01). At 12 weeks, the measures were no longer statistically significant (variation of CFT = group 1 91±184 ?m vs. group 62±152 ?m, P = 0.72). At baseline, there was meaningful correlation between CS and BCVA (r = -0,70; P < 0,001) and also between CS and CFT (r = -0.63; P < 0.001) that remained at 24 weeks. Conclusion: The use of intravitreal bevacizumabe associated with optimized glycemic control improved significantly the visual function, including contrast sensitivity in eyes with DME. However, optimized glycemic control alone also shown to be efficient at 12 weeks

La rétinopathie diabétique (RD) se compose d’une part d’une ischémie rétinienne périphérique et d’autre part d’une exsudation rétinienne responsable d’un œdème maculaire diabétique, première cause de cécité chez les moins 55 ans. Les traitements utilisés actuellement sont non spécifiques et traitent les complications tardives de la RD. Les phases précoces de la RD ne sont donc pas ciblées. L’hyperglycémie chronique entraine un stress oxydant et une activation des PKC qui participent à l’altération des BHR. L’objectif de ce travail a été 1°) d’étudier l’implication de la PKCζ et de la voie Rho/ROCK/Myosine II sur la physiopathogénie de la RD et 2°) de montrer l’effet bénéfique de leurs inhibiteur sur les BHR et sur la reperfusion des capillaires rétiniens. Nous avons confirmé l’hyperactivation de la PKCζ et de la voie Rho/ROCK/Myosine II chez les rats diabétiques et leur participation à la rupture de la BHR externe. Le traitement par leurs inhibiteurs respectifs normalise l’activation des deux enzymes et restaure l’intégrité anatomique et fonctionnelle de la BHR externe. De plus l'hyperactivation de ROCK altère la perfusion rétinienne par 1) constriction focale artériolaire, 2) protrusions membranaires endoluminales des cellules endothéliales (blebbing) et 3) vasoconstriction capillaire diffuse. Nous avons montré que l'ensemble de ces phénomènes étaient réversibles par traitement intravitréen de son inhibiteur le Fasudil. De manière importante le traitement par Fasudil induit également une diminution du VEGF rétinien responsable de la perméabilité des barrières et témoin indirect de l’ischémie rétinienne. Ces travaux éclairent la physiopathogénie de la RD et ouvre des perspectives thérapeutiques permettant de cibler les événements précoces de la RD. / Diabetic retinopathy (DR) mainly results from peripheral retinal ischemia and exudation leading to sight threatening complications such as retinal neovascularization or macular edema. This latter represents the main cause of visual loss among working age individuals. Current treatments address late complications of DR and are non-specific. Therefore, early events are currently not addressed. Chronic hyperglycemia increases oxidative stress and activates PKC leading to blood retinal barrier (BRB) breakdown. The aims of the present work were two fold. First, to assess the implication of PKCζ and the Rho/ROCK/Myosin II pathway on the pathogenesis of DR and second, to assess whether their specific inhibitors have the potential to restore the phenotype. Herein we have demonstrated the pathogenic role of PCKζ and ROCK hyperactivation on the development of diabetes induced external BRB breakdown. Furthermore their inhibitors restored the morphologic and functional aspect of the external BRB. We also found that ROCK hyperactivation was responsible for altered retinal perfusion through several mechanism namely 1) focal constriction of retinal arterioles; 2) endoluminal protrusions of the endothelial cell membrane (blebs) and 3) capillary diffuse vasoconstriction. We were able to demonstrate that all this aspects were reversible by Fasudil, a ROCK inhibitor, administrated into the vitreous. Of importance this treatment decreased also retinal VEGF that is a well-known factor responsible for barrier breakdown and a surrogate marker for retinal ischemia. To conclude the present findings not only shed light on the mechanisms of DR but also open new therapeutic avenues addressing the early events of DR a current unmet medical need.

Diabetic retinopathy is an ischemic retinal neovascular disease causing vision loss among adults. The studies presented involve the design and testing of a gene therapy vector to inhibit retinal revascularization, similar to that found in diabetic retinopathy. Gene therapy has proven to be an effective method to introduce therapeutic proteins to treat retinal diseases. Targeting a specific cell type and expression of therapeutic proteins according to the tissue microenvironment should have an advantage over traditional gene therapy by avoiding unwanted transgene expression. Hypoxia plays a significant role in the pathophysiology of many retinal ischemic diseases. Retinal Mèuller cells provide structural and functional support to retinal neurons, as well as playing a significant role in retinal neovascularization. Targeting Mèuller cells may be an effective strategy to prevent retinal neovascularization under pathological conditions. ... The hypoxia regulated, glial specific vector successfully reduced the abnormal neovascularization in the periphery by 93% and reduced the central vasobliterated area by 90%. A substantial amount of exogenous endostatin was produced in the retinas of P17 OIR mice. A significant increase in human endostatin protein and reduced vascular endothelial growth factor (VEGF) were identified by Western blot and ELISA, respectively. These findings suggest hypoxia-regulated, glial cell-specific scAAV mediated gene expression may be useful to prevent blindness found in devastating retinal diseases involving neovascularization. / by Manas Ranjan Biswal. / Thesis (Ph.D.)--Florida Atlantic University, 2012. / Includes bibliography. / Mode of access: World Wide Web. / System requirements: Adobe Reader.