Imager Evaluation of Diabetic Retinopathy at the Time of Imaging in a Telemedicine Program

Objective: To evaluate the ability of certified retinal imagers to identify presence versus absence of sight-threatening diabetic retinopathy (stDR) (moderate nonproliferative diabetic retinopathy or worse or diabetic macular edema) at the time of retinal imaging in a telemedicine program. Research Design and Methods: Diabetic patients in a primary care setting or specialty diabetes clinic received Joslin Vision Network protocol retinal imaging as part of their care. Trained nonphysician imagers graded the presence versus absence of stDR at the time of imaging. These gradings were compared with masked gradings of certified readers. Results: Of 158 patients (316 eyes) imaged, all cases of stDR (42 eyes [13%]) were identified by the imagers at the time of imaging. Six eyes with mild nonproliferative diabetic retinopathy were graded by the imagers to have stDR (sensitivity 1.00, 95% CI 0.90–1.00; specificity 0.97, 0.94–0.99). Conclusions: Appropriately trained imagers can accurately identify stDR at the time of imaging

Does androgen insufficiency cause lacrimal gland inflammation and aqueous tear deficiency?

PURPOSE: The current investigators have shown that androgen treatment suppresses inflammation and stimulates the function of lacrimal glands in mouse models of Sjögren's syndrome. Recently, others have hypothesized that androgen insufficiency induces an autoimmune process in lacrimal tissue, leading to inflammation, a Sjögren's syndrome-like pathology, and aqueous tear deficiency. The purpose of the present study was to test this hypothesis. METHODS: Lacrimal glands were obtained from adult testicular feminized (Tfm) and control mice; castrated rats, guinea pigs, and rabbits; and castrated rats without anterior or whole pituitary glands and were processed for histology and image analysis. Tear volumes were measured in mice, in patients taking antiandrogen medications, and in age-matched human control subjects. RESULTS: Tfm mice, which are completely resistant to classical androgen action, did not have increased lymphocyte infiltration in their lacrimal glands or decreased tear volumes. No inflammation was evident in lacrimal tissues of male or female rats, guinea pigs, or rabbits 12 to 31 days after castration, no inflammation existed in rat lacrimal glands 15 to 31 days after orchiectomy and pituitary removal, and no aqueous tear deficiency was apparent in patients receiving antiandrogen therapy. CONCLUSIONS: Androgen deficiency may promote the progression of Sjögren's syndrome and its associated lacrimal gland inflammation, meibomian gland dysfunction, and severe dry eye. However, androgen insufficiency alone does not cause lacrimal gland inflammation, a Sjögren's syndrome-like pathology in lacrimal tissue, or aqueous tear deficiency in nonautoimmune animals and humans

Disparities Between Teleretinal Imaging Findings and Patient-reported Diabetic Retinopathy Status and Followup Eye Care Interval: A 10-year Prospective study

Objective: To assess self-reported awareness of diabetic retinopathy (DR) and concordance of eye examination follow-up compared to findings from concurrent retinal images. Research Design and Methods: Prospective observational 10-year study of 26,876 consecutive patients with diabetes that underwent retinal imaging during an endocrinology visit. Awareness and concordance was evaluated using questionnaires and retinal imaging. Results: Awareness information and gradable images were available in 25,360 patients (94.3%). Severity of DR by imaging: no DR 14,317(56.5%); mild DR 6,805(26.8%), vision-threatening DR (vtDR) 4,238(16.7%). Patients did not report being aware of any prior DR in 96.7%, 88.5% and 54.9% (no,mild,vtDR). When DR was present, reporting no prior DR was associated with shorter diabetes duration, milder DR, last eye exam >1 year prior, no dilation, no scheduled appointment, and less specialized provider (all P<0.001). Among patients with vtDR, 41.2%, 58.1% and 64.2% did not report being aware of any DR and follow-up was concordant with current DR severity in 66.7%, 41.3% and 25.4% (P<0.001) when prior examination was performed by a retina specialist, non-retina ophthalmologist, or optometrist (P<0.001). Conclusions: Substantial discrepancies exist between DR presence, patient awareness and concordance of follow-up across all DR severity levels. These discrepancies are present across all eye care provider types with the magnitude influenced by provider type. Thus, patient self-report should not be relied upon to reflect DR status. Modification of medical care and education models may be necessary to enhance retention of ophthalmic knowledge in patients with diabetes and assure accurate communication between all health care providers.</p