A cross sectional study on factors influencing attendance to eye screening

Introduction: Diabetes Mellitus (DM) is on a rising trend globally and the complications of DM particularly diabetic retinopathy are kept on escalating. However, the number of patients who underwent proper eye screening in Malaysia is still unsatisfactory. Methods: This cross-sectional survey was carried out among 170 DM patients using self-administered questionnaires. The data was analyzed by using SPSS in understanding the facilitators and barriers for eye screening among DM patients. Chi-square test was used for the relationship between sociodemographic data, the knowledge score, and the frequency of eye screening. Results: Majority of participants 45.9 % (n=78) highlighted that lack of information regarding diabetes and not understanding the significance of eye screening are the barriers to eye screening. Whereas, 10.6% (n=18) reported lack of access to healthcare facilities, 6.5% (n=11) experienced time limitation and 2.9% (n=5) suffered financial issues. However, more than half of participants (58.2%) have good knowledge related to diabetic eye complication. There was a significant difference between educational level with patients’ attendance in yearly eye screening; χ2 = 8.32, df = 2, p<0.05. Conclusion: Lack of information received by the patients on the importance of eye screening and communication issues seems to be prominent and become the reasons for patients not attending eye screening. For further research, the improvement of default tracking systems and the provision of eye-related educational material are important to enhance health literacy among diabetic patients and the population of Malaysia

Factor influencing decision for eye screening among diabetes patients: a review

Introduction: Individuals with Diabetes Mellitus (DM) are at increased risk for developing diabetic ocular complications. Materials and Methods: A systematic approach was applied to find the relevant topic regarding the said issue. This literature review aimed to determine the system of eye screening, reasons for seeking eye screening and their treatment. Results: A total of 22 papers and one guideline were reviewed in this study. There were four main barriers found in this study regarding with factor influencing decision for eye screening among diabetes patients. Those were diabetic eye screening, management issues on diabetic eye screening and barriers to uptake diabetic eye screening. The details of these finding results were discussed further in the discussion section. Conclusion: The health care system, health care provider and patients itself could provide a clear explanation of factors influencing the decision for diabetic eye screening. A further study is recommended to validate these review finding

Unilateral ischemic central retinal vein occlusion in a young healthy adult: a case report

Central retinal vein occlusion (CRVO) is an obstruction of central retinal vein due to the impingement from the fellow central retinal artery. It is the second most common retinal vascular disease after diabetic retinopathy. Risk factor of CRVO includes diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, male gender and age above 50 years; with 90% of the cases occurred in individual aged 55 years and above. We report a rare case of left eye ischemic CRVO in a 24-year-old healthy gentleman who later on found out to have hypercholesterolemia. He presented with a sudden onset of reduced vision of his left eye. Examination revealed visual acuity (VA) of the left eye was 6/120. Fundus examination showed marked papilloedema with dilated and tortuous blood vessels and extensive flame-shaped hemorrhages with cotton wool spots in all four retinal quadrants. There was a presence of macular edema as well. The ancillary tests confirmed the diagnosis of left eye ischemic CRVO with significant macular edema. The blood investigation revealed elevated cholesterol levels. For treatment, 6 times of monthly intravitreal Ranibizumab injections were planned for the macular edema and oral Atorvastatin 40 milligrams daily was started. Following the intravitreal Ranibizumab injection, his VA has significantly improved with a reduction of macular edema. This report highlights the importance of prompt diagnosis and investigation of CRVO, especially in the younger age group. Early treatment of macular edema secondary to CRVO is able to reduce the edema thus leads to VA improvement

The outcome of Descemet membrane endothelial keratoplasty (DMEK) with different tamponade material.

OBJECTIVE: To compare the outcome of different tamponade material in Descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective, interventional case series that includes 8 patients underwent DMEK performed by a single surgeon within Covid-19 pandemic period. All donor tissues were stripped by the operating surgeon with endothelial cell density of > 2400 cells/mm2. The tamponade material used were air in 2 patients, 20% sulfur hexafluoride (SF6) gas in 3 patients and 12% perfluoropropane (C3F8) gas in 3 patients. The main outcomes were graft detachment rate, rebubbling rate and graft survival rate. RESULTS: The overall graft detachment rate was 25% (2 patients). The graft detachment rate was 0% in 20% SF6 gas group compared to 50% (1 patient) from air tamponade group and 33.3% (1 patient) from 12% C3F8 gas group (p<0.05). The patient from air group underwent rebubbling twice while another patient from 12% C3F8 gas group underwent once. The overall survival rate was 75% (6 patients). All of them did not have graft detachment. CONCLUSION: 20% SF6 gas provides superior tamponade effect compared to both air and 12% C3F8 gas. The detachment rate influenced graft survival. Air tamponade showed higher rebubbling rate

Nonproliferative and proliferative retinopathy

Diabetic retinopathy falls into two main classes: non proliferative and proliferative. The word &quot;proliferative&quot; refers to whether or not there is neovascularization (abnormal blood vessel growth) in the retina. Non-proliferative diabetic retinopathy, previously called background retinopathy, is the earliest stage of  diabetic  eye disease. Non-proliferative diabetic retinopathy is initially characterised by microaneurysms (microscopic blood-filled bulges in the artery walls) which may burst and leak into the retina. Tiny spots or dots of blood may accumulate in the retina, but they usually do not produce noticeable symptoms in the early stages of the disease. As the disease progresses,  hard exudates  (accumulations of fluid that has leaked from blood vessels), abnormalities in the growth of microscopic blood vessels in the retina, and bleeding from the veins that feed the retina may occur. Non-proliferative disease progresses from mild to moderate to severe. While non-proliferative diabetic retinopathy is not itself a sight-threatening condition, it can trigger macular oedema or macular ischaemia, which are other forms of diabetic retinopathy that may cause rapid vision loss at any stage of non-proliferative disease. In addition, the vascular changes that occur in non-proliferative retinopathy lead to retinal ischaemia (lack of blood flow to the retina) and trigger progression to sight-threatening proliferative disease. As the severity of non-proliferative retinopathy increases, the risk of developing sight-threatening proliferative diabetic retinopathy also increases. Proliferative diabetic retinopathy is characterised by  neovascularisation  – that is, the growth of abnormal new blood vessels in the retina. The vessels are weak and may burst and bleed into the retina or  vitreous fluid  (fluid surrounding the retina), causing vision loss. References: 1. American Academy of Ophthalmology Retina-Vitreous Panel. Preferred Practice Pattern® Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2014. Available at:  www.aao.org/ppp . 2. https://www.myvmc.com/diseases/diabetic-eye-disease-non-proliferative-diabetic- retinopathy/ 3. https://www.aao.org/topic-detail/diabetic-retinopathy-europ

Diabetic retinopathy

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How SD-OCT is changing our view of DME

In diabetic macular edema, vascular endothelial damage is a major event that results in the breakdown of the inner blood-retinal barrier and accumulation of fluid and serum macromolecules in the intracellular space.1 The Wisconsin Epidemiologic Study of Diabetic Retinopathy reported that 32% of patients developed macular edema within 22 to 24 years of diabetes diagnosis.

Long-term intraocular pressure changes in patients with neovascular age-related macular degeneration treated with ranibizumab

BACKGROUND/AIMS To investigate the long-term effects of multiple intravitreal injections (IVTs) of ranibizumab (Lucentis) on intraocular pressure (IOP) in patients with neovascular age-related macular degeneration. METHODS In 320 eyes, IOP measurements were performed at baseline prior to injection and compared with IOP measurements of the last visit. Correlations between mean IOP change and total number of IVTs, visual acuity or patient age were tested. RESULTS The mean IOP increase was 0.8 ± 3.1 mm Hg (p < 0.0001). Seven eyes showed final IOP values between 22 and 25 mm Hg. The mean follow-up was 22.7 ± 14.1 months. No further correlations between IOP change and number of IVTs, visual acuity or patient age have been found. CONCLUSIONS This study demonstrated a statistically significant IOP increase in patients treated with repeated injections of ranibizumab. However, IOP increase required no glaucoma treatment during the study. Therefore, repeated injections with ranibizumab can be considered safe with regard to long-term IOP changes in patients without ocular hypertension or glaucoma