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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Annual eye checks are needed, including visual acuity and retinal examination – ideally by retinal photography if resources allow. Screening is valuable because treatment may be started before visual loss occurs. Visual loss is caused by macular oedema (maculopathy) or retinal haemorrhage (proliferative retinopathy). Hyperglycaemia may affect vision by causing swelling of the ocular lens. Cataracts are more common in people with diabetes.
Artificial Intelligence and Hospital Automation
Published in Salvatore Volpe, Health Informatics, 2022
Another important factor in successfully integrating AI is in choosing its area of use. In our current capacity, AI is a more natural fit with certain clinical applications than others. A particularly good match for AI is the detection of diabetic retinopathy, the most common cause of vision impairment and blindness in adults who suffer from diabetes. Diabetic retinopathy occurs when high blood sugar levels damage blood vessels in light-sensitive retinal tissue in the back of the eye. Early detection is critical for managing this condition, but since half of diabetic patients do not see an eye doctor annually, many are not properly screened for diabetic retinopathy, according to Malvina Eydelman, MD, of the FDA Center for Devices and Radiological Health.
Diabetic Retinopathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Retinal vascular disease (diabetic retinopathy) is one of the most common causes of blindness in the United States. The International Diabetes Federation estimates that the global population with diabetes mellitus will reach 700 million by the year 2045. Diabetic retinopathy is a common complication of diabetes and a leading cause of preventable blindness in adults. The global prevalence of diabetic retinopathy is 22.27% of diabetic patients, and vision-threatening diabetic retinopathy is at 6.17%. Diabetic retinopathy is damage to the retinal blood vessels, which become leaky or blocked. Vision loss most commonly occurs due to swelling in the macula, the central part of the retina, which can lead to vision impairment. Abnormal blood vessels can also grow from the retina, causing bleeding and blindness. Subclassifications include nonproliferative diabetic retinopathy, which may or may not be severe, and proliferative diabetic retinopathy. Complications of diabetes mellitus also include macular edema and retinal detachment. Other outcomes include intraretinal hemorrhage, exudates, macular ischemia, vitreous hemorrhage, and neovascularization.
Malpractice Cases Arising From Telephone Based Telemedicine Triage in Ophthalmology
Published in Seminars in Ophthalmology, 2023
Elias H Kahan, Joshua D Shin, Michael E Jansen, Rebecca Hughes Parker, Ravi Parikh
This analysis showed that most medical malpractice lawsuits related to teleophthalmology resulted from delays in evaluation and/or treatment secondary to telephone visits. Although synchronous live audio-visual evaluation and high-resolution images generated through mobile health applications will become more prominent in the coming years, it is unlikely that telephone communication will ever be completely phased out of ophthalmic practice, and these learnings should be leveraged for mitigating future malpractice across all teleophthalmic encounters. Regarding telephone triage in particular, certain steps can be implemented in current practice to avoid the likelihood of malpractice litigation. Based on our findings, certain symptoms that may portend to endophthalmitis or retinal detachment, such as flashes and floaters, especially in the context of previous vitreous hemorrhage, detachment, or retinal repair, should warrant immediate in-person evaluation.
Dual phenotype: co-occurring Leber congenital amaurosis and familial exudative vitreoretinopathy: a case report
Published in Ophthalmic Genetics, 2023
Virginia Miraldi Utz, Jared J. Ebert, Diana S. Brightman, Brittany N. Simpson, Stefanie Benoit, Robert A. Sisk
IQCB1 encodes the protein nephrocystin-5, which is expressed in the connecting cilia of photoreceptor cells and the primary cilia of renal epithelial cells (https://doi.org/10.1038/ng1520). Thus, biallelic pathogenic variants in IQCB1 lead to a ciliopathy with both ocular and renal manifestations known as Senior Loken Syndrome 5 (SLS 5). The ocular findings include early-onset, severe retinal degeneration, and vision loss. The renal component is called juvenile nephronophthisis, and is a progressive cystic kidney disease characterized by polyuria, anemia, and decreasing kidney function that typically results in end-stage kidney disease in early adolescence (https://doi.org/10.1111/nep.13393). Hence, early nephrology involvement is imperative, and routine screening must be performed to detect early stages of renal disease.
Ocular abnormalities among patients with Down syndrome
Published in Alexandria Journal of Medicine, 2022
The prevalence of astigmatism is 14% in the range ±1 to ±2.75 D, whereas only 12% of the cases have a Ref E range above ±3 D. The prevalence of hyperopia is 14% in the range of Ref E + 1 D to +2.75 D, whereas hyperopia cases above +6 D are 12%. These results may appear among DSC because refractive error is the most common cause of subnormal visual acuity. Furthermore, refractive errors may be transient phenomena, as in diabetics whose blood glucose has recently been elevated. Additionally, myopia may be caused by the reversible osmotic swelling of the crystalline lens that accompanies hyperglycemia. Moreover, previous infection or trauma may decrease the visual acuity. Noteworthy, retinal disorders may cause irreversible visual loss especially at age-related macular degeneration. Diabetic retinopathy may cause visual acuity loss, whereas nondiabetic retinovascular disorders may decrease visual acuity. This explanation is in accordance with Walker [27], who revealed similar observation for other cases.