Lloyd M. Aiello

Influence of HLA-DR Phenotype and Myopia on the Risk of Nonproliferative and Proliferative Diabetic Retinopathy

The relationship between HLA-DR phenotype, refractive error, and risk of both nonproliferative and proliferative diabetic retinopathy was studied among 227 insulin-dependent diabetics participating in a case-control study of diabetic retinopathy. In the absence of myopia, risk of both proliferative and nonproliferative diabetic retinopathy was increased for HLA-DR phenotypes 4/0, 3/0, and X/X (HLA susceptible) compared to HLA-DR phenotypes 3/4, 3/X, and 4/X (HLA nonsusceptible). Odds ratios equalled 11.8 and 7.4 respectively. In the presence of myopia this increased risk associated with HLA status was abolished. Myopia decreased the risk of proliferative and nonproliferative diabetic retinopathy among HLA-susceptible individuals, odds ratio equalled .09 and .09, but had no protective influence among HLA-nonsusceptible individuals.

THE JOSLIN VISION NETWORK INNOVATIVE TELEMEDICINE CARE FOR DIABETES: Preserving Human Vision

Despite advances in understanding and treating diabetic retinopathy, diabetes remains a leading cause of new blindness in workingaged American~.~~ In the United States, current levels of eye care and laser surgery save 220 thousand person-years of sight and more than

Ocular Telemedicine for Diabetic Retinopathy and the Joslin Vision Network

471 million in federal dollars a n n ~ a l l y . ~ ~ ~ ~ If these levels of care are provided to everyone with diabetes in the United States, the savings rise to 400 thousand person-years of sight and 624 million federal dollars annually.21-23 Unfortunately, all persons with diabetes who would benefit from timely and appropriate retinal examination and sight-saving laser surgery do not have access to specialized eye care. Reasons for this lack of care and unnecessary loss of vision include3, 24:

Retinal venous caliber abnormality: Detection and analysis using matrix edge fields-based simultaneous smoothing and segmentation

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. The Joslin Vision Network Diabetes Eye Care Program (JVN) is a validated ocular telemedicine program developed at the Joslin Diabetes Center that has provided diabetes eye care to over 70,000 persons. The JVN allows accurate assessment of level of DR severity, detects the presence of nondiabetic eye disease, and allows determination of appropriate treatment recommendations. The JVN integrates eye care in a comprehensive diabetes program, extends access to evidence-based diabetes eye care, and offers alternative means of diabetes eye care in appropriate settings, ultimately preserving vision and preventing visual loss.

Diabetes Mellitus and Visual Function

We present a novel approach for detecting and analyzing Retinal Venous Caliber Abnormalities (VCAB). We use 1) the noise adaptive Matrix Edge Field variational energy functional formulation for simultaneous smoothing and segmentation, and 2) analyze its output, the edge field, to demonstrate the ability to recognize the deformations. This contribution is one step towards a wider vision of establishing an automated, low cost, easy to use classification and decision support system for rapid, accurate, and consistent retinal heath monitoring and lesion detection and classification.1

Retinal blood flow changes in patients with insulin-dependent diabetes mellitus and no diabetic retinopathy.

The National Diabetes Advisory Board reports that nearly 6 million Americans have been diagnosed with diabetes mellitus. An additional 5 million Americans are estimated to have undiagnosed diabetes.1 The majority of the latter has non-insulin-dependent diabetes mellitus (NIDDM), with a strong likelihood of having some degree of diabetic retinal disease at the time of diagnosis.