Objective
To evaluate the impact of long‐term glycaemic control and glycaemic variability on microvascular complications in adolescents and young adults with childhood‐onset Type 1 diabetes.
Methods
...Twenty‐six participants took part in a prospective follow‐up study. We used univariate generalised estimating equations (GEE) analysis with first‐order autoregressive AR(1) covariance structure for repeated measurements to evaluate the relationship between emerging diabetic retinopathy (DR) and each single explanatory variable, namely age at developmental stages from late prepuberty until early adulthood, duration of diabetes and long‐term HbA1c. Thereafter, the simultaneous effect of these three explanatory variables to DR was analysed in a multivariate model.
Results
Twenty‐five participants developed DR by early adulthood after a median diabetes duration of 16.2 years (range 6.3–24.0). No participants had DR during prepuberty. Each of the three variables was independently associated with emerging DR: age (OR 1.47, 95% CI to 1.25 to 1.74, p < 0.001) stronger than diabetes duration (OR 1.42, 95% CI 1.23 to 1.63, p < 0.001) and HbA1c (OR 1.02, 95% CI 1.001 to 1.05, p = 0.041) in this population. In the multivariate analysis of these three explanatory variables, only age was associated with DR (adjusted OR 1.52, 95% CI 1.10 to 2.10, p = 0.012).
Conclusions
The emergence of DR during adolescence and early adulthood is not rare and increases with age in patients with deteriorating metabolic control during puberty and thereafter. This underpins the need to prevent deterioration of glycaemic control from taking place during puberty—seen again in this follow‐up study—in children with diabetes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Aim:To evaluate the social performance of young adults with type 1 diabetes (T1D) since childhood with particular interest in its relation to the severity of diabetic retinopathy (DR). Methods: The ...prevalence of DR was evaluated in a populationbased Finnish cohort of children with TID during 1989-1990. The subjects were contacted 18 years later for evaluation of DR, education, employment, and family relations. Results: 136 of 216 subjects participated in the study in 2007 (mean age 30±3 years, mean diabetes duration 23±4 years, 78 men). There were 42 subjects (31%) with proliferative diabetic retinopathy (PDR). A university degree was held by 9%, a degree from a university of applied sciences by 33%, and 45% had a vocational school education; 7% were full-time students while 4% had received no education after comprehensive school. PDR was associated with lower education. Sixty percent of the subjects with PDR and 68% of those with non-PDR held full-time jobs. Four percent of the non-PDR group were unemployed while 26% of subjects with PDR were outside working life because of either unemployment or retirement. Seventy-one percent of the subjects had a spouse, and 60 subjects had a total of 119 children. PDR did not compromise the likelihood of having a spouse and children. Conclusions: The majority of young adults withTID take active roles in society by working and raising families. However, patients with PDR lacked secondary education significantly more often and were less likely to work than those with non-PDR.
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BFBNIB, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK
Aim was to explore the health-related quality of life (HRQoL) and related factors among older adults with visual impairment (VI). A total of 39 independently living subjects aged ⩾65 years (83 ± ...6.5), referred to the Low Vision Center of the Oulu University Hospital, Finland during one year participated in the study. The participants had low vision or blindness as defined by the World Health Organization (WHO). The 15D, a generic HRQoL instrument, was used to assess the HRQoL, and an ophthalmic examination was performed to assess vision. A population-based control group (n = 1074) was available for comparison. The mean 15D index scores for the participants and the control group were 0.768 (SD = 0.089) and 0.827 (SD = 0.044), respectively, (p < .002). In the dimensions of move (p < .05), see (p < .001), breath (p < .05), usual activities (p < .001), depression (p < .05), and distress (p < .05), the study participants scored statistically significantly lower than the control group. However, the participants had better mental function scores (0.856 vs 0.773, p < .05). Among the participants, there was no difference in the 15D by gender (men 0.755, women 0.774, p > .05), habitation (alone 0.768, with someone 0.770, p > .05), or age (r = –.084), nor did the extent of low vision appear to affect the 15D index in this material. The older adults with VI had poorer 15D index score than Finnish population of equal age, but they scored better in the dimension of mental function. Mental skills may indeed be crucial for independent living despite VI.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
This study aims to use fundus image material from a long-term retinopathy follow-up study to identify problems created by changing imaging modalities or imaging settings (e.g., image centering, ...resolution, viewing angle, illumination wavelength). Investigating the relationship of image conversion factor and imaging centering on retinal vessel geometric characteristics (RVGC), offers solutions for longitudinal retinal vessel analysis for data obtained in clinical routine.
Retinal vessel geometric characteristics were analyzed in scanned fundus photographs with Singapore-I-Vessel-Assessment using a constant image conversion factor (ICF) and an individual ICF, applying them to macula centered (MC) and optic disk centered (ODC) images. The ICF is used to convert pixel measurements into μm for vessel diameter measurements and to establish the size of the measuring zone. Calculating a constant ICF, the width of all analyzed optic disks is included, and it is used for all images of a cohort. An individual ICF, in turn, uses the optic disk diameter of the eye analyzed. To investigate agreement, Bland-Altman mean difference was calculated between ODC images analyzed with individual and constant ICF and between MC and ODC images.
With constant ICF (
= 104 eyes of 52 patients) the mean central retinal equivalent was 160.9 ± 17.08 μm for arteries (CRAE) and 208.7 ± 14.7.4 μm for veins (CRVE). The individual ICFs resulted in a mean CRAE of 163.3 ± 15.6 μm and a mean CRVE of 219.0 ± 22.3 μm. On Bland-Altman analysis, the individual ICF RVGC are more positive, resulting in a positive mean difference for most investigated parameters. Arteriovenous ratio (
= 0.86), simple tortuosity (
= 0.08), and fractal dimension (
= 0.80) agreed well between MC and ODC images, while the vessel diameters were significantly smaller in MC images (
< 0.002).
Scanned images can be analyzed using vessel assessment software. Investigations of individual ICF versus constant ICF point out the asset of utilizing an individual ICF. Image settings (ODC vs. MC) were shown to have good agreement.
Aim
This study aimed to describe visual performance and the need for vision care services among Finnish older people receiving home care. We evaluated the applicability of the Resident Assessment ...Instrument of Home Care (RAI HC) in identifying visual impairment (VI) and the need for vision care services among older people.
Design
A descriptive quantitative, cross‐sectional design.
Methods
Visual impairment and the need for vision care services for older people receiving home care (N = 70) were determined by an optometrist's screening examination and vision assessment by home care workers using the RAI HC instrument. In this study, the definition of visual impairment was visual acuity (VA) <0.63 (logMAR >0.2).
Results
According to the distance VA measurements, 41% of the participants showed VI (<0.63) of the better eye, while the RAI HC assessment revealed VI among 36% of the participants. The Kappa value for interrater reliability in classifying VI was 0.137. The optometrist's vision screening examination recognized a previously unknown and unmet need for vision care services more than twice as often as the RAI HC assessment.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Purpose.
To determine whether phacoemulsification cataract surgery with intraocular lens (IOL) implantation interferes with measuring optic nerve head (ONH) topography using the Heidelberg Retina ...Tomograph (HRT).
Methods.
The study population consisted of 31 women and 12 men aged 63–81 years with no previous history of eye diseases, surgery, laser procedures, or medication. The patients underwent first eye cataract surgery for senile cataract. The HRT II with software version 1.6 was used to obtain 3-dimensional images of the ONH as a part of a comprehensive ocular examination. The quality of the HRT image was assessed using topography standard deviation (TSD). Topography measurements are considered to be unreliable if TSD is more than 50 μm. Re-examination took place 1 month after surgery.
Results.
Before surgery, the topography measurements were unreliable in 35% (15/43) of the eyes; in 3 of these cases, ONH topography could not be calculated at all. One month after cataract surgery, the ONH topography could be calculated in all eyes and only one displayed unreliable topography measurements. The mean TSD was 40 μm before and 22 μm after surgery when calculated for all eyes with measurable topographies. The change in TSD was statistically significant (p<0.0005). The image alignment between the HRT examinations before and after surgery was excellent in 67% (26/39). Magnification changes occurred in 21% (8/39).
Conclusions.
Phacoemulsification cataract surgery with IOL implantation improves the image quality of the HRT. However, because of magnification changes and image misalignment, HRT follow-up of the ONH after cataract surgery is often unreliable.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Purpose
To evaluate retrospectively the potential benefit of a routine 1‐month ophthalmic check‐up after cataract surgery, and the potential harm after terminating this practice and only organizing a ...check‐up for those patients anticipated to need such.
Methods
In 2006, cataract patients of the Oulu University Hospital Eye Clinic were advised to have a check‐up at an ophthalmologist 1 month after uneventful surgery, while in 2009, no check‐up was regarded necessary. The consecutive first 1000 cataract surgery visits in both 2006 and 2009 are included in this study. Data on intra‐ and postoperative complications, ocular comorbidity, planned and unplanned postoperative out‐patient visits, nights in the hospital and phone calls were gathered until 2014. In both time periods, a hospital check‐up was provided for patients experiencing complications or symptoms.
Results
There were 31 complications identified during or immediately after cataract surgery in 2006, and 23 in 2009. Fifty‐eight (2006) and 27 patients (2009) were assigned an out‐patient visit to the hospital. Additional 42 (2006) and 39 patients (2009) contacted the hospital because of symptoms, five (2006) and three (2009) with a referral. Medical or surgical intervention was needed by a third. Long‐term complications other than secondary cataract were rare in both groups. Problems attributable to the lack of a 1‐month check‐up were not found in the later patient group during 5 years of follow‐up.
Conclusion
According to this study, ophthalmic check‐up arranged at 1 month after uneventful cataract surgery is unnecessary. However, the 5–10% of patients with intraoperative problems or ocular comorbidities that could interfere with recovery, or postoperative symptoms, should be seen at low threshold.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Visual impairment (VI) problems are increasing as the global aging population grows. Mobile devices have become essential to interacting with friends and society. Because the visually impaired are no ...exception, it would be useful to determine the functionalities that best support the independence of people with VI. The currently available functionalities and applications were analysed to provide insight about which features the visually impaired value most.
A Webropol survey with structured and open-ended questions was carried out. The participants (n = 26) were asked about their use of mobile applications and opinions regarding the usefulness of certain applications in promoting independent functioning. An instrument was developed for this study based on previous literature, and its quality was assured through an expert panel evaluation and pre-testing. The collected data were analysed statistically and by inductive content analysis.
A majority of the participants were active users of mobile devices. Substantial variation was observed in the evaluations of how useful various applications are to different everyday tasks. The participants suggested numerous improvements, such as additional customization, to the current mobile devices and applications.
Implications for Rehabilitation
People with VI benefit from the use of mobile devices in the same way that the population with normal vision does, and mobile devices and applications can be pivotal to supporting their independence.
The participants offered innovative ideas and suggestions for how mobile devices and applications could be designed to better meet the needs of the visually impaired.
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IJS, NUK, UL, UM, UPUK, VSZLJ
To evaluate clinical outcomes, functional vision and quality of life (QoL) after 35-year duration of type 1 diabetes (T1D) and proliferative diabetic retinopathy (PDR).
A population-based cohort ...study of T1D. Data from laboratory tests, ophthalmic examinations, multifunctional vision-test, and 15D-QoL measurements were analysed.
35 % of the original cohort (n = 216) had PDR, and 48 % of them were re-evaluated. They were 41 ± 3 34–46 years old and 62 % were males. The duration of T1D was 35 ± 4 29–41 years. 76 % had transdermal glucose monitoring. HbA1c had decreased from 80.1 mmol/mol to 63.6 mmol/mol (p < 0.001). Visual acuity was 73–77 ETDRS-letters. Two patients had visual impairment. Visual field sensitivities were lower in PDR vs. healthy controls (23.2 ± 3.9 dB vs. 26.9 ± 1.0 dB, and 14.9 ± 5.6 dB vs. 21.0 ± 2.0 dB, respectively, p < 0.001). Contrast sensitivity was similar, but the reaction time was longer in the PDR group (490.5 ms vs. 462.8 ms, p = 0.004). QoL-parameters concerning sleeping, usual activities, discomfort and symptoms, and sexual activity had decreased, but improved for mobility and distress.
Long-term visual prognosis and QoL remained good despite the declined functional vision caused by PDR.
•Visual prognosis and quality of life remain good in patients with proliferative diabetic retinopathy despite the long-term duration of type 1 diabetes.•Good glycaemic control and modern treatment of proliferative diabetic retinopathy preserves vision and helps to maintain good quality-of-life in patients with type 1 diabetes.•The proper visual function and good QoL seemed to remain likely due to good glycaemic balance and beneficial effect of novel glucose monitoring systems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
To report clinical and genetic characteristics of familial exudative vitreoretinopathy (FEVR) in the Finnish population.
Detailed clinical and genetic data of 35 individuals with heterozygous ...pathogenic variants in FZD4 were gathered and analysed.
Thirty-two individuals with FZD4 c.313A>G variant and three individuals with FZD4 c.40_49del were included in the study. The clinical phenotype was variable even among family members with the same FZD4 variant. Only 34% (N = 12/35) of variant-positive individuals had been clinically diagnosed with FEVR. The median age of the onset of symptoms was 2.3 years, ranging between 0 to 25 years. Median visual acuity was 0.1 logMAR (0.8 Snellen decimal), ranging between light perception and -0.1 logMAR (1.25 Snellen decimal). Most (N = 33/35, 94%) were classified as not visually impaired. Despite unilateral visual loss present in some, they did not meet the criteria of visual impairment according to the WHO classification. Two study patients (N = 2/35, 6%) had severe visual impairment. The most common FEVR stage in study patient's eyes (N = 28/70 eyes, 40%) was FEVR stage 1, that is, avascular periphery or abnormal vascularisation. Most of FZD4-variant-positive study patient's eyes (N = 31/50 eyes, 62%) were myopic. Two individuals presented with persistent hyperplastic primary vitreous expanding the phenotypic spectrum of FEVR. Shared haplotypes extending approximately 0.9 Mb around the recurrent FZD4 c.313A>G variant were identified.
Most study patients were unaffected or had mild clinical manifestations by FEVR. Myopia seemed to be overly common in FZD4-variant-positive individuals.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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