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All you can do is to live with it and bring the required changes in your life, to prevent the condition from worsening. The late stage of diabetes is very painful and can be extremely dangerous if proper care is not taken. In late stages of diabetes, the nerves and blood vessels running through kidneys are damaged due to excess blood glucose levels. This leads to delayed emptying of stomach, known as gastroparesis and can cause several problems, like bloating, heartburn, anorexia, abdominal pain, vomiting, and fullness of stomach. Severe damage may even cut off the blood circulation in feet, resulting into swollen and cold feet. The high sugar levels present in the blood of diabetic patient’s damage the vessels supplying blood to retina, causing them to bulge and leak. Most of these complications are the result of infections caused by bacteria, fungus, virus and other microbes. During the later stages of diabetes, the patient may also develop cardiovascular conditions. For many reasons, DR presents an ideal model for disease management by telemedicine and telehealth. While telemedicine has the potential to extend sight-preserving diabetes eye care, it is crucial that telemedicine programs match the quality of care expected in traditional clinical settings. Telehealth programs for DR should clearly define program goals and program performance in relation to accepted clinical standards. The ATA Practice Recommendations defined 4 clinical categories of assessment for validation (Table 1).
The Joslin Vision Network (JVN) Diabetes Eye Care Program is an ATA-defined category 3 telemedicine program for DR. Imagers and readers who successfully complete a JVN certification program and who demonstrate ongoing ability to meet quality standards according to JVN protocol can acquire and grade JVN images. A prospective study validated the ability of the JVN to determine clinical levels of DR and DME, timing of next retinal evaluation, and need to refer to ophthalmology specialists using JVN stereoscopic nonmydriatic digital-video color retinal images as compared to ETDRS 7-standard fields 35-mm stereoscopic color fundus photographs (ETDRS photos).22 The study enrolled 54 patients (108 eyes) with type 1 or type 2 DM with various levels of DR and DME. Because inability to identify significant nondiabetic-related eye disease would pose a serious shortcoming to any DR telemedicine program, a study was conducted to evaluate the ability of the JVN to detect ocular pathology other than DR in patients with DM compared with dilated retinal examination by retinal specialist ophthalmologists.25 A retrospective chart review of 280 Joslin Diabetes Center outpatients (560 eyes) with type 1 ortype 2 DM who had both JVN imaging and clinical comprehensive eye examination by retinal specialists at the Beetham Eye Institute of the Joslin Diabetes Center was conducted. JVN has been successfully deployed in more than 50 clinical sites within the Indian Health Service, and in each case, the JVN has resulted in increased access to diabetes eye care. In another study, the effect of the JVN was evaluated in a retrospective observational cohort study.
Telemedicine in general, and telemedicine for DM and DR in particular, are likely to play an increasing role in the delivery of health care.
A comprehensive disease management program (CDMP) development effort is under way involving leaders in diabetes clinical management, education, lifestyle modification, and medical informatics from the Joslin Diabetes Center, the Department of Defense, the Veterans Affairs, and the Indian Health Service. Philosophically, this management program has been developed to facilitate an interactive and continuous connection between patients and their care teams. Diabetes and its complications, particularly DR, provide an ideal opportunity for care with telemedicine.
Diabetic Retinopathy Study Report Number 2: Photocoagulation of proliferative diabetic retinopathy. Grading Diabetic Retinopathy From Stereoscopic Color Fundus Photographs—an Extension of the Modified Airlie House Classification.
Retinal Physician delivers in-depth coverage of the latest advances in AMD, diabetic retinopathy, macular edema, retinal vein occlusion as well as surgical intervention in posterior segment care. November, Diabetic Eye Disease month, is a good time to discuss the most common cause of diabetic eye problems: diabetic retinopathy.
Diabetic retinopathy causes leakage and bleeding behind the eye, or more precisely, in the delicate tissue at the back of the eye called the retina. Diabetic retinopathy can be treated with a laser to seal leaking blood vessels, surgery or a newer treatment in which medication is injected into the eye. Regular diabetic eye exams and good blood sugar control are the best way to prevent diabetic eye conditions. If you have diabetes and need an eye physician, call 503-935-5580 or request an appointment at Oregon Eye Specialists. Global Diabetic Retinopathy Project Group  in 2002 proposed a new classification for diabetic retinopathy.
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Does Dual-Energy Flat Panel Detector Radiography can serve as an Ideal Imaging modality in Detection of Vocal Cord Paralysis?
Rapid bedside assessment of the renal function of patients undergoing contrast-enhanced CT. The macula is the most specialized part of the retina, responsible for detailed vision and colour perception. In VEIC we apply all modern innovative therapies for the treatment of macular diseases such as intraocular drug delivery and photodynamic therapy. The intraocular drug delivery is based on the recent observation that the vitreous has the ability to store drugs with biological properties in itself as well as in the retina. The photodynamic therapy is based on the combined action of photosensitive pigments (Visudine), that are administered intravenously and laser radiation, that excites them to obtain biological activity. The inherited diseases of the retina often lead to its degeneration resulting in irreversible loss of vision quite early in life. You have diabetic retinopathy, a condition that happens when diabetes damages blood vessels in the rear of the eye.
Tell your healthcare provider about all medicines, herbal remedies, and supplements you take.
During the surgery, tiny instruments are inserted through small incisions in the sclera (white of the eye).
This condition is caused due to increased sugar levels in blood and leads to several other complications. During the early stages, diabetic symptoms can be controlled with healthy diet and proper treatment, but as the diabetes progresses, symptoms become worse and cause several other complications.
This is also known as diabetic nephropathy and is one of main symptoms of late stage diabetes.
Due to high blood sugar levels, the vagus nerve, responsible for signalling and initiating emptying of stomach gets damaged. Sores, infections, cuts and bruises may also occur on the feet and skin may become hairless and shiny.
Due to this, the retina is not able to get proper blood supply and so essential nutrients and oxygen also do not reach the retina.
The symptoms include problems in getting erection or erectile dysfunction in men, and increased infections in vaginal area, decreased vaginal lubrications, fewer orgasms, and difficulty in arousal in women.
Due to high blood sugar levels of diabetic patients, the arteries become weak and the risk of getting heart attacks and strokes increases.
PhysiciansJobsPlus allows you to post your resume, receive relevant ophthalmology open position alerts via email and apply for positions online. Ocular telemedicine for DR, appropriately deployed and properly validated, has the potential to deliver high-quality, chronic, urgent, and emergent care, limited only by the ability to deploy the latest technologies. Telehealth is closely associated with telemedicine and encompasses a broader definition of remote health care that relies on videoconferencing, electronic patient portals to record and monitor vital signs, transmission of digital images and records, electronic consultation, patient education, and continuing medical education.


There are an estimated 21 million Americans with DM and more than 150 million people worldwide with the condition, with the number of cases increasing at epidemic rates.8,9 DM is a complex, chronic disease that requires lifelong care. Aiello, MD, are both faculty in the Department of Ophthalmology at the Harvard Medical School in Boston.
Because there are evidenced-based methods to preserve vision for those with DM faced with an increased risk of vision loss, ocular telemedicine should include and apply these proven methods. In general, the selection of an ocular telehealth system for evaluating DR should be based on the unique needs of the healthcare setting. Technology considerations addressed the following areas: image acquisition, compression, analysis, data communication and transfer, display capabilities, archiving and retrieval, security, reliability and redundancy, and documentation.
The JVN has been rigorously validated to demonstrate reliable diagnosis compared to current clinical standards and identifies clinical level of DR accurately compared to ETDRS 7-standard fields 35-mm stereoscopic slides and clinical examination by a retinal specialist.
For each retinal field, a stereoscopic pair of images was acquired by a manual horizontal translation of the fundus camera, as is standard for obtaining nonsimultaneous stereoscopic retinal photographs.
Nonsimultaneous 45°-field stereoscopic digital-video color images (JVN images) were obtained according to JVN protocol prior to pupil dilation.
Joslin Vision Network Fields compared to Early Treatment Diabetic Retinopathy (ETDRS) 7-standard fields. Images were graded by certified JVN readers and patients with significant retinal disease underwent evaluation by retinal specialists. In the Indian Health Service, the impact of JVN retinal imaging technology was measured on the rate of surveillance and treatment of DR in this large, well-defined patient population over a 5-year period.26 A computerized patient information system described, on an annual basis, the patient population, the number of patients with DM, and the proportion of the diabetic patients who received appropriate medical services as measured against standards of care before and after implementation of the JVN digital retinal imaging system in a primary care setting. Veterans at the Togus Veterans Health Administration outpatient clinic with DM, impaired fasting glucose, or impaired glucose tolerance were imaged according to JVN protocol prior to scheduled nonophthalmic appointments or based on ophthalmic history.27 Images were transmitted to the Beetham Eye Institute of the Joslin Diabetes Center for grading and recommended treatment plan. Telemedicine has the potential to expand the delivery of care, establish a widespread standard of care that is based on validated clinical standards, and allow patients to participate more fully in their health care.
Overall agreement for specific non-diabetic retinopathy findings as determined by clinical dilated fundus exam, Joslin Vision Network evaluation.
The rationale for this effort was the recognized need to provide a continuum of care for diabetic patients. The program is able to aggregate clinical data from diverse sources, such as electronic medical record systems, lab systems, and data from the home, through the use of physiologic home-monitoring devices.
The JVN is a telemedicine diabetes eyecare program that allows accurate assessment of level of DR, is sensitive in identifying nondiabetic related eye disease, and has the potential to be an integral part of a comprehensive diabetes management program.
Patient adherence to guidelines for diabetes eye care: results from the Diabetic Eye Disease Follow-up Study. Photocoagulation for diabetic macular edema; Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study Report Number 9: Early photocoagulation for diabetic retinopathy.
The effect of intensive treatment of diabetes on the development and progression of long term complications in insulin-dependent diabetes mellitus. Effect of intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes: UKPDS 33.
Preserving human vision: The Joslin Vision Network (JVN) innovative telemedicine care for diabetes. Stereo nonmydriatic digital-video color retinal imaging compared to ETDRS 7-standard field 35-mm stereo color photos to diagnose level of diabetic retinopathy. Use of Joslin Vision Network Digital-Video Nonmydriatic Retinal Imaging to assess diabetic retinopathy in a clinical program.
Nonmydriatic digital retinal imaging alternative for annual retinal examination in persons with previously documented no or mild diabetic retinopathy.
Comparison of nonmydriatic digital retinal imaging vs dilated ophthalmic examination for nondiabetic eye disease in persons with diabetes.
Addition of primary-care based retinal imaging technology to an existing eye care professional referral program increased the rate of surveillance and treatment of diabetic retinopathy. A telemedicine program for diabetic retinopathy in a Veterans Affairs Medical Center—the Joslin Vision Network Eye Health Care Model. The sensitivity and specificity of nonmydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy. A modeled economic analysis of a digital teleophthalmology system as used by three federal healthcare agencies for detecting proliferative diabetic retinopathy.
It reaches both retinal specialists and general ophthalmologists with practical insight regarding current and future treatment strategies in medical and surgical retina care. It causes vision loss because the retina is where the eye forms images and sends them to the brain. This is called “anti-VEGF” treatment (VEGF stands for “vascular endothelial growth factor,” and anti for “antibodies”).
We have 10 convenient locations, and all our physicians are experienced in caring for diabetic eye conditions.
To enhance your browsing experience, please upgrade to a more current browser such as Firefox, Safari or update to Internet Explorer 9. Some of the major diseases that affect the macula, such as age related macular degeneration and diabetic retinopathy lead to impaired vision.
This idea was firstly applied in the treatment of serious intracular infections with antibiotics but recently we found out that the same method can be used for the administration of biological drugs such as antibodies against specific target molecules.
This method has been applied to treat age related macular degeneration in conjuction with drugs against growth factors (anti-VEGF). Once diagnosed with this condition, it is not possible to reverse the process and get back to being normal. It is important that you take care of your body to delay the appearance of these symptoms, but once they start appearing, fix a regular appointment with your healthcare provider. These symptoms are also often accompanied by chills, back pain and fever. The condition can further worsen to result into kidney failure and the person may be required to go on dialysis to remove wastes. This can also lead to the development of ulcers, which can eventually become gangrenes, as the patient cannot feel much of pain and sensation due to numbness in feet.
This triggers abnormal growth of blood vessels, which again get damaged and the vision is hampered. Also, in diabetes, the nerves are damaged due to high blood sugar levels, which can cause several skin complications. The healing of wounds also becomes extremely slow and skin becomes very prone to external infections.
These problems are caused due to damage of the nerves and blood vessels in the associated organs. It becomes even difficult to lay down and sit up, as it may cause dizziness, weakness and vision changes. You need to be specially aware of these symptoms of late stage diabetes and take proper care of your health. The ATA, recognizing the importance of evidence-based care in telemedicine, established consensus recommendations for ocular telemedicine for DR with the intent to improve clinical outcomes and promote informed and reasonable patient expectations. It has demonstrated the ability to identify accurately non–diabetes-related eye disease. An external view image was also acquired for evaluation of ocular adnexa and media clarity. This study showed that undilated digital-video images using the JVN system were comparable to dilated ETDRS photographs in determining the clinical level of DR and validated the agreement between nonmydriatic JVN images and dilated ETDRS photos. Three eyes (2.9%) had JVN images ungradable for DME and 1 of these eyes had DME by clinical examination.


Findings from JVN digital images were compared with findings from dilated retinal examination by retinal specialists performed within an average of 39.6 days of digital imaging.
A procedure log ascertained the proportion of patients who received laser treatments for DR per year.
Implementation of retinal imaging technology in a primary care setting led to a significant increase in the rate of DR surveillance and a proportional increase in the rate of laser treatment for DR for a large patient population.
Patients with significant diabetic eye disease, with nondiabetic ocular findings, or who were overdue for ocular examination were referred for ophthalmic care. 354 patients (29.0%) had either no DR or mild NPDR in both eyes, no evidence of DME, and no significant nondiabetic findings. For ocular telemedicine, advancing technologies are likely to allow automated grading of DR, with computer-assisted identification of lesions of DR and other retinal disorders. In this way, the system is able to present data to a physician in a medically relevant manner that allows patient-doctor communications to be optimized over what is generally a very short patient visit.
The most comprehensive retinal care journal, Retinal Physician puts into perspective what the scientific developments mean to today’s practice and discusses ramifications of new studies, treatments and patient management strategies. Regular follow ups by a specialized ophthalmologist are necessary in order to avoid  irreversible damage to vision. Nowadays the intraocular pathway is the way of choice for the administration of drugs against macular degeneration (anti-VEGF) and macular oedema in cases such as diabetes, inflammations, thrombosis and postoperative oedema.
In addition to that it is often used in the treatment of chronic central serous retinopathy. For the early and correct diagnosis of these diseases careful clinical observation is required combined with electrophysiological examination and genetic identification. During vitrectomy, the eye healthcare provider removes the cloudy vitreous and replaces it with fluid, silicone oil, or gas. Before surgery, an anesthesiologist (a healthcare providerwho provides medicine to control pain) will meet with you. It is replaced with a substitute, such as saline (saltwater) solution, silicone oil, or a gas bubble that holds the retina in place.
This is known as diabetic retinopathy and can lead to cataract or glaucoma and also in extreme cases, complete loss of vision or blindness. DM poses significant personal and societal problems, remaining a leading cause of vision loss in industrialized countries. Reports of clinical applications of the JVN demonstrate the value and potential of this telemedicine program in providing eye care for DR.
These images are labeled, digitized, and stored on the JVN system using proprietary software. Images are graded by certified JVN readers at the Beetham Eye Institute of the Joslin Diabetes Center (Figures 1 and 2).22-24 Stereo image viewing is achieved using LCD-shuttered goggles (Stereographics, San Rafael, CA) and results are recorded on JVN templates designed for clinical diagnosis. JVN images and ETDRS photos were graded on a lesion-by-lesion basis by 2 independent, masked readers to assess ETDRS clinical level of DR.
An independent senior retinal specialist adjudicated disagreements by review of JVN images and ETDRS photos when available. Overall, JVN nonmydriatic digital imaging demonstrated excellent agreement with dilated ophthalmic examination by retinal specialists in the detection of ocular disease other than DR (Figure 4). Integrating diabetic eye care into a comprehensive diabetes care program will allow eye care that considers and addresses risk factors for onset and progression of DR and allows a continuum of care that reduces the risks of complications from DM. In the DPP, patients were randomized to either intensive lifestyle modification, metformin, or placebo treatment. The robust clinical decision support system also rapidly identifies patients at risk or who have other medical issues that need to be addressed. Risk of neovascularization (growth of new, abnormal vessels) in areas of retina that are no longer getting oxygen because the regular vessels are blocked. In VEIC we research the use of the intraocular pathway for the admonistration of drugs like NSAIDS and bio-drugs against target molecules associated with the process of inflammation (anti-TNF). In our Institute we run a protocol to investigate whether the photodynamic therapy can be applied in the level of the ciliary body to reduce the intraocular pressure. The Fundus Department of the University Hospital of Heraklion is a Reference Centre for Hereditary Retinal Diseases. In addition, the retina may be repaired if there is scar tissue. This can help make your vision clearer.
You’ll talk about the type of anesthetic (pain medicine) that will be used during the surgery.
While there are standards other than ETDRS 30° stereo 7-standard fields for grading DR, protocols should define alternate standards used for validation if ETDRS photos are not used.
Importantly, by clearly defining and applying standards, the Telehealth Practice Recommendations for Diabetic Retinopathy apply evidence-based clinical care to ocular telemedicine for DR.
An independent retinal specialist adjudicated inter-reader disagreements in a masked fashion. Recommended follow-up from JVN imaging compared favorably to clinical examination by a retinal specialist and significant nondiabetic ocular pathology was identified. The result will be a continuum-of-care model that fosters productive interactions between patients who take an active part in their care and a variety of providers backed up by resources and expertise. After follow-up of 4.6 years, lifestyle modification reduced the progression to DM by 58%, reinforcing the value of case-management programs. It is expected that the management and healthcare delivery services provided through this application will allow a primary-care practitioner to appropriately manage patients with chronic diseases such as diabetes for longer periods of time before having to refer patients to more expensive subspecialty services. Most people need a monthly injection for a while, and the treatment itself can damage your retina. The availiability of experienced clinical team, modern electrophysiology laboratory, Clinical Genetic Bank and cooperation with the Biogenomica Laboratory of Genetics, that ia specialized in genetic identification of retinal diseases makes VEIC a state of the art Institute for the diagnosis and treatment of inherited retinal diseases.
The images are captured in true color (24 bits) at a resolution of 640 × 480 pixels.
Upon full population of the templates, the JVN software calculates the clinical level of DR based on ETDRS algorithms. ETDRS clinical level of DR, timing of next ophthalmic evaluation of DR, and need for prompt referral to retinal specialist were compared. JVN digital imaging closely matched clinical examination for level of DR and DME, would have resulted in no patients receiving less stringent follow-up, and was well accepted by patients. Thus, the patient is an informed, proactive self-manager using telemedicine technology as a tool to keep DM in control and provide ongoing education and care to minimize complications, symptoms, and disability. The CDMP is a case-management program that provides continuous and immediate contact between patients, care managers and physicians over secure Web sites. Relevant patient demographics, medical histories, related laboratory results, and clinical study data are also recorded. In a nonophthalmic setting, JVN identified severity of DR permitting appropriate triage for eye care, and detected nondiabetic ocular conditions suggesting ophthalmic evaluation in a large percentage of patients, even in the absence of significant DR. It is anticipated that the development of the interactive Web-based education and behavior modules will provide the largest potential benefit with respect to motivating patients to set reasonable goals for their management of DM and thus maximize the clinical benefit. Subsequently, the US Veterans Administration initiated their National Teleretinal Program, which is based on the JVN model.



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