The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and ab...The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry.Their analysis revealed 47 differentially expressed proteins in the GDM group,with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls.Although these findings are promising,the study is limited by its small sample size(n=4 per group)and lacks essential details on the reproducibility and reliability of the protein quantification methods used.Furthermore,the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis.The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM.Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance.Despite its limitations,the study presents valuable insights into potential GDM biomarkers,but larger,well-validated studies are needed to establish their predictive utility and generalizability.展开更多
The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabete...The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.展开更多
We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amaz...We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic.Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs.The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics,and has been beneficial during the coronavirus disease 2019 pandemic.We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability,accessibility and affordability of these programs as methods of healthcare delivery.Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability.However,patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.展开更多
Artificial intelligence(AI),encompassing machine learning and deep learning,is being extensively used in medical sciences.It is slated to positively impact the diagnosis and prognostication of various diseases.Deep le...Artificial intelligence(AI),encompassing machine learning and deep learning,is being extensively used in medical sciences.It is slated to positively impact the diagnosis and prognostication of various diseases.Deep learning,a subset of AI,has been instrumental in diagnosing diabetic retinopathy(DR),diabetic macular edema,glaucoma,age-related macular degeneration,and numerous other ocular diseases.AI performs equally well in the early prediction of glaucoma and agerelated macular degeneration.Integrating AI with telemedicine promises to improve healthcare delivery,although challenges persist in implementing AI algorithms,especially in deve-loping countries.This review provides a compre hensive summary of AI,its applications in ophthalmology,particularly DR,the diverse algorithms utilized for different ocular conditions,and prospects for the future integration of AI in eye care.展开更多
Proliferative diabetic retinopathy(PDR)affects approximately 6%of diabetic patients globally.The overall prevalence of diabetic retinopathy is around 22%.Wet age-related macular degeneration(ARMD),the sight-threatenin...Proliferative diabetic retinopathy(PDR)affects approximately 6%of diabetic patients globally.The overall prevalence of diabetic retinopathy is around 22%.Wet age-related macular degeneration(ARMD),the sight-threatening type of ARMD,affects approximately 1.2%-1.3%of the general population and represents 15%of total ARMD cases.While intravitreal anti-vascular endothelial growth factor injections are still the mainstay therapy,there are a few challenges,such as frequent administration,cost burden,and compliance barriers that prompt the need for exploration into systemic oral alternative drugs like fenofibrate,candesartan,and vorolanib.These oral therapies have the advantage of being noninvasive and systemically accessible with few logistical burdens.This review highlights current evidence supporting the use of oral therapies in PDR and wet ARMD management,along with practical limitations and future prospects.展开更多
Diabetes mellitus ranks among the most prevalent non-communicable diseases worldwide,affecting a vast number of individuals.It can impact almost every organ in the body,leading to serious complications such as diabeti...Diabetes mellitus ranks among the most prevalent non-communicable diseases worldwide,affecting a vast number of individuals.It can impact almost every organ in the body,leading to serious complications such as diabetic retinopathy(DR),diabetic nephropathy,and diabetic neuropathy.Scientific literature indi-cates that patients with severely compromised kidney function may develop non-responsive DR.Moreover,anaemia in individuals with diabetic kidney disease(DKD)complicates DR and can contribute to significant health issues.Optical coherence tomography(OCT)is a widely used non-invasive imaging tool for diagnosing,managing,and predicting DR.OCT findings in patients with DR and DKD include cystoid macular oedema,diffuse retinal thickening,disruptions in the ellipsoid layer,hyperreflective dots,and damage to the external limiting membrane.The review examines OCT patterns of diabetic macular oedema in DKD,correlating these patterns with declines in kidney function and visual acuity.Additionally,we review various biomarkers linked to DR in DKD patients and the growing importance of novel imaging biomarkers in predicting and connecting the severity of DR with DKD.展开更多
The recently published article by Gao et al identifies risk factors for anxiety and depression in patients with diabetic retinopathy.We supplement that there is pathophysiological evidence to show a complex and possib...The recently published article by Gao et al identifies risk factors for anxiety and depression in patients with diabetic retinopathy.We supplement that there is pathophysiological evidence to show a complex and possibly bidirectional re-lation between diabetes,diabetic retinopathy,and mood disorders,especially depression.Longitudinal studies may strengthen proof of a causal relationship between these diseases.A better understanding can help in the holistic manage-ment of these patients.展开更多
BACKGROUND The gut microbiome is integral to human health,with emerging research underscoring its potential impact on ocular health through the gut-eye axis.Various ocular disorders,such as dry eye syndrome,retinal va...BACKGROUND The gut microbiome is integral to human health,with emerging research underscoring its potential impact on ocular health through the gut-eye axis.Various ocular disorders,such as dry eye syndrome,retinal vascular diseases,macular degeneration,and glaucoma,may be influenced by gut dysbiosis,which could significantly contribute to their development and progression.AIM To evaluate the influence of the gut microbiome on the pathogenesis and progression of various ocular diseases.METHODS An extensive search of the scientific literature was undertaken by adhering to Preferred Reporting Items for Systematic Reviews&Meta-Analyses standards,using PubMed(MEDLINE),Scopus,EMBASE,and the Cochrane Library as sources to locate studies addressing the relationship between the gut microbiome and human health.To capture all relevant publications,search terms were systematically applied across these major databases,without limiting the search by language or publication date.Inclusion criteria covered randomized controlled trials,non-randomized controlled trial,prospective studies,cross-sectional studies,and case-control studies.Out of the 3077 articles,36 full texts were included in the review.RESULTS Ocular health appears to be shaped by the gut microbial community through mechanisms such as immune regulation,preservation of the blood–retinal barrier,and the generation of protective metabolites.Disturbances in this microbial balance can provoke measurable alterations in host immunity,providing a plausible immunopathogenic pathway that connects intestinal dysbiosis with eye disease.Both laboratory models and early human data suggest that targeted interventions,including prebiotics,probiotics,synbiotics,and faecal microbiota transfer,hold therapeutic potential.CONCLUSION The gut–eye relationship reflects a multifaceted interaction in which the intestinal microbiome contributes to ocular health through complex biological pathways.Integrating microbiome assessments into diagnostic methods can revolutionize disease management through early detection and targeted interventions.Further,randomised controlled clinical trials are necessary for ocular diseases to prove causal relationships.展开更多
Ocular hypertension(OHT),defined as increased intraocular pressure(IOP,>21 mmHg)in eyes without optic disc changes or visual field changes,is a condition that puts an eye at higher risk of developing glaucomatous o...Ocular hypertension(OHT),defined as increased intraocular pressure(IOP,>21 mmHg)in eyes without optic disc changes or visual field changes,is a condition that puts an eye at higher risk of developing glaucomatous optic neuropathy and may be related to the translaminar pressure gradient,individual differences in IOP-related glaucoma susceptibility,effects of arterial blood pressure on the optic nerve head,and vasospastic factors.IOP remains the most common modifiable risk factor to protect eyes against the development of glaucoma.The association between OHT and diabetes mellitus(DM)is poorly understood,although ocular effects of both conditions are related to vascular compromise of retinal and optic nerve circulation.Increased IOP in diabetic patients is attributable to increased aqueous osmotic gradient and accumulation of extracellular matrix constituents in the trabecular meshwork.Autonomic dysfunction and genetic factors may also play a role.Apart from eyes without diabetic retinopathy(DR)changes,OHT can also be observed in eyes with DR,where it can develop with or without antecedent vitreoretinal intervention.For example,photocoagulation of the retina in earlier stages of proliferative DR protects against the development of OHT,whereas intraocular silicone oil injection promotes it.While IOP has been directly implicated as an independent risk factor for DR,the retinopathy in DM is also related to comorbidities,like hypertension and heart disease,that are also correlated with OHT.All these factors are discussed in a comprehensive review exploring the association of OHT and DM in detail.展开更多
Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologi...Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologies in synthesizing and analyzing multimodal data to enhance efficiency and accuracy in health care delivery.Specifically,deep learning models have demonstrated remarkable capabilities in identifying seven categories of hepatobiliary disorders using ocular imaging datasets,including slit-lamp,retinal fundus,and optical coherence tomography images.Leveraging ResNet-101 neural networks,researchers have developed screening models and independent diagnostic tools,showcasing how AI can redefine diagnostic practices and improve accessibility,particularly in resource-limited settings.By examining advancements in AI-driven health care solutions,this article sheds light on both the challenges and opportunities that lie ahead in integrating such technologies into routine clinical practice.展开更多
Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to s...Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to significant illness including nephropathy,neuropathy,retinopathy,and macrovascular abnormalities including peripheral vasculopathy,and ischaemic heart disease.Research into diabetic retinopathy(DR),which affects one-third of persons with diabetes,has made considerable strides in recent years.In addition,it can lead to several anterior segment complications such as glaucoma,cataract,cornea,conjunctiva,lacrimal glands and other ocular surface diseases.Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells,which raises the likelihood of anterior segment diseases including corneal ulcers,dry eye disease,and chronic epithelial abnormalities.Although DR and other associated ocular complications are well-known,the complexity of its aetiology and diagnosis makes therapeutic intervention challenging.Strict glycaemic control,early detection and regular screening,and meticulous management is the key to halting the progression of the disease.In this review manuscript,we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology,epidemiology,and prospective therapeutic targets.This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes,which are often neglected.展开更多
Glaucoma,a prevalent and debilitating eye disease,has long been associated with vision impairment and blindness.However,recent research has shed light on the often-underestimated psychological dimensions of this condi...Glaucoma,a prevalent and debilitating eye disease,has long been associated with vision impairment and blindness.However,recent research has shed light on the often-underestimated psychological dimensions of this condition.Anxiety and depression,two pervasive psychiatric comorbidities,have been increasingly recognized among glaucoma patients.This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology,in the context of managing depression and anxiety in glaucoma patients.By meticulously examining peer-reviewed literature,we synthesize current knowledge on the prevalence,risk factors,and underlying mechanisms of anxiety and depression in glaucoma.The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders.Factors such as progressive vision loss,complex medication regimens,and the fear of further visual deterioration contribute to their vulnerability.Moreover,we delve into the bidirectional relationship between glaucoma and mood disorders,shedding light on the complex interplay between ocular and emotional health.Our review investigates the implications of anxiety and depression on glaucoma management,including their potential impact on treatment adherence,disease progression,and overall quality of life.We also explore the neurobiological pathways linking glaucoma and mood disorders,providing a foundation for future research and potential therapeutic interventions.In conclusion,recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care.This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma.By addressing anxiety and depression in glaucoma care,healthcare providers can enhance the overall quality of life for these patients,ultimately leading to improved outcomes and a brighter future for those affected by this condition.This review offers valuable insight for healthcare practitioners and researchers,providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.展开更多
Visual rehabilitation following cataract surgery is often an overlooked aspect.Healthcare providers have an important role in the counselling of the patients undergoing cataract surgery in clearing all their doubts th...Visual rehabilitation following cataract surgery is often an overlooked aspect.Healthcare providers have an important role in the counselling of the patients undergoing cataract surgery in clearing all their doubts thus alleviating all their fears and anxiety related to the procedure which will eventually lead to faster and smoother visual rehabilitation.Using standardised communication techniques like CICARE combined with conventional nursing and pain scoring systems can provide an objective and effective method in patient counselling and building a rapport with the patient for a faster visual recovery.展开更多
This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,ch...This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.展开更多
In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions e...In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.展开更多
Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),pr...Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),present in onethird of patients with diabetes,is a vision-threatening complication caused by uncontrolled diabetes,which greatly affects the retinal blood vessels and the lightsensitive inner retina,eventually leading to blindness.Several epidemiological studies elucidate that DR can vary by age of onset,duration,types of diabetes,and ethnicity.Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia.The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging.This review throws light on the pathological processes behind DR,the cascade of events that follow it,as well as the available and emerging treatment options.展开更多
Artificial Intelligence is a multidisciplinary field with the aim of building platforms that can make machines act,perceive,reason intelligently and whose goal is to automate activities that presently require human in...Artificial Intelligence is a multidisciplinary field with the aim of building platforms that can make machines act,perceive,reason intelligently and whose goal is to automate activities that presently require human intelligence.From the cornea to the retina,artificial intelligence(AI)is expected to help ophthalmologists diagnose and treat ocular diseases.In ophthalmology,computerized analytics are being viewed as efficient and more objective ways to interpret the series of images and come to a conclusion.AI can be used to diagnose and grade diabetic retinopathy,glaucoma,age-related macular degeneration,cataracts,IOL power calculation,retinopathy of prematurity and keratoconus.This review article intends to discuss various aspects of artificial intelligence in ophthalmology.展开更多
Intensive care unit-acquired weakness(ICU-AW;ICD-10 Code:G72.81)is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause.The risk factor...Intensive care unit-acquired weakness(ICU-AW;ICD-10 Code:G72.81)is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause.The risk factors for ICU-AW include hyperglycemia,parenteral nutrition,vasoactive drugs,neuromuscular blocking agents,corticosteroids,sedatives,some antibiotics,immobilization,the disease severity,septicemia and systemic inflammatory response syndrome,multiorgan failure,prolonged mechanical ventilation(MV),high lactate levels,older age,female sex,and pre-existing systemic morbidities.There is a definite association between the duration of ICU stay and MV with ICU-AW.However,the interpretation that these are modifiable risk factors influencing ICU-AW,appears to be flawed,because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW.Prevention strategies must be based on other risk factors.Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.展开更多
This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and ...This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and efficacy,this Meta-Analysis is inconclusive.展开更多
Ocular surface squamous neoplasia(OSSN)is a common eye surface tumour,characterized by the growth of abnormal cells on the ocular surface.OSSN includes invasive squamous cell carcinoma(SCC),in which tumour cells penet...Ocular surface squamous neoplasia(OSSN)is a common eye surface tumour,characterized by the growth of abnormal cells on the ocular surface.OSSN includes invasive squamous cell carcinoma(SCC),in which tumour cells penetrate the basement membrane and infiltrate the stroma,as well as non-invasive conjunctival intraepithelial neoplasia,dysplasia,and SCC in-situ thereby presenting a challenge in early detection and diagnosis.Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments,such as topical medicines,whereas advanced invasive lesions may need orbital exenteration,which carries a risk of death.Artificial intelligence(AI)has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management.AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN,aiding ophthalmologists in early detection and diagnosis.AI can also track and monitor lesion progression over time,providing objective measurements to guide treatment decisions.Furthermore,AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response.This manuscript highlights the role of AI in OSSN,specifically focusing on its contributions in early detection and diagnosis,assessment of lesion progression,treatment planning,telemedicine and remote monitoring,and research and data analysis.展开更多
文摘The study by Cao et al aimed to identify early second-trimester biomarkers that could predict gestational diabetes mellitus(GDM)development using advanced proteomic techniques,such as Isobaric tags for relative and absolute quantitation isobaric tags for relative and absolute quantitation and liquid chromatography-mass spectrometry liquid chromatography-mass spectrometry.Their analysis revealed 47 differentially expressed proteins in the GDM group,with retinol-binding protein 4 and angiopoietin-like 8 showing significantly elevated serum levels compared to controls.Although these findings are promising,the study is limited by its small sample size(n=4 per group)and lacks essential details on the reproducibility and reliability of the protein quantification methods used.Furthermore,the absence of experimental validation weakens the interpretation of the protein-protein interaction network identified through bioinformatics analysis.The study's focus on second-trimester biomarkers raises concerns about whether this is a sufficiently early period to implement preventive interventions for GDM.Predicting GDM risk during the first trimester or pre-conceptional period may offer more clinical relevance.Despite its limitations,the study presents valuable insights into potential GDM biomarkers,but larger,well-validated studies are needed to establish their predictive utility and generalizability.
文摘The article"Secondary diabetes due to different etiologies:Four case reports"by Song et al,published in the World Journal of Clinical Cases,delves into the identi-fication of rare causes of secondary diabetes and emphasizes the necessity for healthcare professionals to recognize these conditions.Failure to do so can result in treatment delays and compromised patient outcomes.The article discusses spe-cific types of diabetes,including maturity onset of diabetes in young,pancreas-related diseases,endocrinopathies,drug-induced diabetes,infections,and con-genital genetic syndromes associated with diabetes mellitus.Case summaries highlight how patients with secondary diabetes,stemming from conditions such as Williams-Beuren syndrome and pituitary adenoma,often exhibit distinct characteristics overlooked in clinical practice.The authors stress the importance of a holistic diagnostic approach and advocate for proactive management through early intervention,including genetic tests and antibody detection.Increased awa-reness and education are crucial for timely identification and proper management,ultimately improving patient well-being.These findings prompt a call to action for healthcare professionals to consider rare causes of secondary diabetes,facili-tating better glycemic control and overall patient care.
文摘We hereby comment on the interesting systematic review by Grewal et al where they have provided an overall picture of the current status of available tele-health programs in the United States with emphasis on the Amazon Clinic.Their analysis is an appreciable effort in discovering the features available and features lacking in these tele-health programs.The concept of tele-health originated to curtail the need for physical attendance of patients at health clinics,and has been beneficial during the coronavirus disease 2019 pandemic.We implore that the pearls and pitfalls of these programs have to be understood by policymakers prior to forming a consensus regarding the availability,accessibility and affordability of these programs as methods of healthcare delivery.Unrestricted proliferation of tele-health programs in their current form may pose threats to patient and provider safety and medicolegal liability.However,patients and providers must work together to improve them to meet their expectations and enable them to provide the best care for the ailing public.
文摘Artificial intelligence(AI),encompassing machine learning and deep learning,is being extensively used in medical sciences.It is slated to positively impact the diagnosis and prognostication of various diseases.Deep learning,a subset of AI,has been instrumental in diagnosing diabetic retinopathy(DR),diabetic macular edema,glaucoma,age-related macular degeneration,and numerous other ocular diseases.AI performs equally well in the early prediction of glaucoma and agerelated macular degeneration.Integrating AI with telemedicine promises to improve healthcare delivery,although challenges persist in implementing AI algorithms,especially in deve-loping countries.This review provides a compre hensive summary of AI,its applications in ophthalmology,particularly DR,the diverse algorithms utilized for different ocular conditions,and prospects for the future integration of AI in eye care.
文摘Proliferative diabetic retinopathy(PDR)affects approximately 6%of diabetic patients globally.The overall prevalence of diabetic retinopathy is around 22%.Wet age-related macular degeneration(ARMD),the sight-threatening type of ARMD,affects approximately 1.2%-1.3%of the general population and represents 15%of total ARMD cases.While intravitreal anti-vascular endothelial growth factor injections are still the mainstay therapy,there are a few challenges,such as frequent administration,cost burden,and compliance barriers that prompt the need for exploration into systemic oral alternative drugs like fenofibrate,candesartan,and vorolanib.These oral therapies have the advantage of being noninvasive and systemically accessible with few logistical burdens.This review highlights current evidence supporting the use of oral therapies in PDR and wet ARMD management,along with practical limitations and future prospects.
文摘Diabetes mellitus ranks among the most prevalent non-communicable diseases worldwide,affecting a vast number of individuals.It can impact almost every organ in the body,leading to serious complications such as diabetic retinopathy(DR),diabetic nephropathy,and diabetic neuropathy.Scientific literature indi-cates that patients with severely compromised kidney function may develop non-responsive DR.Moreover,anaemia in individuals with diabetic kidney disease(DKD)complicates DR and can contribute to significant health issues.Optical coherence tomography(OCT)is a widely used non-invasive imaging tool for diagnosing,managing,and predicting DR.OCT findings in patients with DR and DKD include cystoid macular oedema,diffuse retinal thickening,disruptions in the ellipsoid layer,hyperreflective dots,and damage to the external limiting membrane.The review examines OCT patterns of diabetic macular oedema in DKD,correlating these patterns with declines in kidney function and visual acuity.Additionally,we review various biomarkers linked to DR in DKD patients and the growing importance of novel imaging biomarkers in predicting and connecting the severity of DR with DKD.
文摘The recently published article by Gao et al identifies risk factors for anxiety and depression in patients with diabetic retinopathy.We supplement that there is pathophysiological evidence to show a complex and possibly bidirectional re-lation between diabetes,diabetic retinopathy,and mood disorders,especially depression.Longitudinal studies may strengthen proof of a causal relationship between these diseases.A better understanding can help in the holistic manage-ment of these patients.
文摘BACKGROUND The gut microbiome is integral to human health,with emerging research underscoring its potential impact on ocular health through the gut-eye axis.Various ocular disorders,such as dry eye syndrome,retinal vascular diseases,macular degeneration,and glaucoma,may be influenced by gut dysbiosis,which could significantly contribute to their development and progression.AIM To evaluate the influence of the gut microbiome on the pathogenesis and progression of various ocular diseases.METHODS An extensive search of the scientific literature was undertaken by adhering to Preferred Reporting Items for Systematic Reviews&Meta-Analyses standards,using PubMed(MEDLINE),Scopus,EMBASE,and the Cochrane Library as sources to locate studies addressing the relationship between the gut microbiome and human health.To capture all relevant publications,search terms were systematically applied across these major databases,without limiting the search by language or publication date.Inclusion criteria covered randomized controlled trials,non-randomized controlled trial,prospective studies,cross-sectional studies,and case-control studies.Out of the 3077 articles,36 full texts were included in the review.RESULTS Ocular health appears to be shaped by the gut microbial community through mechanisms such as immune regulation,preservation of the blood–retinal barrier,and the generation of protective metabolites.Disturbances in this microbial balance can provoke measurable alterations in host immunity,providing a plausible immunopathogenic pathway that connects intestinal dysbiosis with eye disease.Both laboratory models and early human data suggest that targeted interventions,including prebiotics,probiotics,synbiotics,and faecal microbiota transfer,hold therapeutic potential.CONCLUSION The gut–eye relationship reflects a multifaceted interaction in which the intestinal microbiome contributes to ocular health through complex biological pathways.Integrating microbiome assessments into diagnostic methods can revolutionize disease management through early detection and targeted interventions.Further,randomised controlled clinical trials are necessary for ocular diseases to prove causal relationships.
文摘Ocular hypertension(OHT),defined as increased intraocular pressure(IOP,>21 mmHg)in eyes without optic disc changes or visual field changes,is a condition that puts an eye at higher risk of developing glaucomatous optic neuropathy and may be related to the translaminar pressure gradient,individual differences in IOP-related glaucoma susceptibility,effects of arterial blood pressure on the optic nerve head,and vasospastic factors.IOP remains the most common modifiable risk factor to protect eyes against the development of glaucoma.The association between OHT and diabetes mellitus(DM)is poorly understood,although ocular effects of both conditions are related to vascular compromise of retinal and optic nerve circulation.Increased IOP in diabetic patients is attributable to increased aqueous osmotic gradient and accumulation of extracellular matrix constituents in the trabecular meshwork.Autonomic dysfunction and genetic factors may also play a role.Apart from eyes without diabetic retinopathy(DR)changes,OHT can also be observed in eyes with DR,where it can develop with or without antecedent vitreoretinal intervention.For example,photocoagulation of the retina in earlier stages of proliferative DR protects against the development of OHT,whereas intraocular silicone oil injection promotes it.While IOP has been directly implicated as an independent risk factor for DR,the retinopathy in DM is also related to comorbidities,like hypertension and heart disease,that are also correlated with OHT.All these factors are discussed in a comprehensive review exploring the association of OHT and DM in detail.
文摘Artificial intelligence(AI)has become an indispensable tool in modern health care,offering transformative potential across clinical workflows and diagnostic innovations.This review explores the sation of AI technologies in synthesizing and analyzing multimodal data to enhance efficiency and accuracy in health care delivery.Specifically,deep learning models have demonstrated remarkable capabilities in identifying seven categories of hepatobiliary disorders using ocular imaging datasets,including slit-lamp,retinal fundus,and optical coherence tomography images.Leveraging ResNet-101 neural networks,researchers have developed screening models and independent diagnostic tools,showcasing how AI can redefine diagnostic practices and improve accessibility,particularly in resource-limited settings.By examining advancements in AI-driven health care solutions,this article sheds light on both the challenges and opportunities that lie ahead in integrating such technologies into routine clinical practice.
文摘Diabetes mellitus(DM)is one of the chronic metabolic noncommunicable diseases that has attained worldwide epidemics.It threatens healthy life around the globe,with mild-to-severe secondary complications and leads to significant illness including nephropathy,neuropathy,retinopathy,and macrovascular abnormalities including peripheral vasculopathy,and ischaemic heart disease.Research into diabetic retinopathy(DR),which affects one-third of persons with diabetes,has made considerable strides in recent years.In addition,it can lead to several anterior segment complications such as glaucoma,cataract,cornea,conjunctiva,lacrimal glands and other ocular surface diseases.Uncontrolled DM also caused gradual damage to corneal nerves and epithelial cells,which raises the likelihood of anterior segment diseases including corneal ulcers,dry eye disease,and chronic epithelial abnormalities.Although DR and other associated ocular complications are well-known,the complexity of its aetiology and diagnosis makes therapeutic intervention challenging.Strict glycaemic control,early detection and regular screening,and meticulous management is the key to halting the progression of the disease.In this review manuscript,we aim to provide an in-depth understanding of the broad spectrum of diabetic complications in the anterior segment of the ocular tissues and illustrate the progression of diabetes and its pathophysiology,epidemiology,and prospective therapeutic targets.This first such review article will highlight the role of diagnosing and treating patients with a plethora of anterior segment diseases associated with diabetes,which are often neglected.
文摘Glaucoma,a prevalent and debilitating eye disease,has long been associated with vision impairment and blindness.However,recent research has shed light on the often-underestimated psychological dimensions of this condition.Anxiety and depression,two pervasive psychiatric comorbidities,have been increasingly recognized among glaucoma patients.This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology,in the context of managing depression and anxiety in glaucoma patients.By meticulously examining peer-reviewed literature,we synthesize current knowledge on the prevalence,risk factors,and underlying mechanisms of anxiety and depression in glaucoma.The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders.Factors such as progressive vision loss,complex medication regimens,and the fear of further visual deterioration contribute to their vulnerability.Moreover,we delve into the bidirectional relationship between glaucoma and mood disorders,shedding light on the complex interplay between ocular and emotional health.Our review investigates the implications of anxiety and depression on glaucoma management,including their potential impact on treatment adherence,disease progression,and overall quality of life.We also explore the neurobiological pathways linking glaucoma and mood disorders,providing a foundation for future research and potential therapeutic interventions.In conclusion,recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care.This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma.By addressing anxiety and depression in glaucoma care,healthcare providers can enhance the overall quality of life for these patients,ultimately leading to improved outcomes and a brighter future for those affected by this condition.This review offers valuable insight for healthcare practitioners and researchers,providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.
文摘Visual rehabilitation following cataract surgery is often an overlooked aspect.Healthcare providers have an important role in the counselling of the patients undergoing cataract surgery in clearing all their doubts thus alleviating all their fears and anxiety related to the procedure which will eventually lead to faster and smoother visual rehabilitation.Using standardised communication techniques like CICARE combined with conventional nursing and pain scoring systems can provide an objective and effective method in patient counselling and building a rapport with the patient for a faster visual recovery.
文摘This comprehensive review embarks on a captivating journey into the complex relationship between cardiology and normal-tension glaucoma(NTG),a condition that continues to baffle clinicians and researchers alike.NTG,characterized by optic nerve damage and visual field loss despite normal intraocular pressure,has long puzzled clinicians.One emerging perspective suggests that alterations in ocular blood flow,particularly within the optic nerve head,may play a pivotal role in its pathogenesis.While NTG shares commonalities with its high-tension counterpart,its unique pathogenesis and potential ties to cardiovascular health make it a fascinating subject of exploration.It navigates through the complex web of vascular dysregulation,blood pressure and perfusion pressure,neurovascular coupling,and oxidative stress,seeking to uncover the hidden threads that tie the heart and eyes together in NTG.This review explores into the intricate mechanisms connecting cardiovascular factors to NTG,shedding light on how cardiac dynamics can influence ocular health,particularly in cases where intraocular pressure remains within the normal range.NTG's enigmatic nature,often characterized by seemingly contradictory risk factors and clinical profiles,underscores the need for a holistic approach to patient care.Drawing parallels to cardiac health,we examine into the shared vascular terrain connecting the heart and the eyes.Cardiovascular factors,including systemic blood flow,endothelial dysfunction,and microcirculatory anomalies,may exert a profound influence on ocular perfusion,impacting the delicate balance within the optic nerve head.By elucidating the subtle clues and potential associations between cardiology and NTG,this review invites clinicians to consider a broader perspective in their evaluation and management of this elusive condition.As the understanding of these connections evolves,so too may the prospects for early diagnosis and tailored interventions,ultimately enhancing the quality of life for those living with NTG.
文摘In the retrospective study by Luo et al regarding clinical outcomes in gestational diabetes mellitus(GDM),the results are statistically significant in favour of the benefits of individualized nutrition interventions enumerated therein.The study has provided important evidence to improve maternal and child health in the Asian population.The methods,however,appear to have considerable limi-tations,wherein the time point of diagnosis of GDM,severity of GDM,selection bias,compliance to therapy,important maternal covariates,observable microvascular abnormalities and the confounding effect of added insulin have not been considered.We have provided suggestions to improve the external validity of the study,including the use of Equator Network reporting guidelines and inclusion of overweight and obese patients in future studies.
文摘Diabetes mellitus(DM)is a chronic metabolic non-communicable disease with the ability to cause serious microvascular and macrovascular complications throughout the body,including in the eye.Diabetic retinopathy(DR),present in onethird of patients with diabetes,is a vision-threatening complication caused by uncontrolled diabetes,which greatly affects the retinal blood vessels and the lightsensitive inner retina,eventually leading to blindness.Several epidemiological studies elucidate that DR can vary by age of onset,duration,types of diabetes,and ethnicity.Recent studies show that the pathogenesis of diabetic retinopathy has spread its roots beyond merely being the result of hyperglycemia.The complexity of its etiopathology and diagnosis makes therapeutic intervention challenging.This review throws light on the pathological processes behind DR,the cascade of events that follow it,as well as the available and emerging treatment options.
文摘Artificial Intelligence is a multidisciplinary field with the aim of building platforms that can make machines act,perceive,reason intelligently and whose goal is to automate activities that presently require human intelligence.From the cornea to the retina,artificial intelligence(AI)is expected to help ophthalmologists diagnose and treat ocular diseases.In ophthalmology,computerized analytics are being viewed as efficient and more objective ways to interpret the series of images and come to a conclusion.AI can be used to diagnose and grade diabetic retinopathy,glaucoma,age-related macular degeneration,cataracts,IOL power calculation,retinopathy of prematurity and keratoconus.This review article intends to discuss various aspects of artificial intelligence in ophthalmology.
文摘Intensive care unit-acquired weakness(ICU-AW;ICD-10 Code:G72.81)is a syndrome of generalized weakness described as clinically detectable weakness in critically ill patients with no other credible cause.The risk factors for ICU-AW include hyperglycemia,parenteral nutrition,vasoactive drugs,neuromuscular blocking agents,corticosteroids,sedatives,some antibiotics,immobilization,the disease severity,septicemia and systemic inflammatory response syndrome,multiorgan failure,prolonged mechanical ventilation(MV),high lactate levels,older age,female sex,and pre-existing systemic morbidities.There is a definite association between the duration of ICU stay and MV with ICU-AW.However,the interpretation that these are modifiable risk factors influencing ICU-AW,appears to be flawed,because the relationship between longer ICU stays and MV with ICU-AW is reciprocal and cannot yield clinically meaningful strategies for the prevention of ICU-AW.Prevention strategies must be based on other risk factors.Large multicentric randomized controlled trials as well as meta-analysis of such studies can be a more useful approach towards determining the influence of these risk factors on the occurrence of ICU-AW in different populations.
文摘This published Meta-Analysis by Lin et al is an indirect comparison between two drugs Chiglitazar and Thiazolidinedione which are commonly used for glycemic control in type-Ⅱ diabetes mellitus.In terms of safety and efficacy,this Meta-Analysis is inconclusive.
文摘Ocular surface squamous neoplasia(OSSN)is a common eye surface tumour,characterized by the growth of abnormal cells on the ocular surface.OSSN includes invasive squamous cell carcinoma(SCC),in which tumour cells penetrate the basement membrane and infiltrate the stroma,as well as non-invasive conjunctival intraepithelial neoplasia,dysplasia,and SCC in-situ thereby presenting a challenge in early detection and diagnosis.Early identification and precise demarcation of the OSSN border leads to straightforward and curative treatments,such as topical medicines,whereas advanced invasive lesions may need orbital exenteration,which carries a risk of death.Artificial intelligence(AI)has emerged as a promising tool in the field of eye care and holds potential for its application in OSSN management.AI algorithms trained on large datasets can analyze ocular surface images to identify suspicious lesions associated with OSSN,aiding ophthalmologists in early detection and diagnosis.AI can also track and monitor lesion progression over time,providing objective measurements to guide treatment decisions.Furthermore,AI can assist in treatment planning by offering personalized recommendations based on patient data and predicting the treatment response.This manuscript highlights the role of AI in OSSN,specifically focusing on its contributions in early detection and diagnosis,assessment of lesion progression,treatment planning,telemedicine and remote monitoring,and research and data analysis.
