The purpose of this study was to evaluate the visual function and the ophthalmic status of young Finnish adults with long duration of type 1 diabetes in relation to the history of the metabolic control.
A population-based cohort of children with type 1 diabetes examined in the Northern Ostrobothnia hospital district in 1989 (n?=?216) was re-examined 18?years later. High-contrast visual acuity (best-corrected visual acuity), contrast sensitivity, refractive error, lens status, intraocular pressure, stage of diabetic retinopathy and received treatments were evaluated. The metabolic control was reflected by the mean of glycated haemoglobin A1 or glycated haemoglobin A1c values of the years 1983-1989 and 1992-2007, respectively.
In all, 96 men and 76 women age 30?±?3?years with type 1 diabetes duration of 23?±?4?years attended the re-evaluation. About 60% (103/172) had normal best-corrected visual acuity and 3% had low vision. Contrast sensitivity was abnormal in two-thirds. Half had myopia. Four patients had cataract surgery. Low childhood glycated haemoglobin A1 was indicative, and favourable glycated haemoglobin A1c during youth was a significant predictor of better contrast sensitivity and ocular state in adulthood.
The majority of the patients have useful vision, although minor functional impairments are commonly detectable. Long duration of type 1 diabetes in association with non-optimal glycaemic control threatens visual function already at young adulthood. Thus, strong emphasis to control diabetes from onset is important in maintaining good visual function.
The purpose of this study was to evaluate the visual function and the ophthalmic status of young Finnish adults with long duration of type 1 diabetes in relation to the history of the metabolic control.
A population-based cohort of children with type 1 diabetes examined in the Northern Ostrobothnia hospital district in 1989 (n?=?216) was re-examined 18?years later. High-contrast visual acuity (best-corrected visual acuity), contrast sensitivity, refractive error, lens status, intraocular pressure, stage of diabetic retinopathy and received treatments were evaluated. The metabolic control was reflected by the mean of glycated haemoglobin A1 or glycated haemoglobin A1c values of the years 1983-1989 and 1992-2007, respectively.
In all, 96 men and 76 women age 30?±?3?years with type 1 diabetes duration of 23?±?4?years attended the re-evaluation. About 60% (103/172) had normal best-corrected visual acuity and 3% had low vision. Contrast sensitivity was abnormal in two-thirds. Half had myopia. Four patients had cataract surgery. Low childhood glycated haemoglobin A1 was indicative, and favourable glycated haemoglobin A1c during youth was a significant predictor of better contrast sensitivity and ocular state in adulthood.
The majority of the patients have useful vision, although minor functional impairments are commonly detectable. Long duration of type 1 diabetes in association with non-optimal glycaemic control threatens visual function already at young adulthood. Thus, strong emphasis to control diabetes from onset is important in maintaining good visual function.
Abstract. Purpose: To evaluate the factors affecting the sensitivity and specificity of the stereometric optic nerve head (ONH) parameters of the Heidelberg Retina Tomograph (HRT) to glaucomatous progression in stereoscopic ONH photographs. Methods: The factors affecting the sensitivity and specificity of the vertical cup : disc ratio, the cup : disc area ratio, the cup volume, the rim area and a linear discriminant function to progression were analysed. These parameters were the best indicators of progression in a retrospective study of 476 eyes. The reference standard for progression was the masked evaluation of stereoscopic ONH photographs. Results: The factors having the most significant effect on the sensitivity and specificity of the stereometric ONH parameters were the reference height difference and the mean topography standard deviation (TSD), indicating image quality. Also, the change in the TSD and age showed consistent, but variably significant, influence on all parameters tested. The sensitivity and specificity improved when there was little change in the reference height, the image quality was good and stable, and the patients were younger. The sensitivity and specificity of the vertical cup : disc ratio was improved by a large disc area and high baseline cup : disc area ratio. The rim area showed a better sensitivity and specificity for progression with a small disc area and low baseline cup : disc area ratio. Conclusion: The factors affecting the sensitivity and specificity of the stereometric ONH parameters to glaucomatous progression in disc photographs are essentially the same as those affecting the measurement variability of the HRT.
To follow up prospectively the intraocular pressure (IOP) of healthy eyes with senile cataract undergoing phacoemulsification surgery over a duration of 4 years.
Thirty-five patients entering first eye cataract surgery had IOP measured by applanation tonometry pre-operatively and on day 1, at 1 month, 6 months, 1 year, 2 years and 4 years after surgery at 9 a.m. and again at 2 p.m. in the Department of Ophthalmology, Oulu University Hospital. Thirty-four patients attended the 1-year checkup, and the 2- and 4-year results are available for 31.
The pre-operative IOP was 16.0 (SD 4.3, range 6-25) mmHg in the morning and 16.4 (SD 4.0, range 8-25.5) mmHg in the afternoon. On the first postoperative day, the IOP was 2.1 ± 5.6 mmHg higher than before surgery (p = 0.029). At 1 month, the IOP morning measurement had decreased 2.8 ± 3.6 mmHg, and in the afternoon, the decrease was 3.0 ± 2.7 mmHg from the pre-operative level. At 6 months, the decrease was 3.3 ± 2.7 mmHg in the morning and 3.6 ± 2.7 mmHg in the afternoon, at 1 year, 3.2 ± 3.0 mmHg and 3.5 ± 3.2 mmHg, at 2 years, 3.2 ± 2.4 mmHg and 3.1 ± 2.8 mmHg, and at the 4-year postoperative checkup, 3.6 ± 3.4 mmHg and 3.6 ± 2.7 mmHg, respectively (p = 0.000 for all time-points).
IOP decreases by about 3 mmHg (16-23% from the pre-operative IOP level) after phacoemulsification and remains at this reduced level with no trend towards an increase during 4 years.
This study evaluated the influence of diabetes on the health-related quality of life (HRQoL) scores of adult patients with diabetes in northern Finland.
A total of 3771 patients of the population of 10,264 patients aged ?15 years with the right for reimbursement of the cost of diabetes medication attended fundus photography screening for retinopathy in 2012. The 15D HRQoL scores and data on age, sex, type and duration of diabetes were gathered concurrently. The results were compared with the 15D scores reported in Finnish population studies.
The 15D score was obtained from 2461 patients aged 60±14 years; 20% had type 1 diabetes (T1D). The mean±SD 15D index was 0.930±0.079 in patients with T1D and their mean±SD age was 46±15 years. The mean±SD 15D index of the patients with type 2 diabetes (T2D) was 0.890±0.100 and their mean±SD age was 63±11 years. The 15D index was no lower than in the Finnish general population in either patient group or in any age group. However, the 15D score was negatively influenced by an increasing duration of diabetes in both patients with T1D and patients with T2D. No sex difference was found.
The mean HRQoL score of patients with diabetes in this study is comparable with that of the general population of equal age. Neither the type of diabetes nor sex independently affected the HRQoL score, but a longer duration of diabetes seemed to impair the HRQoL score. Current diabetes care appears to maintain a normal HRQoL score in this diabetic population in Finland.
Health-related quality of life--using the 15D instrument--of young adults with type 1 diabetes since childhood. Population-based Oulu cohort study of diabetic retinopathy.
The aim of this study was to evaluate the health-related quality of life (HRQoL) of young adults with type 1 diabetes (T1D) since childhood using the 15D instrument. The possible impact of diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR) on the HRQoL was focused on.
During the years 1989-1990, the prevalence of DR was evaluated from ocular fundus photographs of a population-based cohort of children with T1D living in the Northern Osthrobothnia Hospital District, Finland. These 216 individuals were contacted 18 years later and invited for assessment of the 15D HRQoL as well as current stage of DR. The results were compared with age- and gender-standardized Finnish general population.
The 15D data were obtained from 123 patients aged 29±3 years with a duration of diabetes of 23±4 years. The mean 15D score was similar in the patients with T1D and the general population [0.954±0.062 versus 0.964±0.052, respectively (p=0.085)]. However, the subgroup of patients with PDR (N=38) had a statistically significantly lower mean 15D score than those subjects with nonproliferative or no DR [0.931±0.086 versus 0.965±0.044, respectively (p=0.026)].
Young adults with T1D since childhood had 15D HRQoL score equal to that of age- and gender-standardized general population as long as no more severe than nonproliferative DR was present. Presence of PDR, not T1D of long duration per se, significantly impaired the 15D score.
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.
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.
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.
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.
Diabetic retinopathy (DR) is the most common complication of diabetes and needs to be diagnosed early to prevent severe sight-threatening retinopathy. Digital photography with telemedicine connections is a novel way to deliver cost-effective, accessible screening to remote areas. Screening for DR in a mobile eye examination unit (EyeMo) is compared to traditional service models (i.e. local municipal services or a commercial service provider). The quality of images, delays from screening to treatment, the stage of DR, coverage of screening and the rate of visual impairment due to DR are evaluated.
EyeMo utilizes telemedicine technology. The electronic databases of the hospital and information from the Finnish Register of Visual Impairment were used to determine delays and the rate of visual impairment.
Fourteen thousand eight hundred and sixty-six fundus photographs were taken in EyeMo in 2007-2011. Coverage reached 78% of potential clients. No DR was detected in 43%, mild background retinopathy in 23%, moderate or severe background retinopathy in 31% and proliferative retinopathy in 3% of the evaluations. The quality of images was higher (p
PURPOSE: The purpose of this study was to retrospectively evaluate whether it is possible to decrease the risk of Molteno tube erosion through the conjunctiva by using a new technique where the silicone tube is inserted into a scleral tunnel instead of being covered only by the conjunctiva. METHODS: We reviewed Molteno implants carried out at the University Hospital of Oulu, in 332 patients who underwent traditional Molteno implantation between October 1986 and October 1998 and 92 patients who underwent surgery with the new technique between November 1998 and April 2001. RESULTS: With our former technique, conjunctival erosions occurred in 15 eyes of 15 patients (4.5%) after a median follow-up of 3.5 months (range 1-72 months); no conjunctival complications were discovered in patients who underwent surgery using the new technique during a median follow-up of 22 months (range 10-39 months). (p = 0.038, two-sample test of proportions). CONCLUSION: Inserting the Molteno tube into a scleral tunnel prevents tube extrusion through the conjunctiva in eyes with Molteno implants. The technique for making the scleral tunnel is described.
To evaluate the prevalence and stage of diabetic retinopathy (DR) in a population-based cohort of young Finnish adults who have had type 1 diabetes (T1D) since childhood.
The cohort includes all 5- to 16-year-old patients with T1D who lived in the Northern Ostrobothnia Hospital District of Finland, in 1989 (n = 216). DR was evaluated from fundus photographs taken in 1989-1990 and again in 2007. The patients were 7 ± 4 years age (range 0-15 years) at the time of diagnosis of T1D, and the average duration of diabetes at the re-evaluation was 23 ± 4 years (range 17-32 years).
The prevalence of DR was analysed in 172 patients (80% of the original cohort) at 22-35 years. Proliferative DR (PDR) was observed in 35% (60/172) and non-proliferative DR in 59% (101/172), with no signs of DR being present in the remaining 6% (11/172) of the subjects. The prevalence of DR did not differ by gender (p = 0.356).
After the 18-year follow-up, a high prevalence of DR and PDR (94% and 35%, respectively) was found in patients who have had T1D since childhood, with no difference between the genders.
