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Horm Metab Res 2005; 37: 35-38
DOI: 10.1055/s-2005-861396
Review
© Georg Thieme Verlag KG Stuttgart · New York

Diabetic Retinopathy: A Review of the Aarhus Approach to Studies on Epidemiology, Computerised Grading, and the Pathophysiology of the Disease

T.  Bek1
  • 1 Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
Further Information

Publication History

Received 7 November 2004

Accepted after Revision 2 March 2005

Publication Date:
25 May 2005 (online)

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Abstract

Diabetic retinopathy is one of the leading causes of blindness in the western world (Munier et al 1998). The challenges for improving the visual prognosis in this disease are comprehensive, and involve a multitude of methodological approaches. Thus, ongoing research programmes are aimed at studying as diverse aspects of diabetic retinopathy as epidemiology, genetics, screening, diagnosis, treatment, and understanding of the pathophysiology of the disease. This review presents the scientific approach followed at Aarhus University Hospital in relation to three of these aspects-epidemiology, computerised grading, and elucidation of the pathophysiology of diabetic retinopathy.

Key words

Diabetic retinopathy screening · Type 2 diabetes · Diabetic maculopathy · Computerised grading · Retinal hyperperfusion · Autoregulation · Vasomotion · Retinal vessel analyzer

References

  • 1 Kristinsson J K, Stefansson E, Jonasson F, Gislason I, Bjornsson S. Screening for eye disease in type 2 diabetes mellitus.  Acta Ophthalmol. 1994;  72 (3) 341-346
    PubMedGoogle Scholar
  • 2 Owens D R, Gibbins R S, Lewis P A, Wall S, Allen J C, Morton R. Screening for diabetic retinopathy by general practitioners: Ophthalmoscopy or retinal photography as 35 mm colour transparences.  Diabet Med. 1988;  15 (2) 170-175
    PubMedGoogle Scholar
  • 3 Kristensen J K, Sandbaek A, Lassen J F, Bro F, Lauritzen T. Use and validation of public data files for identification of the diabetic population in a Danish county.  Dan Med Bull. 2001;  48 33-37
    PubMedGoogle Scholar
  • 4 Hove M, Kristensen J K, Lauritzen T, Bek T. The prevalence of retinopathy in type 2 diabetic patients in an unselected population from Aarhus county, Denmark.  Acta Ophthalmol. 2004;  82 443-448
    PubMedGoogle Scholar
  • 5 Early Treatment for Diabetic  Retinopathy Study (ETDRS). Early treatment diabetic retinopathy study research group. Grading Diabetic Retinopathy from Stereoscopic color Fundus Photographs-An Extension af the Modified Airlie House Classification. ETDRS Report Number 10.  Ophthalmology. 2000;  98 786-806
    PubMedGoogle Scholar
  • 6 Aldington S, Kohner E M, Meuer S, Klein R, Sjølie A K. Methodology for retinal photography and assessment af diabetic retinopathy: the EURODIAB IDDM Complications Study.  Diabetologia. 1995;  38 (4) 437-444
    CrossrefPubMedGoogle Scholar
  • 7 Larsen M, Godt J, Larsen N, Lund-Andersen H, Sjølie A K, Agardh E, Kalm H, Grunkin M, Owens D R. Automated detection of fundus photographic red lesions in diabetic retinopathy.  Invest Ophthalmol Vis Sci. 2003;  44 (2) 761-766
    CrossrefPubMedGoogle Scholar
  • 8 Larsen N, Godt J, Grunkin M, Lund-Andersen H, Larsen M. Automated detection of diabetic retinopathy in a fundus photographic screening population.  Invest Ophthalmol Vis Sci. 2003;  44 (2) 767-771
    CrossrefPubMedGoogle Scholar
  • 9 Bek T, Helgesen A. The regional distribution of diabetic retinopathy lesions may predict risk factors for the progression of the disease.  Acta Ophthalmol. 2001;  79 501-505
    PubMedGoogle Scholar
  • 10 Liesenfeld B, Kohner E, Piehlmeier W, Kluthe S, Aldington S, Porta M, Bek T, Obermaier M, Mayer H, Mann G, Holle R, Hepp . A Telemedical Approach to the Screening of Diabetic Retinopathy: Digital Fundus Photography.  Diabetes Care. 2000;  23/3 345-348
    PubMedGoogle Scholar
  • 11 Hejlesen O K, Plougmann S, Ege B M, Larsen O V, Bek T, Cavan D. Using the internet in patient-centred diabetes care for communication, education, and decision support.  Medinfo. 2001;  10/2 1464-1468
    PubMedGoogle Scholar
  • 12 Luzio S, Hatcher S, Zahlmann G, Mazik L, Morgan M, Liesenfeld B, Bek T, Schuell H, Schneider S, Owens S R, Kohner E. Diabetic Medicine.  in press. ; 
    PubMedGoogle Scholar
  • 13 Hejlesen O K, Ege B, Englmeier K, Aldington S, McCanna L, Bek T. TOSCA-Imaging. Developing Internet Based Image Processing Software for Screening and Diagnosis of Diabetic Retinopathy.  Medinfo. 2004;  13/1 222-226
    PubMedGoogle Scholar
  • 14 Ege B M, Bek T, Larsen O V, Hejlesen O K. Using a model of the colour content in retinal fundus images to screen for sight threatening diabetic retinopathy. Proceedings of the XVIIth International Congress of the European Federation for Medical Informatics. Budapest, Hungary; 25 - 29 August, 2002 90: 18-23
    Google Scholar
  • 15 Ege B M, Hejlesen O K, Larsen O V, Bek T. The relation between age and colour composition in the normal fundus photograph.  Acta Ophthalmol. 2002;  80 485-489
    PubMedGoogle Scholar
  • 16 Bek T. TOSCA-Imaging. Final report of EU-project IST-1999-12 364. ISBN 87 - 989 506 - 0-6 2003: 1-59
    Google Scholar
  • 17 Hove M, Kristensen J K, Lauritzen T, Bek T. Computerised quantitative analysis of retinopathy in type 2 diabetes. Identification of parameters of prognostic value for developing visual loss secondary to diabetic maculopathy.  Acta Ophthalmol.. in press; 
    PubMedGoogle Scholar
  • 18 Kohner E M. The effect of diabetic control on diabetic retinopathy. Review.  Eye 7. 1993;  (pt 2) 309-311
    PubMedGoogle Scholar
  • 19 Kristinsson J K, Gottfredsdottir M S, Stefansson E. Retinal vessel dilatation and elongation precedes diabetic macular edema.  Br J Ophthalmol. 1997;  81 (4) 274-278
    PubMedGoogle Scholar
  • 20 Grunwald J, DuPont J, Riva C E. Retinal hemodynamics in patients with early diabetic retinopathy.  Br J Ophthalmol. 1996;  80 327-331
    PubMedGoogle Scholar
  • 21 Garhofer G, Zawinka C, Resch H, Kothy P, Schmetterer L, Dorner O. Reduced response of retinal vessel diameters to flicker stimulation in patients with diabetes.  Br J Ophthalmol. 2004;  88 (7) 887-891
    CrossrefPubMedGoogle Scholar
  • 22 Stansberry K B, Shapiro S A, Hill M A, McNitt P M, Meyer M D, Vinik A I. Impaired peripheral vasomotion in diabetes.  Diabetes Care. 1996;  19/7 715-721
    PubMedGoogle Scholar
  • 23 Bek T. Diabetic retinopathy caused by changes in retinal vasomotion. A new hypothesis.  Acta Ophthalmol. 1999;  77 376-380
    PubMedGoogle Scholar
  • 24 Jeppesen P. Physiological functions and pharmaculogical characteristics of porcine retinal arterioles. Ph. D. thesis. University of Aarhus 2002
    Google Scholar
  • 25 Orgul S, Gugleta K, Flammer J. Physiology of perfusion as it relates to the optic nerve head.  Surv Ophthalmol. 1999;  43 suppl 1 S17-S26
    PubMedGoogle Scholar
  • 26 Jeppesen P, Aalkjær C, Bek T. Myogenic response in isolated porcine retinal arterioles.  Curr Eye Res. 2003;  27 (4) 217-222
    CrossrefPubMedGoogle Scholar
  • 27 Jeppesen P, Aalkjær C, Bek T. Bradykinin relaxation in porcine retinal arterioles is inhibited by L-NAME.  Invest Ophthalmol Vis Sci. 2002;  43/6 1891-1896
    PubMedGoogle Scholar
  • 28 Jeppesen P, Aalkjær C, Bek T. Glibenclamide and ouabain inhibits adenosine relaxation in small isolated retinal arterioles.  Curr Eye Res. 2002;  25/1 23-28
    PubMedGoogle Scholar
  • 29 Hessellund A, Aalkjaer C, Bek T. The influence of acidosis on the tone of porcine retinal vessels.  submitted. ; 
    PubMedGoogle Scholar
  • 30 Hessellund A, Jeppesen P, Aalkjær C, Bek T. Characterization of vasomotion in porcine retinal arterioles.  Acta Ophthalmol. 2003;  81 (3) 278-282
    PubMedGoogle Scholar
  • 31 Hessellund A, Jeppesen P, Aalkjær C, Bek T. Effect of cyclic GMP on retinal vasomotion.  submitted. ; 
    PubMedGoogle Scholar
  • 32 Jeppesen P, Gregersen P, Bek T. Age-dependent decrease in the myogenic response of retinal arterioles as studied with the Retinal Vessel Analyser (RVA).  Graefe’s Arch Clin Exp Ophthalmol.. in press; 
    PubMedGoogle Scholar
  • 33 Bayerle-Eder M, Polska E, Kopf A, Roden M, Waldhausl W, Pleiner H, Wipler B, Wolzt M, Schmetterer L. Free fatty acids exert a greater effect on ocular and skin blood flow than triglycerides in healthy subjects.  Eur J Clin Invest. 2004;  34 (8) 519-526
    CrossrefPubMedGoogle Scholar

T. Bek

Department of Ophthalmology

Aarhus University Hospital · DK-8000 Aarhus C · Denmark ·

Phone: + 45 89493223

Fax: + 45 86121653

Email: toke.bek@mail.tele.dk

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