Significance:The pathological changes in clinically significant diabetic macular edema lead to greater retinal thickening in males than in females. Therefore, male sex should be considered a potential risk factor for identifying individuals with the most severe pathological changes. Understanding this excessive retinal thickening in males may help preserve vision.Purpose: To investigate the sex differences in retinal thickness for diabetic patients. We tested whether males with clinically significant macular edema had even greater central macular thickness than expected from sex differences without significant pathological changes. To determine which retinal layers contribute to abnormal retinal thickness.Methods: From 2047 underserved adult diabetics from Alameda County, CA, 142 patients with clinically significant macular edema were identified by EyePACS certified graders using color fundus images (Canon CR6-45NM). First, central macular thickness from spectral domain optical coherence tomography (iVue, Optovue) was compared for 21 males vs. 21 females without clinically significant macular edema. Then, a planned comparison contrasted the greater values of central macular thickness for males vs. females with clinically significant macular edema, as compared to those without. Mean retinal thickness and variability of central macular layers were compared for males vs. females.Results: Males without clinically significant macular edema had a 12 μm greater central macular thickness than females, 245 ± 21.3 μm and 233 ± 13.4 μm, respectively, t(40) = −2.18, P = .04.Males with clinically significant macular edema had a 67 μm greater central macular thickness than females, 383 ± 48.7 μm and 316 ± 60.4 μm, P < .001, i.e. males had 55 μm or > 5x more, t(20) = 2.35, P = .015. In males, the outer nuclear layer thickness was more variable F 10,10 = 9.34. Conclusions:Underserved diabetic males had thicker retinas than females, exacerbated by clinically significant macular edema.
PurposeTo investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier.MethodsFundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 μm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately.ResultsCyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 μm) than in the green channel (349 ± 433 μm, P < .006).ConclusionsCysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early stages of diabetic macular edema or the outer blood retinal barrier.
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