Retinal imaging to identify target organ damage in older Africans: A pilot study

Jones, Rebecca; Putnam, H; Philippin, Heiko; Cleland, Charles M.; Steel, David; Gray, William K.; Klaptocz, Joanna; Swai, Bernadetha; Walker, Richard

doi:10.1111/jch.13352

Cited by 4 publications

(3 citation statements)

References 20 publications

(43 reference statements)

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“…Early recognition and treatment can prevent or cure 80% of cases 9 . Features observed in the retina may provide insight about the systemic health of individuals 10 , such as in previous studies where ophthalmoscopy identified biomarkers of hypertension and its severity 11 . Vascular diseases are also common amongst older people living with HIV, and are often undertreated in SSA 12 .…”

Section: Introductionmentioning

confidence: 91%

Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population

George

Murphy

Hogg

et al. 2022

Sci Rep

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Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.

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Section: Introductionmentioning

confidence: 91%

Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population

George

Murphy

Hogg

et al. 2022

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…Early recognition and treatment can prevent or cure 80% of cases [9]. Features observed in the retina may provide insight about the systemic health of individuals [10], such as in previous studies where ophthalmoscopy identi ed biomarkers of hypertension and its severity [11]. Vascular diseases are also common amongst older people living with HIV, and are often undertreated in SSA [12].…”

Section: Introductionmentioning

confidence: 99%

Ophthalmic pathologies in an older HIV-positive Tanzanian population and their association with neurological morbidity and evaluation of a low-resource screening strategy

George¹,

Murphy²,

Hj³

et al. 2021

Preprint

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Background Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Objectives To evaluate clinical utility of HIV-retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. Methods A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Results Of 129 individuals assessed, 69.8% were visually impairment. Six had suspected HIV retinopathy. HAND prevalence was 66.7%. HIV retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of HIV-retinopathy for HAND was poor (AUROC 0.545–0.617) but specificity and positive predictive value were high. Conclusions Ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.

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“…In the last 10 years, the age standardised mean systolic BP has risen in east, west, central and southern Africa more than any other region of the world [1]. The burden of HTN is a particular concern in Tanzania, and data on the prevalence of the sequelae of HTN are limited [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Retinopathy in adults with hypertension and diabetes mellitus in Western Tanzania: a cross‐sectional study

Woodward

Mgaya

Mwanansao

et al. 2020

Tropical Med Int Health

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objective Little is known about the retinal manifestations of arterial hypertension (HTN) and diabetes mellitus (DM) in Western Tanzania and how to maximise the utilisation of scarce eye health resources. To address this, we determined the prevalence of hypertensive and diabetic retinopathy (DR), associated risk factors and relevant patient knowledge. methods Adults with HTN or DM attending outpatient clinics at Bugando Medical Center (BMC) from June to August 2017 were enrolled. Fundus photographs were obtained, and data were collected on blood pressure (BP), body mass index (BMI), blood sugar, visual acuity (VA) and responses to questions about the effects of HTN and DM on the eye. results A total of 180 persons were screened. When only individuals with DR were considered, bivariate regression found systolic BP was significantly associated with severity of DR (P = 0.034). Receiver operating characteristic (ROC) curve analysis using the maximum Youden index revealed the optimum cutoff using duration of DM to predict any DR was 8 years (AUC = 0.75, 95% CI 0.65-0.85). Fewer persons with HTN were aware of the effect of high BP on the eye (61.6%) than persons with DM who were aware of the effect of high blood sugar on the eye (74.4%) (P = 0.048). conclusion Efforts should be made to vigorously treat HTN among adults with DM and refer adults with duration of DM of 8 years or more for a dilated retinal examination. Additional efforts should be made to promote awareness of the sight threatening potential of HTN in resource-limited settings.

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Retinal imaging to identify target organ damage in older Africans: A pilot study

Cited by 4 publications

References 20 publications

Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population

Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population

Ophthalmic pathologies in an older HIV-positive Tanzanian population and their association with neurological morbidity and evaluation of a low-resource screening strategy

Retinopathy in adults with hypertension and diabetes mellitus in Western Tanzania: a cross‐sectional study

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