The purpose of this paper is to review male-female differences in the incidence and prevalence of diabetes and diabetic retinopathy. These differences will be established primarily through results from our present research and a review of related literature. Previously, we have demonstrated that neuroretinal dysfunction can be used to predict the location of future retinopathy up to three years before it is manifest. Our current research suggests that, for type 2 diabetes, the normal differences in neuroretinal function between nondiabetic males and females under 50 years of age are altered in patients with type 2 diabetes. Furthermore, local neuroretinal function in type 2 diabetes is more abnormal in adult males compared with adult females. The literature also suggests that there are male-female differences in the occurrence of diabetes. In adolescence, the incidence of type 1 diabetes is greater in males, whereas in type 2 diabetes, the incidence is greater in females. This excess of females in type 2 diabetes shifts to a more equal incidence between the two sexes in adults. In addition, advanced retinopathy in type 1 diabetes appears to be more common in males, and the presence and severity of diabetic retinopathy at the time of diagnosis in type 2 diabetes appears to be more associated with male sex. Although the reasons for male-female differences identified in this review are unknown, sex appears to be a significant factor in certain aspects of diabetes incidence and diabetic retinopathy.

Purpose To determine whether hard exudates (HE) within one disc diameter of the foveola is an acceptable criterion for the referral of diabetic patients suspected of clinically significant macular edema (CSME) in a screening setting. Methods 143 adults diagnosed with diabetes mellitus were imaged using a non-mydriatic digital fundus camera at the Alameda County Medical Center in Oakland, CA. Non-stereo fundus images were graded independently for the presence of HE near the center of the macula by two graders according to the EyePACS grading protocol. The patients also received a dilated fundus exam on a separate visit. CSME was determined during the dilated fundus examination using the criteria set forth by the Early Treatment Diabetic Retinopathy Study. Subsequently, the sensitivity and specificity of hard exudates within one disc diameter of the foveola in non-stereo digital images used as a surrogate for the detection of CSME diagnosed by live fundus examination were calculated. Results The mean age of 103 patients included in the analysis was 56±17years. CSME was diagnosed in 15.5% of eyes during the dilated exam. For the right eyes, the sensitivity of hard exudates within one disc diameter from the foveola as a surrogate for detecting CSME was 93.8% for each of the graders; the specificity was 88.5% and 85.1%. For the left eyes, the sensitivity was 93.8% and 75% for each of the two graders, respectively; the specificity was 87.4% for both graders. Conclusions This study supports the use of HE within a disk diameter of the center of the macula in non-stereo digital images for CSME detection in a screening setting.

A digital light projector is implemented as an integrated illumination source and scanning element in a confocal non-mydriatic retinal camera, the DLP-Cam. To simulate scanning, a series of illumination lines are rapidly projected on the retina. The backscattered light is imaged onto a 2-dimensional rolling shutter CMOS sensor. By temporally and spatially overlapping the illumination lines with the rolling shutter, confocal imaging is achieved. This approach enables a low cost, flexible, and robust design with a small footprint. Qualitative image comparison with commercial non-mydriatic SLOs and fundus cameras shows comparable fine vessel visibility and contrast.

In this review article, we first present a brief overview of the vascular and neural components of diabetic retinopathy. Next, the multifocal electroretinogram (mfERG) technique, which can map neuroretinal function noninvasively, is described. Findings in diabetic retinal disease using the mfERG are reviewed. We then describe the progress that has been made to predict the onset and progression of diabetic retinopathy and edema in specific retinal locations, using quantitative models based on the mfERG. Finally, we consider the implications for the future of these predictive models.

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.