Abstract. Rosmond R, Wallerius S, Wanger P, Martin L, Holm G, Björntorp P (The Cardiovascular Institute, Sahlgrenska University Hospital, Göteborg; and Huddinge University Hospital, Huddinge; Sweden). A 5-year follow-up study of disease incidence in men with an abnormal hormone pattern. J Intern Med 2003; 254: 386-390.Objectives. Previous studies have suggested that abnormal levels of cortisol and testosterone might increase the risk of serious somatic diseases. To test this hypothesis, we conducted a 5-year follow-up study in middle-aged men. Methods. A population-based cohort study conducted in 1995 amongst 141 Swedish men born in 1944, in whom a clinical examination supplemented by medical history aimed to disclose the presence of cardiovascular disease (CVD) (myocardial infarction, angina pectoris, stroke), type 2 diabetes and hypertension were performed at baseline and at follow-up in the year 2000. In addition, salivary cortisol levels were measured repeatedly over the day. Serum testosterone concentrations were also determined. Using the baseline data, an algorithm was constructed, which classified the secretion pattern of cortisol and testosterone from each individual as being normal or abnormal. Results. By the end of follow-up, men with an abnormal hormone secretion pattern (n ¼ 73) had elevated mean arterial pressure (P ¼ 0.003), fasting insulin (P ¼ 0.009) and insulin : glucose ratio (P ¼ 0.005) compared with men with a normal secretion pattern (n ¼ 68). Body mass index, waist circumference, and waist : hip ratio were significantly elevated in both groups. However, the 5-year incidence of CVD, type 2 diabetes, and hypertension were significantly higher (P < 0.001) in men with an abnormal neuroendocrine secretory pattern compared to men with a normal pattern. Conclusions. These data suggest that an abnormal neuroendocrine secretory pattern is prospectively associated with an increased incidence of cardiovascular-related events and type 2 diabetes.

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Aim: To evaluate central retinal thickness and foveal function using optical coherence tomography (OCT) and the Rarebit Fovea Test (RFT) in patients with diabetes without previously known retinopathy or maculopathy. Method: Forty-two patients with diabetes mellitus (DM) were selected from the screening records at St Erik Eye Hospital. Inclusion criteria were absence of macular or other retinal changes at previous screening examination and best corrected visual acuity >1.0. These patients and 42 healthy controls were examined with the recently developed RFT, and retinal thickness was measured using OCT. Lens thickness and light scatter were evaluated by Scheimpflug photography. Results: Significantly more DM subjects (12/42) had a subnormal RFT result compared with the controls (2/42) (p = 0.007). None of the 12 DM subjects had maculopathy, one had mild non proliferative diabetic retinopathy, and five had minimal non-proliferative diabetic retinopathy. The retinal thickness in the pericentral zone was significantly (p,0.05) thinner in DM patients with subnormal RFT compared with the controls. Conclusion: Decreased RT and subnormal RFT results were found in a subgroup of diabetes patients, despite normal screening results. Prospective studies are under way to evaluate the prognostic implications. S tandard procedures for diabetes mellitus (DM) screening are fundus photography or funduscopy with dilated pupils. However, there is evidence suggesting that neuronal changes have an important role in the development of diabetic retinopathy (DRP) and that retinal degeneration may precede visible or vascular changes.1 2 In a recent study, the retinal thickness was found to be decreased in subjects with DM type 1 and minimal DRP compared with healthy controls. 3The Rarebit technique including perimetry and the Rarebit Fovea Test (RFT) was recently developed with the explicit aim to reveal low degree damage of the visual system. 4 In a previous study, 5 the effect of RFT stimulus luminance on examination results was studied, and the limits for normality established. The aim of the current study was to evaluate the ability of RFT to detect foveal dysfunction in DM patients without previously known retinopathy or maculopathy.

ABSTRACT.Purpose: To develop and evaluate a simple and rapid algorithm for optic disc measurements on digital fundus photographs, relying on the macula-disc centre distance as a reference when converting length expressed in pixels to metric distance. Methods: Measurements were performed on fundus photographs from 68 normal subjects, acquired using five different cameras. The magnification factor and actual size in lm of 1 pixel was known for only one camera. The measurements from this camera were compared to corresponding measurements from a confocal scanning laser ophthalmoscope. Results: Using the described algorithm, no significant differences in mean disc or cup size were observed between the tested cameras, despite differences in magnification factor (range 0.5-2.5). There were no significant differences between disc and cup measurements obtained with the confocal scanning laser ophthalmoscope and those obtained with the described algorithm in the 20 subjects examined. Conclusion: The algorithm described in the current study provided clinically relevant measurements of optic disc parameters. The final program can be used directly on the acquired images, with the examined subject still available for re-examination.

. Purpose:  Retinal images acquired by means of digital photography are often used for evaluation and documentation of the ocular fundus, especially in patients with diabetes, glaucoma or age‐related macular degeneration. The clinical usefulness of an image is highly dependent on its quality. We set out to develop and evaluate an automatic method of evaluating the quality of digital fundus photographs. Methods:  A method for making a numerical quantification of image sharpness and illumination was developed using Matlab™ image analysis functions. Based on their sharpness and illumination measures, 1000 fundus photographs, randomly selected from a clinical database, were assigned to four predefined quality groups (not acceptable, acceptable, good, very good). Six independent observers, comprising three experienced ophthalmologists and three ophthalmic nurses with extensive experience in fundus image acquisition, classified a selection of 100 of these images into the corresponding quality groups. Results:  Automatic quality evaluation was more sensitive than evaluation by human observers in terms of ability to discriminate between good and very good images. The median concordance between the six human observers and the automatic evaluation was substantial (kappa = 0.64). Conclusions:  The proposed method provides an objective quality assessment of digital fundus photographs which agrees well with evaluations made by qualified human observers and which may be useful in clinical practice.