bluuebunny/crossref_metadata_2025_split huggingface dataset:
1809-PUB: Painful Diabetic Neuropathy—Patients Treated with High-Frequency (10 kHz) Spinal Cord Stimulation (SCS) Experience Significant Reductions in A1C and Weight
Authors: KLONOFF DAVID C. , LEVY BRIAN L. , JAASMA MICHAEL , BHARARA MANISH , NASR CHRISTIAN E. , CARAWAY DAVID L. , PETERSEN ERIKA , ARMSTRONG DAVID G. 
Published: June 2023

Objective: Up to 9 million Americans have painful diabetic neuropathy (PDN), which can be debilitating. For PDN patients, 10 kHz SCS has been shown to provide mean pain relief of 77% at 24 months (24M), and here we report secondary, novel potential benefits for A1C and body weight.
Methods: Subjects received a 10 kHz SCS implant plus medical management for their pain and diabetes. Subjects were followed for 24M post-implantation. Key inclusion criteria were: PDN ≥12M refractory to medications, lower limb pain ≥5cm (10cm VAS), and A1C ≤10%. For T2D subjects, changes in weight were evaluated for all subjects and cohorts with pre-implant BMI ≥30 and ≥35, and changes in A1C were evaluated for cohorts with pre-implant A1C ≥7.0% and ≥8.0%.
Results: For cohorts evaluated, A1C and weight generally decreased with time (Fig. 1). For subjects with pre-implant A1C ≥8.0%, the mean A1C reduction was 0.52% at 6M (p=0.064) and 1.04% at 24M (p=0.007). For all subjects, the mean weight reduction was 1.8 kg at 12M (p=0.058) and 3.1 kg at 24M (p=0.003). For subjects with pre-implant BMI ≥35, the mean weight reduction was 5.4 kg at 24M (p=0.005).
Conclusions: Previously reported pain relief and sensory improvement, coupled with reductions in A1C and weight reported here, further demonstrate the benefits of 10 kHz SCS treatment in the comprehensive care of T2D patients with PDN.

Disclosure
D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. B.L.Levy: Advisory Panel; Nevro Corp., CeQur SA, Consultant; Nevro Corp., CeQur SA, Digma Medical. M.Jaasma: Consultant; Bone Health Technologies, Inc., Employee; Nevro Corp., Bone Health Technologies, Inc. M.Bharara: Employee; Nevro Corp. C.E.Nasr: Advisory Panel; Siemens, Horizon Therapeutics plc. D.L.Caraway: Employee; Nevro Corp. E.Petersen: Consultant; Abbott, Biotronik, Medtronic, Nalu, Nevro Corp., Presidio Medical, Saluda Medical, Vertos Medical Inc., Research Support; Nalu, Nevro Corp. D.G.Armstrong: Research Support; Medaxis LLC.

Funding
Nevro Corp.
1811-PUB: Real-World Safety of the Combined Use of Dapagliflozin and Metformin in Type 2 Diabetes Mellitus Patients in China—Post Hoc Analysis of the DONATE Study
Authors: GUO LIXIN , WANG JING , LI LI , YUAN LIN , CHEN SHENG , WANG HUI , LI TONGHUAN , QI LIN , YANG HONG 
Published: June 2023

Background: Dapagliflozin is effective and well-tolerated in type 2 diabetes mellitus (T2DM) patients and is often combined with metformin in clinical practice, with or without other antidiabetic agents. Yet, real-world data on the safety of the combined use of dapagliflozin and metformin are limited.
Methods: The DONATE study assessed the safety of dapagliflozin in 2,990 Chinese T2DM patients who received ≥1 dose of dapagliflozin. This post-hoc analysis assessed the incidences of adverse events (AEs), serious AEs (SAEs), and AEs of special interest (AESIs) during the 24-week follow-up in patients receiving both dapagliflozin and metformin, with or without other antidiabetic agents.
Results: In total, 2,165 patients (72.4%) from the DONATE study received both dapagliflozin and metformin. Comparable with that observed in the overall population, of these patients, 780 (36.0%) had ≥1 AE: 197 (9.1%) were drug-related as judged by the investigator, 129 (6.0%) were serious, and 96 (4.4%) resulted in treatment discontinuation. Urinary tract infections (UTIs), genital tract infections (GTIs) and hypoglycaemia developed in 50 (2.3%), 32 (1.5%), and 23 (1.1%) patients, respectively. In patients receiving dapagliflozin and metformin without other antidiabetic agent (n=322), 86 (26.7%) had ≥1 AE: 12 (3.7%) were drug-related as judged by the investigator, 8 (2.5%) were serious, and 6 (1.9%) resulted in treatment discontinuation. UTIs, GTIs, and hypoglycaemia developed in 4 (1.2%), 2 (0.6%), and 1 (0.3%) patient, respectively. The incidences of AEs, SAEs, and AESIs were also low when dapagliflozin and metformin were used together with dipeptidyl peptidase-4 inhibitor (DPP-4i, 37.5%, 3.1%, and 6.9%) or insulin (36.5%, 7.1%, and 5.0%).
Conclusion: The combined use of dapagliflozin and metformin, with or without other antidiabetic agents such as DDP-4i or insulin, showed a good safety profile in Chinese T2DM patients in the real world.

Disclosure
L. Guo: None. J. Wang: None. L. Li: None. L. Yuan: None. S. Chen: None. H. Wang: None. T. Li: None. L. Qi: None. H. Yang: None.
1812-PUB: Safety and Effectiveness of Empagliflozin/Linagliptin FDC in Uncontrolled T2DM Patients with COVID-19 Infection
Authors: SENGUPTA ASOKTARU 
Published: June 2023

Background: COVID-19 infection prognosis is known to worsen in patients with various co-morbidities particularly with uncontrolled diabetes mellitus and is often associated with increased serum levels of various inflammatory markers such as CRP, IL-6, D-dimer, LDH etc. Hence optimal glycemic care is crucial for a good prognosis in type 2 Diabetes (T2D) patients with COVID-19 infection. Efficacy and safety of Empagliflozin/linagliptin fixed dose combination (FDC) in T2D patients is well known. In the present study, the safety and effectiveness of Empagliflozin/Linagliptin FDC was evaluated in T2D patients diagnosed with COVID-19 infection.
Aim: To evaluate the safety, effectiveness of T2D patients with COVID-19 infection with empagliflozin/linagliptin FDC.
Methods: A single center, retrospective observational study included T2D patients who were on Empagliflozin/Linagliptin (25/5 mg) at the time of COVID-19 diagnosis and were followed up for 6 months. Laboratory (HbA1c, Ferritin, LDH, IL-6, CRP, D-Dimer) and clinical assessments (need for oxygen support & steroids) were done at baseline, 3rd, and 6th months. Repeated measures ANOVA was used to determine the mean difference at specified time intervals and any p-value &lt; 0.05 was considered statistically significant.
Results: A total of 50 T2D patients were included with mean age (SD) was 57.44 ± 9.88 years. Patients treated with Empagliflozin/Linagliptin FDC at 6 months showed significant reduction in HbA1c (6.87 ± 0.22 mg/dL from 10.2± 0.9 mg/dL), CRP (8.9 ± 2.79 mg/dL from 99.2 ± 4.00 mg/dL), LDH (288 ± 45.12U/L from 675 ± 95.41U/L), ferritin (408.4 ± 131.00 ng/mL from 1100± 216.2 ng/mL), IL-6 (8.97 ± 2.40 pg/mL from 95.56 ± 23.4 pg/mL). Also, the need for oxygen support and daily steroid dose requirement had become lesser over 6 months.
Conclusion: Once daily Empagliflozin/Linagliptin (25/5 mg) FDC was found to be safe, effective, and well tolerated in non-critically ill T2D patients with COVID-19 infection.

Disclosure
A.Sengupta: None.
1819-PUB: Multicentric Real-World Evaluation of CGM Metrics across Urban and Semi-urban Dedicated Diabetes Care Centres in 887 T2DM
Authors: CHAWLA PURVI M. , PUNATAR DHARMEN H. , DESHMANE RAJESH , BHOJANE SONALI , CHAWLA MANOJ S. 
Published: June 2023

We evaluated the CGM metrics using the Libre Pro across 7 centres in India enrolling 887 people with T2DM, from January - December 2022. CGM metrics were analysed for the Time in Range (TIR), Time Below Range (TBR), Time Above Range (TAR). The target range used for all CGM was as per ADA recommendation of 70-180 mg/dl. We excluded patients with complications of T2DM. The mean (±SD, 95% CI) estimated A1c, TIR, TBR, TAR % were 7 (±1.8, 6.9 to 7.1), 56 (±24, 54 to 58), 9.2 (±12, 8.3 to 10), 35 (±27, 33 to 36). There was a negative significant correlation between eA1c and TIR (Pearson r -0.69, 95% CI -0.72 to 0.65, p &lt;0.0001). There was a negative significant correlation between eA1c and TBR (Pearson r -0.53, 95% CI -0.57 to 0.48, p &lt;0.0001). There was a positive significant correlation between eA1c and TAR (Pearson r 0.86, 95% CI 0.85 to 0.88, p &lt;0.0001). The findings is indicative of the mean TIR, as a reflection of the glycemic control, across several geographically spread centres with varied representation of urban and semi-urban settings, delivering diabetes care to a diverse patient population. The significant correlation of the CGM metrics is encouraging and TIR should be the prime focus to improvise the glycemic care, that would further help improve TBR and adopt CGM.

Disclosure
P.M.Chawla: None. D.H.Punatar: None. R.Deshmane: None. S.Bhojane: None. M.S.Chawla: None.
1821-PUB: Relationship between Time in Range and Glucose Management Indicator in Adolescents and Children with Type 1 Diabetes Mellitus
Authors: LEI MENGYUN , LV JING , MAI XIAODONG , DENG HONGRONG , WANG CHAOFAN , YANG DAIZHI , YANG XUBIN , XU WEN , YAN JINHUA 
Published: June 2023

Objective: To investigate the relationship between time in range (TIR, 3.9-10.0mmol/L) and glucose management indicator (GMI) in adolescents and children with type 1 diabetes mellitus (T1DM) and explore the impact of coefficient of variation (CV) on their relationship.
Methods: Data derived from continuous glucose monitoring (CGM) and other clinical data (including age, duration of T1DM, and laboratory-measured HbA1c) were obtained from the annual follow-up of the Guangdong T1DM Translational Medicine Study. The patients under 18 years old were included. The patients were divided into CV≤36% group and CV&gt;36% group by the attainment of CV. The relationship between TIR and GMI of both groups was assessed with correlation coefficient. Further, patients were divided into 4 groups by the interquartile range of CV. The linear regression model was used to calculate the TIR predicted value corresponding to the same GMI in 4 groups.
Results: The 56 eligible datasets collected from May 2014 to August 2021 were included. The median age, duration of T1DM, and laboratory-measured HbA1c were 14.00 (12.00, 16.00) years, 4.15 (1.66, 5.29) years, and 9.00 (7.65, 11.23) %, respectively. The median TIR, GMI, CV, and valid number of days the CGM device was worn were 60.73 (42.59, 77.72) %, 7.37 (6.78, 8.56) %, 30.38 (24.87, 34.94) %, and 3.39 (2.97, 4.84) days, respectively. TIR and GMI were highly linear correlated (R2=0.89, p&lt;0.001), and a significantly higher Spearman’s correlation coefficient was observed in the CV≤36% group than in CV&gt;36% group ((R2=0.92, p&lt;0.001) vs. (R2=0.63, p=0.004)). When the GMI was 7%, the corresponding TIR predicted values gradually decreased with the increase of CV, which were 75.66% (CV≤24.87%), 73.48% (24.87%&lt;cv≤30.38%), 69.16% (30.38%34.94%).
Conclusions: TIR and GMI were highly linear correlated in adolescents and children with T1DM. With constant GMI, the less the glycemic fluctuation, the higher the TIR.&lt;/cv≤30.38%), 69.16% (30.38%

Disclosure
M.Lei: None. J.Lv: None. X.Mai: None. H.Deng: None. C.Wang: None. D.Yang: None. X.Yang: None. W.Xu: None. J.Yan: None.

Funding
Science and Technology Planning Project of Guangzhou (202102010154)
1833-PUB: Effects of Lifestyle on Obesity and Hypertension in Adolescents—Data from Western India
Authors: HASNANI DHRUVI , JHA SANTOSH , SABOO BANSHI D. , HASNANI SHRIJI , JAMALPURE SNEHAL , CHAVDA VIPUL 
Published: June 2023

Background and Objectives: Hypertension (HT) is a leading risk factor for blood vessel diseases worldwide and its prevalence is increasing among adolescents. Lifestyle changes cause increased obesity, thereby increasing the risk of developing HT. In this study, the prevalence of HT and associated risk factors were assessed in adolescents in Gujarat, India.
Methodology: Each of the urban and rural cohorts included 400 subjects, aged 14-18 years, with similar gender distributions. Physiological parameters, including body mass index (BMI) and blood pressure, were recorded, and a questionnaire was used to evaluate medical history and lifestyle patterns with an emphasis on food habits. The association between the recorded parameters and obesity and HT was evaluated.
Results: The prevalence of HT was higher in the urban cohort than in the rural cohort (20% vs. 17%), and a weak association with a family history of HT was observed in both cohorts. Obesity and high-fat diet had a moderate to relatively strong association with HT in both cohorts. More than 35% of the participants who regularly consumed junk food were hypertensive.
Conclusion: The changing lifestyle with less physical activity and increased consumption of high-fat and high-sugar diets may have been responsible for the increasing obesity among adolescents, thereby increasing the prevalence of HT. A systematic approach to the recognition, monitoring, prevention, and treatment of obesity is crucial for addressing this global health issue.

Disclosure
D.Hasnani: None. S.Jha: None. B.D.Saboo: None. S.Hasnani: None. S.Jamalpure: None. V.Chavda: None.
1842-PUB: Ischemic Stroke in Patients with Diabetes Mellitus during COVID-19 Pandemic in South Korea, Using National Emergency Department Information System
Authors: JEONG PARK MIN , YEON JANG SOO , MOOK CHOI KYUNG , HYUN BAIK SEI , JIN YOO HYE 
Published: June 2023

Background: Coronavirus disease 2019 (COVID-19) put strain on patients using health care services, which results in suboptimal care for diseases requiring prompt management, such as ischemic stroke. Patients with diabetes mellitus (DM), high risk group of stroke, were compromised with routine diabetic care during pandemic. Until now, the influence of this outbreak on the management of ischemic stroke has not been clarified both in total and DM subjects.
Methods: This nationwide population-based study analyzed 11,734 patients diagnosed of acute ischemic stroke and underwent intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) during January 2019 (reference year) to December 2020 (pandemic year). The changes in the frequency of ED visit, treatment modality and outcomes by ischemic stroke were compared between pandemic and reference period. Subgroup analysis in DM patients was also performed.
Results: During COVID-19 pandemic, incidence of ischemic stroke available requiring for urgent procedures increased by 7.57% in South Korea (5,653 in 2019 vs 6,081 in 2020). In total subjects, time for symptom onset to ED visit and for ED visit to admission was significantly delayed. As a treatment modality, the rate of IVT increased, while that of patients applied mechanical ventilation decreased. Especially, DM patients aged more than seventies exhibited a significant higher chance to ICU admission rate during pandemic (p-value &lt; 0.01). Nevertheless, there was no significant difference in hospital-stay days and in-hospital mortality both in total and DM subjects.
Conclusion: During COVID-19 pandemic, the incidence of ischemic stroke necessary for emergency care was increased and elderly DM patient showed a higher ICU admission rate. However, overall treatment outcome of ischemic stroke was preserved during this outbreak period in South Korea.

Disclosure
M.Park: None. S.Jang: None. K.Choi: None. S.Baik: None. H.Yoo: None.
1844-PUB: What Impacts Stress Coping Ability in Type 2 Diabetes When It Is Measured by Japanese Method—A Cross-Sectional Study
Authors: ONO YURIKO , SAKAI RYOSUKE , IWASE HIROYA , TANAKA TORU , FUKUI MICHIAKI 
Published: June 2023

Stress can cause diabetes or elevated blood glucose levels. Previous researches showed that higher ability of stress coping leaded to better glycemic control. Sense of Coherence (SOC) is considered one of the abilities to cope with stress and promote health. The 3-item 7-point Japanese version of SOC (SOC-3), a shortened version of SOC-29 and SOC-13, was designed to be easier to use in clinical study. Since no studies have revealed factors associated with SOC scale as assessed by SOC-3 (SOC-3s), we examined factors associated with SOC-3s in persons with type 2 diabetes. We selected 1179 persons with type 2 diabetes who visited the diabetic outpatient clinic at our hospital from January 2018 to February 2020. Questionnaire is as follows. Regression analysis was performed to examine factors associated with SOC-3s. Responses were obtained from 785 persons (499 men and 286 women). In multivariate analysis, SOC-3s was significantly associated with HbA1c (β = -0.078, p = 0.035), duration of diabetes (β = -0.076, p = 0.045), exercise habits (β = 0.093, p = 0.014), drinking habits (β = 0.080, p = 0.035), regular meal times (β = 0.102, p = 0.007). Duration of diabetes and lifestyles were associated with SOC-3s in persons with type 2 diabetes besides glycemic management.

Disclosure
Y.Ono: None. R.Sakai: None. H.Iwase: None. T.Tanaka: None. M.Fukui: None.
1853-PUB: Extrapancreatic Effects of GIP on Bone
Authors: YAMAUCHI TAISUKE , NAKAMURA NOBUHISA , MIYABE MEGUMI , ITO MIZUHO , HOSHINO RINA , KANADA SAKI , SEKIYA TAKEO , MATSUBARA TATSUAKI , MIYAZAWA KEN , GOTO SHIGEMI , NARUSE KEIKO 
Published: June 2023

Glucose-dependent insulinotropic polypeptide (GIP) exhibits extrapancreatic effects through the receptor for GIP (GIPR). In this study, we used Ni-Ti Closed Coil Spring (Ni-Ti) in GIPR-deficient mice (GIPRKO) and wild-type mice (WT) to investigate the effect of GIP on force-induced bone remodeling due to orthodontic tooth movement. It was investigated. Ni-Ti was attached between the maxillary bone and the maxillary left first molar (M1) of GIPRKO and WT, and mechanical load was applied by pulling the M1 in the mesial direction. Remaining amount and bone quality were measured. A histological examination of the maxilla was also performed. As a result, compared to WT, GIPRKO showed a significant increase in tooth movement distance and a significant decrease in residual alveolar bone mass. TRAP staining showed an increase in osteoclasts in GIPRKO compared to WT on the tooth moving side. We also found that GIPRKO reduced osteoblasts in the steady state and suppressed osteoblasts after tooth movement. These results suggest that GIPRK impairs bone remodeling through increased bone resorption due to mechanical load, and that GIP plays an important role in bone remodeling.

Disclosure
T.Yamauchi: None. S.Goto: None. K.Naruse: None. N.Nakamura: None. M.Miyabe: None. M.Ito: None. R.Hoshino: None. S.Kanada: None. T.Sekiya: None. T.Matsubara: None. K.Miyazawa: None.
1854-PUB: Benefits of Bariatric Surgery on Risk Cluster Assignment in Individuals at High Risk for Type 2 Diabetes
Authors: SANDFORTH LEONTINE , LEMBO ERMINIA , VERRASTRO ORNELLA , SANDFORTH ARVID , FRITSCHE ANDREAS , JUMPERTZ VON SCHWARTZENBERG REINER , MINGRONE GELTRUDE , BIRKENFELD ANDREAS L. 
Published: June 2023

A recent data-driven classification of subjects at risk for type 2 diabetes (T2D) has identified three subtypes at high risk to develop T2D and/or complications. Among these, clusters 5 and 6 were specifically insulin resistant and both had a very high risk for nephropathy, despite the fact that cluster 6 had a delayed development of T2D. We hypothesized that particularly clusters 5 and 6 benefit from bariatric surgery (BS) in terms of risk reduction.
We investigated 72 obese individuals at risk for T2D who underwent BS and were followed up for up to 24 months (15.3±4.5 months). At baseline, 97% of subjects were assigned to high risk clusters 5 or 6. Cluster 5 had a mean BMI of 42.8±4.9 kg/m2 vs. 42.5±4.0 kg/m2 in cluster 6, p=0.3. At baseline, HOMA-IR was 8.3±4.9 in cluster 5 and 4.7±2.6 in cluster 6 (p&lt;0.001). After BS, subjects from both clusters normalized HOMA-IR (1.7±1.0 vs. 1.5±1.0) with cluster 5 benefitting significantly more from BS (p group over time &lt;0.001). Unadjusted HOMA-β did not differ between clusters before and after BS. Importantly, 93% of individuals switched to low risk clusters 2 and 4 after BS with comparable distribution of baseline cluster assignment (p=0.5, figure).
These data show that BS leads to a switch from high to low risk clusters in persons at risk for T2D and suggest that BS decreases the risk for future complications also in high risk individuals, especially in high risk cluster 5.

Disclosure
L.Sandforth: None. E.Lembo: None. O.Verrastro: None. A.Sandforth: None. A.Fritsche: Advisory Panel; Novo Nordisk, Lilly, Sanofi, Boehringer-Ingelheim, Speaker's Bureau; AstraZeneca, SYNLAB Holding Deutschland GmbH. R.Jumpertz von schwartzenberg: Other Relationship; Sanofi, Amgen Inc., Lilly, Novo Nordisk. G.Mingrone: Advisory Panel; Fractyl Health, Inc., Board Member; Novo Nordisk, Consultant; Novo Nordisk, Fractyl Health, Inc., ReCor Medical, Inc. A.L.Birkenfeld: None.
1855-PUB: Generation and Identification of Pik3r3 Gene Pancreatic Beta-Cell Knockout Mice Model
Authors: ZHU XIAO-RONG 
Published: June 2023

Objective: To construct Pik3r3 gene pancreatic beta cell knockout mice by the Cre recombinase system, and provide a more specific animal model for the study of the role and mechanism of Pik3r3 in insulin secretion.
Methods: Pik3r3 flox/flox transgenic mice were constructed by CRISPR/Cas9 technology and hybridized with pancreatic beta cell specific Cre recombinase (Ins2-cre) tool mice. We identified their progeny genotype by PCR and sequencing technology. The knockout (KO) and their wild type (WT)mice were used to measure body weight, glucose tolerance, and insulin secretion level.
Results: pancreatic beta cell specific Pik3r3 gene conditional knockout mice, with the genotype of Pik3r3 flox/flox/CreT, were successfully constructed. Further studies showed that Pik3r3 KO mice had impaired glucose tolerance but no significant change in body weight compared with WT mice.
Conclusion: The Pik3r3 gene pancreatic beta cell knockout mouse model was successfully constructed, which provides a research platform for exploring the role of Pik3r3 gene in the development of diabetes.

Disclosure
X.Zhu: None.

Funding
National Natural Science Foundation of China (82000733)
26-LB: Identifying the Risk of Diabetic Retinopathy Progression Using Machine Learning on Ultrawide Field Retinal Images
Authors: NIGAM AMBER , SUN JIE , SUBHASH VARSHINI , SILVA PAOLO S. 
Published: June 2023

Estimating the risk of diabetic retinopathy (DR) progression is one of the most important and difficult tasks when caring for individuals with diabetic eye disease. Current DR severity scales have informed clinicians on the progression risk and provided recommendations for follow-up and treatment. The use of artificial intelligence (AI) algorithms may improve in this process. In this study, we developed and validated machine learning (ML) models for DR progression from ultrawide field (UWF) retinal images, which were labeled for baseline DR severity and progression based on clinician review of the images and 3-year longitudinal follow-up using the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. This dataset has 8 classes: no DR nonprogression (14.62%), Mild nonproliferative DR (NPDR) progression (10.16%) /nonprogression (10.73%), Moderate NPDR progression (10.1%) /nonprogression (15.85%), Severe NPDR progression (11.27%) /nonprogression (10.68%), and proliferative DR (16.55%). A total of 9970 unique images were split into the train, the validation, and the test datasets based on 60-20-20 proportions. The class imbalance was addressed during model building through data augmentation. The ResNet model fine-tuned on this dataset has a classification test accuracy of 81% and an AUC of 0.967 on the test dataset. The objective of the model is to reduce false negatives, which refers to predicting a class that is less progressive than the true label. The predicted labels for 91% of the images were either correct labels or were the labels with greater progression than the original labels. These findings demonstrate the accuracy and feasibility of using machine learning models for identifying DR progression developed using UWF images. Potentially, the use of machine learning algorithms may further refine the risk of disease progression and personalize screening intervals that may reduce costs and improve vision-related outcomes.

Disclosure
A. Nigam: None. J. Sun: None. V. Subhash: None. P. S. Silva: Research Support; Optos plc., Optomed, Speaker's Bureau; Novartis, Roche Pharmaceuticals, Bayer Inc.