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Paolo Silva, Jerry Cavallerano, Jennifer Sun, Lloyd Aiello, Lloyd Aiello; Peripheral Diabetic Retinal Lesions Identified on Ultrawide Field (UWF) Imaging May Predict 3-Year Diabetic Retinopathy Progression. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1725.
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To evaluate the correlation between peripheral diabetic retinopathy (DR) lesions identified on UWF images and DR progression over 3 years of followup.
Standardized mydriatic UWF imaging (Optos P200MA) was performed on 204 eyes of 102 patients. Images were graded for DR severity. Distribution of DR lesions on UWF images peripheral to ETDRS fields (far peripheral lesions) were noted. DR severity on subsequent dilated exams performed by retina specialists, and mean A1c values over the preceding 1 and 2 years were recorded.
A1c at 1 and 2 years prior to imaging was available in 75% (152) and 77% (158) of subjects. Median number of prior A1c results was 3 (Q1,Q3: 2,4) at 1 yr and 5 (5,7) at 2 yrs. Mean A1c was 8.1±1.2%, 7.9±1.2% and 8.1±1.5% at imaging and over the preceding 1 and 2 yrs, respectively. Baseline UWF images had far peripheral H/Ma, IRMA, NVE or any of these lesions in 45% (92), 28% (57), 9% (18) and 50% (102) of eyes. In eyes with NPDR (N=130), presence of far peripheral H/Ma, IRMA or any peripheral change was observed in 49%, 28% and 54%. Followup exams were recorded in 87% (178), 79% (162) and 63% (128) of eyes at 1, 2 and 3 yrs. DR progression of ≥1 step occurred in 11% (20), 12% (19) and 12% (16) of eyes by 1, 2 and 3 yrs, respectively. Increasing DR severity and A1c were associated with DR progression after 1, 2 and 3 yrs (DR: p<0.0001,=0.001,=0.004; A1c: p=0.04, 0.04, 0.03). After adjusting for DR severity in eyes with NPDR, far peripheral DR lesions present at the time of imaging were associated with greater risk for ≥1 step progression at 1 (21% vs 8%, p=0.05), 2 (21% vs 7%, p=0.04) and 3 yrs (26% vs 7%, p=0.02). This increased progression risk remained significant after additionally adjusting for prior 1-yr (p=0.013, 0.001, 0.002) and 2-yr (p=0.003, 0.001, 0.002) mean A1c. Absence of far peripheral DR lesions at baseline resulted in a 62%, 67% and 73% risk reduction for DR worsening over the ensuing 1, 2 and 3 yrs, respectively.
In this cohort of patients followed at a single center over 3 years, baseline DR severity and A1c were the greatest predictors of progression, emphasizing the importance of accurate DR assessment and glycemic control. In eyes with NPDR, presence of far peripheral DR lesions may predict subsequent DR progression independent of baseline DR severity and glycemic control.
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