September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Diabetic Retinopathy (DR) Severity and Prevalence of Predominantly Peripheral Lesions (PPL) Identified using Nonmydriatic Ultrawide Field (UWF) Retinal Imaging in the National Indian Health Service Teleophthalmology Program
Author Affiliations & Notes
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Mark B Horton
    National Teleophthalmolgy Reading Center, Indian Health Service, Phoenix, Arizona, United States
  • Dawn Clary
    National Teleophthalmolgy Reading Center, Indian Health Service, Phoenix, Arizona, United States
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Jerry D Cavallerano
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd Paul Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Paolo Silva, None; Mark Horton, None; Dawn Clary, None; Jennifer Sun, None; Jerry Cavallerano, None; Lloyd Paul Aiello, Optos, plc (R), Optos, plc (F)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1651. doi:
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      Paolo Sandico Silva, Mark B Horton, Dawn Clary, Jennifer K Sun, Jerry D Cavallerano, Lloyd Paul Aiello; Diabetic Retinopathy (DR) Severity and Prevalence of Predominantly Peripheral Lesions (PPL) Identified using Nonmydriatic Ultrawide Field (UWF) Retinal Imaging in the National Indian Health Service Teleophthalmology Program. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1651.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : To evaluate DR severity and prevalence of PPL among American Indian and Alaska Native (AIAN) communities.

Methods : Retrospective review of UWF imaging data from the Indian Health Service (IHS)-Joslin Vision Network (JVN) program deployed in 21 sites across 6 states serving AIAN communities from October 1, 2014 to August 30, 2015. Patients underwent JVN UWF imaging (Daytona, Optos, plc, 200o stereoscopic pair). All images were evaluated for PPL (lesions greater in severity outside as compared to within Early Treatment Diabetic Retinopathy Study fields) by JVN-validated protocol on identical color calibrated LCD high resolution monitors by certified graders at a centralized reading center.

Results : A total of 8,109 subjects received UWF imaging with mean age 54.2±13.3 years, diabetes duration 10.0±9.3 years, 44.6% male. DR severity (N=16,218 eyes) was: no DR 69.7% (11,298), very mild nonproliferative DR (NPDR) 8.2% (1,328), mild 2.7% (437), moderate 10.5% (1,705), severe 0.02% (11), proliferative DR (PDR) 2.8% (445), and ungradable 6.1% (994). In eyes with DR (N=3,926 eyes), PPL were present in 685 (17.5%) and consisted of hemorrhages and/or microaneurysms (H/Ma) in 93.6% (641), venous beading 2.0% (14), intraretinal microvascular abnormalities 1.3% (9) and neovascularization 3.1% (21). PPL were more common in eyes with less severe DR (very mild to mild NPDR 25.5%, moderate and severe NPDR 10.6%, PDR 11.7%, p<0.0001). The presence of PPL suggested a more severe DR diagnosis in 7.2% (281) of eyes, increasing severity to very mild (138 eyes), mild (63), moderate (58), severe NPDR (1) and PDR (21).

Conclusions : In a standardized DR telehealth program serving AIAN communities, PPL were present in 17.5% and suggested a worse DR severity in 7.2% of eyes. A previous teleophthalmology study in a non AIAN population reported similar rates with PPL in 14.1% and a more severe diagnosis in 9.0%. Additionally, in this AIAN cohort, PPL were more frequently identified in eyes with less severe DR. The significantly increased risk of DR progression in eyes with PPL reinforces the need for careful followup in these eyes with early DR and PPL in the AIAN population.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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