June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical Features Predict Diabetic Retinopathy Progression
Author Affiliations & Notes
  • Cecilia S Lee
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Aaron Y Lee
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Doug Baughman
    Ophthalmology, University of Washington, Seattle, Washington, United States
  • Atul Varma
    Mid Yorkshire Hospitals NHS Trust, Yorkshire, United Kingdom
  • Salim Natha
    Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom
  • Louise Downey
    Hull Royal Infirmary, Hull, United Kingdom
  • Geeta Menon
    Frimley Park Hospital, Frimley, United Kingdom
  • Sajjad Mahmood
    Manchester Royal Eye Hospital, Manchester, United Kingdom
  • Usha Chakravarthy
    Belfast Health and Social Care Trust, Belfast, United Kingdom
  • David Paul Crabb
    City, University of London, London, United Kingdom
  • Alastair K Denniston
    University Hospitals Birmingham NHS Foundation Trust, London, United Kingdom
  • Clare Bailey
    Bristol Eye Hospital, Bristol, United Kingdom
  • Adnan Tufail
    Moorfields Eye Hospital, London, United Kingdom
  • Catherine A Egan
    Moorfields Eye Hospital, London, United Kingdom
  • Footnotes
    Commercial Relationships   Cecilia Lee, None; Aaron Lee, None; Doug Baughman, None; Atul Varma, Allergan (R), Bayer (R), Novartis (R); Salim Natha, None; Louise Downey, None; Geeta Menon, Bayer (R), Novartis (R); Sajjad Mahmood, alimera (R), bayer (F), bayer (R), novartis (F), novartis (R); Usha Chakravarthy, None; David Crabb, Allergan (R), Novartis (R); Alastair Denniston, None; Clare Bailey, None; Adnan Tufail, Allergan (S), Bayer (S), Genentech (S), GlaxoSmithKline (S), Novartis (S), Roche (S); Catherine Egan, Haag-Streit UK (R), Heidelberg Engineering (R)
  • Footnotes
    Support  NEI, Bethesda, MD, K23EY02392; Research to Prevent Blindness, Inc. New York, NY
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4283. doi:
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      Cecilia S Lee, Aaron Y Lee, Doug Baughman, Atul Varma, Salim Natha, Louise Downey, Geeta Menon, Sajjad Mahmood, Usha Chakravarthy, David Paul Crabb, Alastair K Denniston, Clare Bailey, Adnan Tufail, Catherine A Egan; Clinical Features Predict Diabetic Retinopathy Progression. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4283.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH)

Methods : Anonymized data were extracted from 19 hospitals in the United Kingdom at the initial and follow-up visits for diabetic eyes until 2014. Time to development of PDR stratified by baseline diabetic retinopathy (DR) severity was calculated with Cox regression after adjusting for age, gender, race, and starting visual acuity.

Results : A total of 50,254 patient eyes were included. The percentages of progression to PDR in 5 years differed by baseline DR severity: No DR (2.2%), mild (13.0%), moderate (27.2%), and severe NPDR (45.5%). Compared to no DR, the hazard of progressing to PDR in patient eyes that presented with mild, moderate, and severe NPDR were 6.71 (95%CI 5.46 to 8.24, p=2x10-16), 14.80 (95%CI 12.10 to 18.09, p=2x10-16), 28.19 (95%CI 22.92 to 34.67, p=2x10-16), respectively. In comparison to no DR, the eyes with mild, moderate, and severe were 2.56 (95%CI 1.91 to 3.42, p=2.36x10-10), 5.60 (95%CI 4.26 to 7.36, p<2x10-16), 5.60 (95%CI 4.26 to 7.36, p<2x10-16) times more likely to develop VH, respectively.

In the subanalyses that only included eyes with severe NPDR, the eyes with IRMA had a significantly increased hazard of developing PDR (Hazard Ratio (HR) 1.77, 95% CI 1.25-2.49, p=0.0013), while those with 4 quadrant dot blot hemorrhages (4Q DBHs) had an increased hazard of developing VH (HR 3.84, 95% CI 1.39-10.62, p=0.0095), compared to those with venous beading.

Conclusions : Baseline severities and features are key prognostic factors for PDR. IRMA increases risk of PDR while 4Q DBHs increases risk of VH. Clinical features of DR may help guide screening intervals and future clinical studies on DR progression.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Figure 1. Kaplan-Meyer curves stratified by baseline severity of diabetic retinopathy (DR). A, progression to proliferative diabetic retinopathy, B, progression to vitreous hemorrhage (VH). x-axis, time in year. y-axis; percentage of patient eyes at risk; NPDR, non-proliferative diabetic retinopathy. Shaded areas, 95% confidence intervals

Figure 1. Kaplan-Meyer curves stratified by baseline severity of diabetic retinopathy (DR). A, progression to proliferative diabetic retinopathy, B, progression to vitreous hemorrhage (VH). x-axis, time in year. y-axis; percentage of patient eyes at risk; NPDR, non-proliferative diabetic retinopathy. Shaded areas, 95% confidence intervals

 

Figure 2. Kaplan-Meyer curves stratified by presence of baseline clinical features. A, progression to proliferative diabetic retinopathy. B, progression to vitreous hemorrhage(VH). x-axis, time in year. y-axis; percentage of patient eyes at risk; IRMA, intraretinal microvascular abnormalities; DBH, dot blot hemorrhages. Shaded areas, 95% confidence intervals

Figure 2. Kaplan-Meyer curves stratified by presence of baseline clinical features. A, progression to proliferative diabetic retinopathy. B, progression to vitreous hemorrhage(VH). x-axis, time in year. y-axis; percentage of patient eyes at risk; IRMA, intraretinal microvascular abnormalities; DBH, dot blot hemorrhages. Shaded areas, 95% confidence intervals

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