June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Hemorrhages and/or Microaneurysm Distribution and Counts Identified on Ultrawide Field Imaging and the Risk of Diabetic Retinopathy Progression Over 4 Years
Author Affiliations & Notes
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Hala El Rami
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
  • Rasha Barham
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
  • Aditi Gupta
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
  • Alan Fleming
    Optos plc, Dunfermline, United Kingdom
  • Jano van Hemert
    Optos plc, Dunfermline, United Kingdom
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Belmont, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Paolo Silva, Optos (F); Hala El Rami, None; Rasha Barham, None; Aditi Gupta, None; Alan Fleming, Optos (E); Jano van Hemert, Optos (E); Jennifer Sun, None; Lloyd Aiello, Optos (R), Optos (F)
  • Footnotes
    Support  Massachusetts Lions Eye Research Fund, Balik-Scientist Program of the Department of Science and Technology, Republic of the Philippines; Lions’ International Sight First Research Grant
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2947. doi:
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    • Get Citation

      Paolo Sandico Silva, Hala El Rami, Rasha Barham, Aditi Gupta, Alan Fleming, Jano van Hemert, Jennifer K Sun, Lloyd P Aiello; Hemorrhages and/or Microaneurysm Distribution and Counts Identified on Ultrawide Field Imaging and the Risk of Diabetic Retinopathy Progression Over 4 Years. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2947.

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

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Abstract

Purpose : To determine the association between hemorrhages and/or microaneurysm (HMa) counts and distribution, as identified using ultrawide field imaging (UWFI), and risk of diabetic retinopathy (DR) progression over 4 years.

Methods : Single-site prospective 4-year longitudinal study. Eyes with mild to moderate nonproliferative DR (NPDR) on ETDRS photos were evaluated. ETDRS photos and UWFI were acquired using standardized protocols at the same visit. Baseline HMa counts in ETDRS fields and in UWFI areas not covered by ETDRS photos were obtained. A ratio of HMa counts outside to HMa counts within the ETDRS fields was calculated. A ratio >1.0 was termed a predominantly peripheral HMa distribution (PPL-HMa), ≤1.0 termed posterior distribution (Post-HMa). Based on ETDRS definitions of severe H/Ma (≥20 per field), severe HMa on UWFI was considered ≥80 overall. Follow-up ETDRS photos were acquired at 4 years.
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Results : 102 eyes were evaluated [48 (47%) mild, 54 (53%) moderate NPDR]. Follow-up 4-year ETDRS photos were acquired in 38 (79.2%) eyes with mild and 44 (81.5%) eyes with moderate NPDR. In mild NPDR, 12 (31.6%) had PPL-HMa and 26 (68.4%) Post-HMa. DR severity progressed ≥2-step (≥2-step-prog) in 16.7% with PPL-HMa (2 of these eyes developed PDR, H/Ma ratio 3.45 & 2.73) and 0% with Post-HMa (p=0.033). In moderate NPDR, 5 (11.4%) had PPL-H/Ma and 39 (88.6%) Post-HMa. ≥2-step-prog with PPL-HMa was 20% vs 23% with Post-HMa (p=NS). In mild NPDR, 8 (21.0%) had HMa count ≥80 and 30 (79.0%) had <80. ≥2-step-prog was 100% in eyes with ≥80 compared to 0% when <80. (p=0.005). In moderate NPDR, 23 (52.3%) had HMa count ≥80 and 21 (47.7%) had <80 with ≥2-step-prog of 43.5% in ≥80 and 0% in <80 (p=0.006). In mild to moderate NPDR, an increase of 10 HMa on UWFI increased the risk for 2-step-prog (OR: 1.23, 95% CI 1.09-1.46, p=0.002), a finding that remained significant after correcting for baseline DR severity (p=0.006).

Conclusions : In mild to moderate NPDR at baseline, more peripheral HMa and more total HMa are associated with increased progression over 4 years. For every 10 HMa identified on UWFI, the risk for DR progression over 4 yrs may be increased 23%. The larger retina area imaged and the greater number of HMa seen on UWF may provide a better overall assessment of DR activity and risk of progression.

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

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