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Yoko Dodo, Tomoaki Murakami, Noriyuki Unoki, Ken Ogino, Akihito Uji, Shin Yoshitake, Nagahisa Yoshimura; White dots as a novel marker of diabetic retinopathy severity in ultrawide field imaging. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3411.
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© ARVO (1962-2015); The Authors (2016-present)
Diabetic retinopathy (DR) is often accompanied with well-demarcated smaller white dots in the sensory retina, although its relevance remains ill-defined. We thus evaluated the association of white dots with the severity of DR and the nonperfusion areas in fluorescein angiography (FA) images using ultrawide field scanning laser ophthalmoscope (Optos200Tx®).
We retrospectively reviewed 125 eyes of 77 patients with DR on whom ultrawide field photograph was obtained using Optos200Tx®. We selected at random 25 eyes of individual categories in international classification of DR severity (no apparent retinopathy, mild nonproliferative diabetic retinopathy [NPDR], moderate NPDR, severe NPDR, and proliferative diabetic retinopathy [PDR]). White dots were fine and well-demarcated, and delineated with higher signal levels on green laser (532 nm) images but not on red laser (633 nm) images. We counted them using ultrawide field photograph, and evaluated the association of white dots with DR severity.
The numbers of white dots were 8.6±9.7, 3.9±4.9, 3.7±4.9, and 2.3±3.5 in the superonasal, inferonasal, superotemporal, and inferotemporal quadrants respectively in 100 eyes with DR. Eyes with DR had larger number of white dots than those with no apparent retinopathy (18.5±17.7 vs. 2.5±2.8, p<0.001). The number of white dots in eyes with moderate NPDR (17.7±16.0, p=0.030), severe NPDR (21.8±21.1, p<0.001), or PDR (28.0±17.9, p<0.001) was significantly larger than that in eyes with mild NPDR (6.3±4.0). There was a positive correlation between the number of white dots and the number of intraretinal hemorrhages in 100 eyes with DR (r=0.453, p<0.001). Thirty-two eyes with intraretinal microvascular abnormality (IRMA) had more white dots than 68 eyes without IRMA (25.4±20.1 vs. 15.2±15.6, p=0.005), although there were no differences in number of white dots between eyes with or without venous beading (20.6±14.8 vs. 18.0±18.4, p=0.138).
These data suggest that white dots delineated by ultrawide field photograph are related to the severity of DR.
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