Abstract
Purpose :
To determine if fully automated computerized detection algorithms applied to ultrawide field (UWF) images can identify the risk of diabetic retinopathy (DR) progression associated with predominantly peripheral hemorrhages and microaneurysms (PPL-HMA).
Methods :
Patients with UWF images and 4-year follow-up imaging were identified by electronic medical record review. All baseline UWF images were evaluated using a fully automated HMA detection algorithm to determine HMA count and location within, and peripheral to, the ETDRS 7-standard fields. Algorithm performance AUC was 0.902- 0.948 for mild and moderate nonproliferative DR (NPDR). PPL-HMA were defined as present when at least 1 field had a number of HMAs that were greater in the peripheral retina than within the ETDRS fields. 4-year individual and composite outcomes for DR progression were evaluated [≥2-step progression, development of proliferative diabetic retinopathy (PDR), intravitreal injections (IVT)].
Results :
Images from 1,712 eyes with baseline and 4-year follow-up UWF images were reviewed. Mean age was 52.6±16.6 years, diabetes duration 14.0±10.6 years, hemoglobin A1c 8.2%±1.8, 54.4% male, and 87.2% white. Baseline DR severity was: no DR 61.1%(1021), mild 22.4%(375), moderate 8.8%(147), severe 1.9%(32), PDR 4.5%(75), high-risk PDR 1.3%(21). PPL-HMA were present in 16.7%(279) of eyes with increasing frequency in more severe DR (No DR-9.1%, Mild-22.4%, Moderate-29.9%, Severe-46.9%, PDR-40.0%, High-risk-62.0%, trend p<0.0001). Progression rates for PPL-HMA (N=236) versus no PPL-HMA (N=1139) over 4-years in eyes with no, mild, moderate or severe NPDR were 14.4%(34) vs 5.53% (74), p<0.0001 for the composite outcome; 8.1%(19) vs 4.1%(55), p=0.0083 for ≥2-step progression; 10.2%(24) vs 2.3% (31), p<0.0001 for PDR development; and 4.7%(11) vs 1.9%(25), p=0.0081 for intravitreal injections. Findings remained significant after correcting for diabetes duration, hemoglobin A1c and DR severity.
Conclusions :
A fully automated HMA detection algorithm identified PPL-HMA in 20% of eyes and was associated with a 2-3 fold increased risk of DR progression, development of PDR and receipt of intravitreal injections independent of diabetes duration, baseline DR severity and HbA1c levels over 4 years. These findings suggest that the automated evaluation for PPL might assist in predicting future DR risks.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.