Incorporating Predominantly Peripheral Diabetic Retinopathy (DR) Lesion Identification in a Teleophthalmology Program Predicts DR Progression over 4 Years in Eyes with Early DR

Abstract

Purpose : Longer follow-up intervals for early DR have been proposed. The presence of predominantly peripheral lesions (PPL) have been shown to be a risk factor for DR progression. However, their association with DR worsening in early DR are not well characterized. This study evaluates the association of PPL and DR progression from an active teleophthalmology program using nonmydriatic ultrawide field (NM-UWF) imaging in eyes with early nonproliferative DR (NPDR) .

Methods : Eyes with mild or moderate NPDR on initial NM-UWF teleophthalmology imaging and 4-year follow-up UWF retinal imaging were identified by electronic medical record review. All NM-UWF images were evaluated following standardized grading of DR severity and presence of PPL. The 4-year individual ≥2-step progression, development of proliferative DR (PDR), intravitreal injections (IVT) and composite outcomes for DR progression were evaluated.

Results : Images from 774 eyes with gradable NM-UWF and 4-year follow-up UWF retinal images were reviewed. Mean age was 51.8±15.4 yrs, diabetes duration 18.3±9.7 yrs, hemoglobin A1c (HbA1c) 8.4±1.7%, 59.0% male, and 82.0% white. Baseline DR severity by NM-UWF was mild NPDR 73.5 %(569) and moderate 26.5%(205). PPL were present in 11.5%(89) and were composed of hemorrhages/microaneurysms 98.9% (88) and intraretinal microvascular abnormalities 5.6%(5). Comparing rates of progression in eyes with PPL (N=89) and without PPL (N=785), 4-year composite progression rate was 21.3%(19) vs 6.6%(45), p<0.0001; ≥2-step progression 21.3%(19) vs 4.4%(34), p<0.0001; IVT 1.1%(1) vs 2.4%(19), p=0.36; and PDR development 21.4%(19) vs 4.5%(31), P<0.0001. In eyes with mild or moderate NPDR, and in the combined cohort, the significant associations remain even after correcting for baseline diabetes duration, HbA1c and DR severity (p<0.0001).

Conclusions : In an active teleophthalmology setting, the presence of PPL in early NPDR was associated with an increased risk of worsening DR independent of baseline DR severity and HbA1c levels. In eyes with PPL, there was a 3.2 and 4.8-fold increased risk for DR progression and PDR development, respectively. These findings suggest that in teleophthalmology programs for DR, evaluation of peripheral lesions may be important before extending follow-up intervals in early NPDR.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.