Multimodal imaging of the initial stages of diabetic retinopathy. Different disease pathways in different patients.

Abstract

Purpose : To evaluate the prevalence of different disease pathways (ischemia, neurodegeneration and edema) in the initial stages of diabetic retinopathy (DR).

Methods : In this retrospective cross-sectional study, eyes were grouped by DR severity using the 7-field ETDRS protocol (levels 10-20, 35 and 43-47). Neurodegeneration was identified by thinning of the retinal nerve fiber layer (RNFL) and/or ganglion cell layer (GCL). Edema was identified by thickening of the inner nuclear layer (INL), outer plexiform layer (OPL), or full retina. Ischemia was identified by metrics of retinal vessel density.

Results :
142 eyes from 142 patients (28% women) aged 52-88 years were imaged. Loss of vessel density (ischemia) was significantly different between ETDRS groups (p<0.020). On multivariate regression analysis, it remained significantly different between stages of the disease and showed associations with age (p<0.001), gender (p=0.028) and metabolic control (p=0.034). No significant differences between ETDRS groups were found in retinal thinning (neurodegeneration) or retinal thickness (edema).

Conclusions : Eyes with the same ETDRS retinopathy grading from different diabetic patients show that the prevalence of different disease pathways varies between patients even within the same severity group. Ischemia (loss of vessel density) is the only disease pathway that shows correlation with retinopathy severity and metabolic control.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.