July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Association of Systemic Comorbities with Predominantly Peripheral Diabetic Retinopathy Lesions (PPL) Identified on Ultrawide Field (UWF) Retinal Imaging
Author Affiliations & Notes
  • Paolo Sandico Silva
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Robert C. Stanton
    Kidney and Hypertension, Joslin Diabetes Center, Boston, Massachusetts, United States
    Medicine, Harvard Medical School, Boston, Massachusetts, United States
  • Mohamed Ashraf Elmasry
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Alan Fleming
    Optos, plc, Dunfermline, United Kingdom
  • Enrico Pellegrini
    Optos, plc, Dunfermline, United Kingdom
  • Jano van Hemert
    Optos, plc, Dunfermline, United Kingdom
  • Dot Tolls
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Ann M Tolson
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
  • Drew Lewis
    Estenda Solutions, Conshohocken, Pennsylvania, United States
  • Jeff Stainback
    Estenda Solutions, Conshohocken, Pennsylvania, United States
  • Jerry D Cavallerano
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Jennifer K Sun
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Paolo Silva, Optos (F), Welch Allyn (F); Robert Stanton, None; Mohamed Elmasry, None; Alan Fleming, Optos plc (E); Enrico Pellegrini, Optos plc (E); Jano Hemert, Optos plc (F); Dot Tolls, None; Ann Tolson, None; Drew Lewis, None; Jeff Stainback, None; Jerry Cavallerano, None; Jennifer Sun, None; Lloyd Aiello, Kalvista Pharmacueticals (I), Kalvista Pharmacueticals (C), Mingsight (C), Novo Nordisk (C), Optos (R), Retinal Solutions (C)
  • Footnotes
    Support  Massachusetts Lions Eye Research Fund
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 4772. doi:
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      Paolo Sandico Silva, Robert C. Stanton, Mohamed Ashraf Elmasry, Alan Fleming, Enrico Pellegrini, Jano van Hemert, Dot Tolls, Ann M Tolson, Drew Lewis, Jeff Stainback, Jerry D Cavallerano, Jennifer K Sun, Lloyd P Aiello; Association of Systemic Comorbities with Predominantly Peripheral Diabetic Retinopathy Lesions (PPL) Identified on Ultrawide Field (UWF) Retinal Imaging. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4772.

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

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Abstract

Purpose : To evaluate the association of systemic comorbidities with presence of PPL on UWF imaging in eyes of patients with diabetes (DM).

Methods : All Beetham Eye Institute UWF images and electronic medical records from 5/1/09-8/30/18 were reviewed. UWF images with no diabetic retinopathy (DR) or any level of nonproliferative DR (NPDR) were evaluated using an automated hemorrhage and/or microaneurysm (HMA) detection algorithm to determine HMA count and location within, and peripheral to, the ETDRS 7 fields. Algorithm performance AUC against manual MA identification was 0.90-0.95 for images with NPDR. PPL-HMA were defined as present when at least 1 field had greater HMAs number in the peripheral retina than within the ETDRS fields.

Results : Images and records from 13,015 eyes with gradable UWF were studied. Mean age was 57.5±17.1 yrs, DM duration 21.0±10.6 yrs, 2-year mean HbA1c 8.2±1.6, 49.5% male, 71.6% white and 56.4% type 2. Baseline DR severity by UWF imaging was: no DR 6.9%, mild NPDR 48.2%, moderate 32.4% and severe 12.5%. PPL-HMA were present in 52.6% with mild and 59.9% with moderate or more severe NPDR. Presence of PPL-HMA was associated with longer DM duration (p<0.0001) and increasing DR severity (p<0.0001). Correcting for DM duration and DR severity, presence of PPL-HMA was associated with renal disease [↑serum creatinine, p=0.005; ↑urine albumin/creatinine ratio, p=0.02; ↓estimated glomerular filtration rate (eGFR), p=0.02] and anemia (↓hematocrit, p=0.001; ↓red blood cell count, p<0.0001; ↓mean corpuscular volume, p<0.0001). PPL were not associated with HbA1c or serum lipids when correcting for DM duration and DR severity. Presence of PPL-HMA was associated with severe chronic kidney disease (eGFR <15ml/min; present: 47.4% vs absent: 41.1%, p<0.0001).

Conclusions : PPL are associated with >4-fold increased risk of DR progression. In this cohort using a fully automated HMA detection algorithm, systemic associations of PPL-HMA with renal disease and anemia have been identified for the first time and are independent of DR severity and HbA1c. These findings are consistent with previously known associations between DR and nephropathy and anemia, and support studies to determine the potential use of automated HMA counts as a marker for systemic disease.

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

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