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Michael Gilbert, Mohamed Ashraf Elmasry, Jae Rhee, Abdulrahman Rageh, Paolo S Silva, Jennifer K Sun, Lloyd Paul Aiello, Miin Roh; Progression of Diabetic Retinopathy in Presence of Age-related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2020;61(7):5193.
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To evaluate the association between presence of age-related macular degeneration (AMD) and future progression of diabetic retinopathy (DR)
We retrospectively identified patients with DR, with or without AMD at the Joslin Diabetes Center. Inclusion criteria were age ≥50yrs, baseline visit 2007-2014, ≥4 years follow-up, and ICD-9/10 diagnosis code of DR with or without AMD. Patients were excluded if they had prior anti-VEGF, proliferative DR (PDR) or wet AMD at baseline. Followup was terminated once a patient received anti-VEGF therapy. AMD grading used the Age-related Eye Disease Study classification system. DR progression was defined as ≥2-step progression in clinical grade or progression to PDR. Logistic regression analysis was performed adjusting for age, gender, diabetes type, and baseline DR severity. Baseline HbA1c was available in 223 of 398 patients (56.0%), so HbA1c adjustments were done separately.
233 eyes (142 patients) had DR with AMD and 478 eyes (256 patients) DR without AMD. Baseline DR severity was 69.9%, 25.1%, and 5.0% mild, moderate and severe nonproliferative DR (NPDR), respectively. At baseline, DR with AMD patients were older (66.0 vs 61.3yrs, p=0.003) with lower HbA1c (7.70% vs 8.24%, p<0.001), milder DR (76.2% vs 66.9% mild NPDR, 19.3% vs 27.8% moderate NPDR, and 4.5 vs 5.2% severe NPDR, p=0.039), more often female (65.5% vs 49.2%, p=0.002) and had longer follow-up (8.7 vs 7.5yrs, p<0.001). DR progression of ≥2 steps was less frequent in eyes with AMD (N=8) compared to eyes without AMD (N=43, 3.6% vs 9.0%, p=0.01), and remained statistically different even after adjusting for age, gender, DM type, and baseline DR severity (P=0.048). In eyes with AMD, 6 (2.7%) progressed to PDR vs 42 (8.8%) in eyes without AMD. After adjusting for the same criteria, significantly less progression to PDR occurred in eyes with AMD (P=0.022). Adjusting for baseline HbA1c when present (N=223), the lower rates of >2-step progression in eyes with DR and AMD remained statistically significant (2.7% vs 11.2%, p=0.024) while PDR onset rates were similar but not statistically significant (2.7% vs 10.4%, p=0.08).
These data suggest a lower rate of DR progression and onset of PDR over 4 or more years in patients with mild to severe NPDR and coexisting AMD at baseline.
This is a 2020 ARVO Annual Meeting abstract.
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