June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
Visual field changes in proliferative and severe non-proliferative diabetic retinopathy: natural history without treatment and after pan-retinal photocoagulation in the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS)
Author Affiliations & Notes
  • Debora Hana Lee
    School of Medicine, University of California, Irvine, Irvine, California, United States
    National Eye Institute, Bethesda, Maryland, United States
  • Elvira Agron
    National Eye Institute, Bethesda, Maryland, United States
  • Tiarnan D L Keenan
    National Eye Institute, Bethesda, Maryland, United States
  • Emily Chew
    National Eye Institute, Bethesda, Maryland, United States
  • Footnotes
    Commercial Relationships   Debora Lee, None; Elvira Agron, None; Tiarnan Keenan, None; Emily Chew, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3822. doi:
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      Debora Hana Lee, Elvira Agron, Tiarnan D L Keenan, Emily Chew; Visual field changes in proliferative and severe non-proliferative diabetic retinopathy: natural history without treatment and after pan-retinal photocoagulation in the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS). Invest. Ophthalmol. Vis. Sci. 2020;61(7):3822.

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

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Abstract

Purpose : Preserved visual fields is one major advantage quoted for anti-VEGF over pan-retinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR). However, visual field changes over the natural history of untreated DR are unknown. This study analyzed visual field changes in untreated DR, and compared these with DR treated with PRP.

Methods : Data were used from the DRS (1972-1979) and ETDRS (1980-1989), two unique historical datasets in which eyes with DR were randomized to PRP or no treatment. Visual field scores (VFS) were obtained with the Goldmann perimeter using the IV/4e stimulus (DRS), and the I/4e and I/2e stimuli (ETDRS). The current analysis included eyes with severe non-proliferative DR (SNPDR) or PDR, randomized to either the immediate or deferred argon laser PRP arms. Any eyes in the deferred arm that received argon laser were censored from the point of treatment. The outcome of annual VFS change was calculated using mixed models.

Results : A total of 2189 DRS eyes and 1325 ETDRS eyes, followed for median of 2.3 years (IQR 1.7–4.0) and 6.3 years (5.0–7.3), respectively, were included. Mean annual VFS changes from baseline were -42.0 (95% CI -46.9, -37.1) , -11.0 (-13.8, -8.3), and -2.9 (-5.1, -0.7) in untreated eyes and -42.9 (-47.5, -38.3), -30.8 (-33.6, -28.0), and -12.8 (-15.1, -10.5) in treated eyes, using the IV/4e, I/4e, and I/2e stimuli, respectively. Mean annual VFS changes from the 4-month visit were -37.1 (-43.0, -31.2), -9.6 (-13.3, -6.0), and -4.1 (-7.1, -1.0) in untreated eyes and -29.5 (-34.2, -24.7), -18.1 (-21.3, -14.8), and -4.3 (-6.1, -2.4) in treated eyes (See Figure).

Conclusions : The natural history of untreated SNPR and PDR involves a significant decline over time in the peripheral visual field. PRP causes a rapid initial decline in the visual field. Subsequent rates of visual field decline are relatively similar in untreated DR and DR treated with PRP. No future randomized studies will ever provide a comparison between untreated and treated PDR. These findings have implications for assessment of the relative merits of anti-VEGF versus PRP for PDR.

This is a 2020 ARVO Annual Meeting abstract.

 

Figure. Change over time in visual field score, of untreated and treated eyes, obtained using the IV/4e (top), I/4e (middle), and I/2e (bottom) stimuli.

Figure. Change over time in visual field score, of untreated and treated eyes, obtained using the IV/4e (top), I/4e (middle), and I/2e (bottom) stimuli.

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