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mimi liu, Chin-Yu Lin, Verena Steffen, Zdenka Haskova; Insights into the progression of diabetic retinopathy severity among primary care patients with diabetes in the United States. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3313.
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To assess the risk of diabetic retinopathy (DR) worsening and risk of progression to vision-threatening forms of DR (clinically significant macular edema [CSME] or proliferative DR [PDR]) among patients with diabetes in a US primary care setting.
Eyes of 22,116 patients with diabetes were analyzed using data and images collected from 1999–2016 (Source: Inoveon Corporation, Oklahoma City, OK). DR severity and CSME were assessed from 7-field color fundus photographs by professional graders at a centralized reading center. DR severity was graded using the Early Treatment Diabetic Retinopathy Study (ETDRS) DR Severity Scale (DRSS); analyses included eyes with valid baseline and postbaseline DRSS values (42,011 eyes). Occurrence of ≥ 2-step DR worsening was assessed in the overall population and by baseline DRSS. Development of CSME (using ETDRS criteria) or PDR was analyzed among eyes with no CSME and no PDR, respectively, at baseline.
For all eyes evaluated, the Kaplan-Meier rate for time to first ≥ 2-step worsening was 2.7% at year 2 and 7.1% at year 4. Rate of DRSS worsening by ≥ 2 steps was greatest among eyes with baseline DRSS 43–53 (moderate to severe nonproliferative DR [NPDR]; Figure 1). When all eyes with baseline DRSS 43–53 were analyzed together, the Kaplan-Meier rate for time to first ≥ 2-step worsening was 11.6% at year 2 and 26.4% at year 4. The time to development of CSME, PDR, or either CSME or PDR among eyes with baseline DRSS 43–53 is shown in Figure 2 (the number of eyes at risk over time is shown below the graph).
The results from this study show that eyes with moderate to severe NPDR were at greatest risk of progression to vision-threatening forms of DR. These data also suggest the existence of 3 clinical subtypes among eyes with DR: one at increased risk of CSME, one at increased risk of PDR, and one at increased risk of developing both.
This is a 2020 ARVO Annual Meeting abstract.
Figure 1. Percentage of eyes with ≥ 2-step DR worsening at year 2 by baseline DR severity (2-year Kaplan-Meier rate).
Figure 2. Time to development of CSME, PDR, or either CSME or PDR among eyes with baseline DRSS 43–53. Shaded areas represent 95% CIs. Number at risk refers to the number in the study without CSME or PDR at that time.
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