June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Comparing Retinopathy Progression and Long-Term Visual Outcomes between Diabetics with and without Foot Ulcers
Author Affiliations & Notes
  • Christopher Zhu
    Ophthalmology, The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Medicine, San Antonio, Texas, United States
  • Joanna Sohn
    Ophthalmology, The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Medicine, San Antonio, Texas, United States
  • Luca Rosignoli
    Ophthalmology, The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Medicine, San Antonio, Texas, United States
  • Footnotes
    Commercial Relationships   Christopher Zhu None; Joanna Sohn None; Luca Rosignoli None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, OD74. doi:
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      Christopher Zhu, Joanna Sohn, Luca Rosignoli; Comparing Retinopathy Progression and Long-Term Visual Outcomes between Diabetics with and without Foot Ulcers. Invest. Ophthalmol. Vis. Sci. 2023;64(8):OD74.

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

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Abstract

Purpose : The relationship between patients with diabetic foot ulcers (DFUs) and ocular outcomes of diabetic retinopathy (DR) remains unknown. Given that ulcers are a severe sequela of diabetes, we hypothesize that diabetic patients with DFUs progress quicker through DR grades than those without DFUs and have worse visual outcomes.

Methods : A retrospective review was performed on patients that were diagnosed with DFUs and underwent ophthalmic and foot examinations within the past 10 years; 426 diabetic eyes were included. The progression of non-proliferative DR (NPDR) to proliferative DR (PDR) and change in visual acuity (LogMAR) were assessed as primary endpoints.

Results : The study group consisted of 426 total eyes (213 subjects) split into two groups: patients without DFUs (282 eyes) and patients with (144 eyes). The mean age of the non-DFU group was 63.3 ± 10.5 years, 55.3% of whom were male compared to the DFU group averaging 59.9 ± 11.0 years, 54.2% of whom were male. Among the non-DFU group, PDR conversion from NPDR was observed in 35.6% of eyes compared to 50.7% of DFU eyes (p=0.03). At the initial visit, 28.0% of non-DFU eyes had macular edema (ME) compared to 32.6% of DFU eyes (p=0.32). By the final visit, 37.6% of non-DFU eyes had ME compared to 64.6% of DFU eyes (p<0.0001). Furthermore, 38.7% of non-DFU patients experienced at least one vitreous hemorrhage during the follow-up period compared to 55.6% of DFU patients (p=0.0009). Among those requiring anti-VEGF injections, non-DFU patients averaged 6.9 injections per eye while DFU patients averaged 4.3 per eye (p=0.01). No significant differences between the two groups were found regarding changes in visual acuity, tractional retinal detachments, vitrectomy history, or need for PRP.

Conclusions : Our results were consistent with our hypothesis that DFU patients experienced a significantly higher rate of conversion from NPDR to PDR compared to patients without DFUs, although no significant differences in visual acuity were found. Additionally, DFU patients had a higher prevalence of macular edema, vitreous hemorrhage, and a greater need for anti-VEGF injections. All diabetic patients should undergo timely retinal examinations and management, and our findings suggest that patients with DFUs should receive higher stratification for such screenings with closer management.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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