Abstract
Purpose :
To evaluate the effect of diabetic retinopathy (DR) lesion types, severity, and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study (ETDRS) diabetic retinopathy severity scale (DRSS).
Methods :
We performed a post hoc analysis of the DRCR Retina Network Protocol AA, a multi-center prospective longitudinal observational study of 544 eyes with nonproliferative diabetic retinopathy (NPDR) and an ETDRS-DRSS score of Level 35-53. The primary outcome is disease worsening, defined as either DRSS worsening by ≥2 steps from baseline on ultrawide field images (UWF)-color images or receipt of DR treatment over 4 years. DR lesions of interest included hemorrhages and/or microaneurysms (H/Ma), intraretinal microvascular abnormalities (IRMA), new vessels elsewhere (NVE), and venous beading (VB), all of which were evaluated within the entire visible image area on baseline UWF-color and UWF-fluorescein angiography (UWF-FA) images. We defined more severe DR lesions severity as the lesion grade that is beyond what is seen on each NPDR level assessed from the baseline UWF-color image within the ETDRS 7 standard fields.
Results :
The risk of disease worsening over 4 years was similar despite the distribution of the H/Ma or IRMA within each peripheral field on UWF images. Greater risk of disease worsening was associated with the presence of more severe lesion grade outside the ETDRS fields for H/Ma (HR = 1.74 [95% CI, 1.28-2.36]) on UWF-color; and for H/Ma (HR = 1.90 [95% CI, 1.38-2.61]), IRMA (HR = 1.68 [95% CI, 1.13-2.49]), and NVE (HR = 1.99 [95% CI, 1.36-2.93]) on UWF-FA.
Conclusions :
These results suggest that features on UWF-color and UWF-FA images may provide additional prognostic value in determining the risk of DRSS worsening. The optimal method of disease risk assessment on UWF imaging still needs to be determined.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.