Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression...

Area of Science:

• Ophthalmology
• Diabetology
• Medical Imaging

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss in diabetic patients.
• Standard imaging may miss peripheral DR lesions that could indicate higher risk.
• Ultrawide field (UWF) imaging allows visualization of the entire retina.

Purpose of the Study:

• To investigate the association between peripheral diabetic retinopathy lesions identified on UWF imaging and the progression of DR.
• To determine if the extent of peripheral lesions impacts DR progression rates.

Main Methods:

• A prospective, longitudinal cohort study of 100 participants (200 eyes).
• Baseline UWF and standard 7-field ETDRS photographs were obtained.
• Predominantly peripheral lesions (PPLs) were defined as DR lesions extending beyond standard ETDRS fields on UWF images.
• DR progression was assessed over 4.2 years using ETDRS photographs.

Main Results:

• Eyes with PPLs showed a 3.2-fold increased risk of 2-step or more DR progression and a 4.7-fold increased risk of progression to proliferative DR (PDR) compared to eyes without PPLs.
• The risk of DR progression and PDR was significantly associated with the increasing extent of PPLs.
• These associations remained significant after adjusting for diabetes type, duration, HbA1c, and baseline DR severity.

Conclusions:

• The presence and extent of PPLs on UWF imaging are significant independent predictors of DR progression.
• Detailed peripheral retinal evaluation is essential for comprehensive risk assessment of DR progression.
• UWF imaging provides critical information for managing diabetic retinopathy, especially in patients with less severe baseline DR.