Retinal Vessel Analysis as a Tool to Quantify Risk of Diabetic Retinopathy

Diabetic retinopathy remains a leading cause of visual impairment and blindness worldwide. Identifying high-risk asymptomatic individuals who will likely develop the sight-threatening forms of diabetic retinopathy is an important clinical goal as it allows early, targeted implementation of preventive strategies to reduce their risk of vision loss. However, diabetic retinopathy is not a linear disease. Predicting the risk of diabetic retinopathy is challenging, and the current approach simply based on an assessment of traditional risk factors lacks precision. Retinal vessel analysis may offer a novel and noninvasive tool to improve risk prediction for diabetic retinopathy. With the use of this technology, studies have shown that a spectrum of structural alterations in the retinal vasculature can now be reliably quantified. In particular, variations in retinal vessel caliber have been consistently associated with the risks of retinopathy development and progression and shown to have prognostic predictive value above and beyond the conventional risk factors. Despite the promising results, there remain several unresolved issues that need to be addressed before the research findings on retinal vessel analysis are translated into clinical application. Coupling with standard clinical assessment, the additional information obtained from this technology could potentially guide clinical decision making, patient prognostication, and possibly monitor therapeutic response.