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Peripheral lesions associated with diabetic retinopathy progression
Both the presence and increasing extent of predominantly peripheral lesions were associated with an increased risk of diabetic retinopathy progression, according to a study recently published in Ophthalmology.
Silva and colleagues conducted a prospective, longitudinal cohort study of 200 eyes of 100 participants.
Researchers evaluated baseline mydriatic nonsimultaneous stereoscopic seven-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs using a Zeiss (FF4) 30 fundus camera (Carl Zeiss Meditec) and mydriatic nonsimultaneous stereoscopic 200 ultrawide field (UWF) images using the Optos P200MA (Optos). ETDRS images were also taken 4.2 ± 0.3 years after baseline.
Predominantly peripheral lesions (PPLs) were defined as diabetic retinopathy (DR) lesions largely located outside standard ETDRS fields.
Results showed that, eyes with PPLs had a 3.2-fold increased risk of two-step or more diabetic retinopathy progression among eyes without baseline proliferative diabetic retinopathy (PDR). Additionally, eyes with PPLs had a 4.7-fold increased risk of progression to PDR.
"UWF imaging allowed the evaluation of retinal lesions peripheral to those visualized with seven-standard field ETDRS photography," the authors wrote. "The presence of DR lesions located predominantly in this peripheral area seemed to identify a subset of eyes at greatly increased risk of DR progression and onset of PDR."
The researchers also noted that increasing extent of PPLs were associated with an increased risk of DR progression.
They concluded: "If these results are confirmed and refined in a broader diabetes population, the rigorous evaluation of the peripheral retina may become an essential and routine component of accurately characterizing DR severity and thus may prompt a revision of the ETDRS grading algorithms to best optimize the association of DR severity grade and clinical outcome." – by Chelsea Frajerman Pardes