The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

Abstract

PURPOSE To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH). DESIGN Multicenter, national cohort study. METHODS Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity. RESULTS Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25–2.49, P =.0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39–10.62, P = .0095). CONCLUSIONS Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH.

Venous beading in two or more quadrants might not be a sensitive grading criterion for severe nonproliferative diabetic retinopathy

“…Additionally, VB, IRMA, duration of diabetes, hypertension, logMAR vision, and arteriovenous nicking were determined as independent risk factors for NPDR progression to PDR after adjustment for age and sex, while the age of DM onset was determined as an independent protective factor, which was consistent with previous studies [ 19 , 23 – 26 ]. Furthermore, our results indicated that VB and IRMA were important predictors of NPDR progression to PDR, and the ORs of VB were even greater than that of IRMA.…”

“…Previous clinicopathologic study demonstrated that IRMA had the particular potential for neovascularization [ 18 ]. Recent study suggested that IRMA significantly increased risk of PDR [ 19 ]. Additionally, our study also contributed data regarding the prevalence of other retinal vascular lesions, including capillary nonperfusion, arteriovenous nicking, and DME, among different DR severity levels.…”

Evaluating the Impact of Uveitis on Visual Field Progression Using Large-Scale Real-World Data

“…Such ''Big Data'' approaches have been successfully used to characterize the population and predict outcomes in other ophthalmic diseases. [11][12][13][14][15] This study aims to use largescale EMR data for comparing the rate of visual field (VF) loss in uveitis patients with glaucoma, compared to those with primary open-angle glaucoma (POAG), and explore whether this is associated with IOP.…”

The unmet need for better risk stratification of non‐proliferative diabetic retinopathy

“…Instead, the regenerative activity of the retina results in the gradual reabsorption of some lesions, meaning that they can disappear from fundus photographs . Alternatively, microaneurysms may rupture, forming haemorrhages, which are significantly associated with the development of vitreous haemorrhages and diabetic macular oedema in later life .…”