title: Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years.
abstract: OBJECTIVE
  To determine whether peripheral diabetic retinopathy (DR) lesions identified on ultrawide field (UWF) imaging are associated with increased DR progression.
  
  
  METHODS
  Prospective, longitudinal cohort.
  
  
  METHODS
  Two hundred eyes of 100 participants previously enrolled in a comparative instrument validation study.
  
  
  METHODS
  Baseline mydriatic 7-standard field Early Treatment Diabetic Retinopathy Study (ETDRS) photographs and UWF images were obtained. On UWF images, DR lesions with a greater extent outside versus inside standard ETDRS fields were defined as predominantly peripheral lesions (PPLs). Follow-up ETDRS photographs were obtained 4.2±0.3 years after baseline. Baseline and follow-up DR severity were graded from ETDRS photographs.
  
  
  METHODS
  Rates of 2-step or more progression and progression to proliferative DR (PDR) in eyes with PPLs compared with eyes without PPLs identified on UWF imaging at baseline.
  
  
  RESULTS
  In eyes without PDR (n = 109) at baseline, 56 (51%) had at least 1 field with PPLs and 43 (39%) had DR progression. Compared with eyes without PPLs, eyes with PPLs had a 3.2-fold increased risk of 2-step or more DR progression (6 [11%] vs. 19 [34%]; P = 0.005) and a 4.7-fold increased risk for progression to PDR (3 [6%] vs. 14 [25%]; P = 0.005). These findings remained statistically significant after adjusting for gender, diabetes type, diabetes duration, hemoglobin A1c (HbA1c) levels, and baseline DR severity. Increasing extent of fields with PPLs increased the risk for 2-step or more DR progression (P = 0.004) and progression to PDR (P = 0.009).
  
  
  CONCLUSIONS
  Presence and increasing extent of PPLs were associated with increased risk of DR progression over 4 years, independent of baseline DR severity and HbA1c levels. Increasing extent of PPLs substantially increased the risk of DR progression and progression to PDR, especially with less severe DR at baseline. These findings demonstrate that detailed peripheral retinal evaluation provides important information that is necessary to assess completely the risk of DR progression.
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address: paoloantonio.silva@joslin.harvard.edu.
authors.forename: Paolo S
authors.initials: PS
authors.lastname: Silva
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jerry D
authors.initials: JD
authors.lastname: Cavallerano
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Nour Maya N
authors.initials: NM
authors.lastname: Haddad
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Hanna
authors.initials: H
authors.lastname: Kwak
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Kelli H
authors.initials: KH
authors.lastname: Dyer
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Omar
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Hasanain
authors.initials: H
authors.lastname: Shikari
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lloyd M
authors.initials: LM
authors.lastname: Aiello
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Sun
authors.affiliation: Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lloyd Paul
authors.initials: LP
authors.lastname: Aiello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis*; D003952:Diagnostic Imaging / Q000379:methods*; D003941:Diagnostic Techniques, Ophthalmological; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012163:Retinal Detachment / Q000175:diagnosis; D012166:Retinal Hemorrhage / Q000175:diagnosis; D015861:Retinal Neovascularization / Q000175:diagnosis; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D014823:Vitreous Hemorrhage / Q000175:diagnosis; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human