title: Relevance of Retinal Thickness Changes in the OCT Inner and Outer Rings to Predict Progression to Clinical Macular Edema: An Attempt of Composite Grading of Macular Edema.
abstract: OBJECTIVE
  To characterize the relevance of macular thickness changes in the inner and outer rings in the progression of macular edema in eyes/patients with diabetes type 2.
  
  
  METHODS
  A total of 374 type 2 diabetic patients with mild nonproliferative diabetic retinopathy (ETDRS levels 20-35) were included in a 12-month prospective observational study to identify retinopathy progression. Retinal thickness analyses were performed in 194 eyes/patients using Cirrus SD- OCT and 166 eyes/patients using Spectralis SD-OCT. The DRCR.net classification of subclinical and clinical macular edema was used. A composite grading of macular edema is proposed in this study.
  
  
  RESULTS
  A total of 317 eyes/patients completed the study. SD-OCT identified clinical macular edema in 24 eyes/patients (6.7%) and subclinical macular edema in 104 eyes/patients (28.9%) at baseline. Increased thickness of the central subfield is the best predictor for the development of clinical macular edema, with 85.7% sensitivity and 71.9% specificity (OR: 2.57, 95% CI: 0.82-7.99). However, the involvement of the inner and outer rings is a cumulative predictor of progression to clinical macular edema (OR: 8.69, 95% CI: 2.85-26.52).
  
  
  CONCLUSIONS
  A composite OCT grading of macular edema taking into account the retinal thickness changes in the inner and outer macular rings offers a simple way to characterize macular edema, with added clinical value.
authors.affiliation: Centre for Clinical Trials, Department of Ophthalmology, University of Padova, Padova, Italy.
authors.forename: Stela
authors.initials: S
authors.lastname: Vujosevic
authors.forename: Monica
authors.initials: M
authors.lastname: Varano
authors.forename: Catherine
authors.initials: C
authors.lastname: Egan
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.forename: Geeta
authors.initials: G
authors.lastname: Menon
authors.forename: Ali
authors.initials: A
authors.lastname: Erginay
authors.forename: Frank D
authors.initials: FD
authors.lastname: Verbraak
authors.forename: Henrik
authors.initials: H
authors.lastname: Lund-Andersen
authors.forename: Jose P
authors.initials: JP
authors.lastname: Martinez
authors.forename: Ignasi
authors.initials: I
authors.lastname: Jürgens
authors.forename: Erica
authors.initials: E
authors.lastname: Smets
authors.forename: Caroline
authors.initials: C
authors.lastname: Coriat
authors.forename: Peter
authors.initials: P
authors.lastname: Wiedemann
authors.forename: Victor
authors.initials: V
authors.lastname: Ágoas
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.forename: Frank G
authors.initials: FG
authors.lastname: Holz
authors.forename: Sandrina
authors.initials: S
authors.lastname: Nunes
authors.forename: Dalila
authors.initials: D
authors.lastname: Alves
authors.forename: Catarina
authors.initials: C
authors.lastname: Neves
authors.forename: Torcato
authors.initials: T
authors.lastname: Santos
authors.forename: Luisa
authors.initials: L
authors.lastname: Ribeiro
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
authors.forename: Amparo Navea
authors.initials: AN
authors.lastname: Tejerina
authors.forename: José
authors.initials: J
authors.lastname: Cunha-Vaz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003930:Diabetic Retinopathy / Q000145:classification / Q000175:diagnosis*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008269:Macular Edema / Q000145:classification* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology