Enhancing Risk Assessment in Patients with Diabetic Retinopathy by Combining Measures of Retinal Function and Structure

• Type of Material: Article
• Authors: April Maa, Emory University; MG Brigell, Aerpio Pharmaceut; B Chiang, Stanford University; CQ Davis, LKC Technol Inc
• Language: English
• Date: 2020-08-01
• Publisher: ARVO
• Publication Version: Final Published Version
• Copyright Statement: © 2020 The Authors.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1167/tvst.9.9.40
• Title of Journal or Parent Work: Translational Vision Science & Technology
• Volume: 9
• Issue: 9
• Start Page: 1
• End Page: 9
• Keywords: diabetic retinopathy; Electronigram; Ophthalmology; electroretinography; Life Sciences & Biomedicine; Progression; Science & Technology; fundus photography; prognosis; Screening program
• Research Categories: Chemistry, Pharmaceutical; Physics, Optics; Health Sciences, Opthamology

Abstract

Purpose To determine whether combining measures of retinal structure and function predicts need for intervention for diabetic retinopathy (DR) better than either modality alone. Methods The study sample consisted of 279 diabetic patients who participated in an earlier cross-sectional study. Patients were excluded if they were previously treated for macular edema or proliferative DR or if they had other retinopathies. Medical records were reviewed for ocular interventions including vitrectomy, intravitreal injection, and laser treatment. Need for intervention was analyzed using Kaplan-Meier analyses and Cox proportional hazards. Baseline electroretinograms and fundus photographs were obtained. Two definitions of structural positive findings were as follows: 1. Early Treatment of Diabetic Retinopathy Study diabetic retinopathy severity scale (ETDRS-DR) severity ≥ level 53 (ETDRS-DR+) and 2. ETDRS-DR+ or clinically significant macular edema (VTDR+). A positive function finding corresponded to a RETeval DR Score >23.5 (RETeval+). Results For patients with VTDR+ the incidence of intervention was 19%, 31%, and 53% after 1, 2, and 3 years of follow-up. In these patients, intervention incidence increased to 34%, 54%, and 74% the subsequent 1, 2, and 3 years if function was above criterion (RETeval+), whereas RETeval−  results reduced the risk to 3%, 4%, and 29%, respectively, reducing risk to similar levels seen for patients with VTDR− results at baseline. Conclusions Prediction of subsequent intervention was best when combining structural and functional information. Translational Relevance This study demonstrates that clinical management of diabetic retinopathy is improved by adding electroretinography to fundus photographic information in assessing the risk of the need for intervention.