Progression to proliferative retinopathy and macular oedema requiring treatment. Assessment of the alternative classification of the Wisconsin Study

Abstract

ABSTRACT.Purpose: To study the ability of the alternative classification of the Wisconsin Study to predict progression to retinopathy requiring laser treatment in patients with diabetes. Methods: A total of 1585 diabetic patients were included in the study. Of them, 294 (19%) were diagnosed with diabetes before and 1291 (81%) after age 30 years. Retinopathy was diagnosed on fundus photographs using a modification of the Wisconsin scale, and graded into 6 levels according to the worse eye. The first visit during the study period was used to represent baseline examination. The time points for detection of proliferative retinopathy (PDR) and clinically significant macular oedema (CSME) were recorded during a mean follow-up time of 2.9 years. Results: Progression to PDR and/or CSME was significantly related to increasing severity of retinopathy at baseline (p∞0.001; test for trend). Fifty per cent of patients with severe non-proliferative retinopathy (NPDR) (level 51) at entry progressed within one year to PDR and/or CSME; the 3-year risk for such progression in patients with mild (level 31) and moderate NPDR (level 41) was 25 and 60%, respectively. The incidence of progression to PDR and to CSME was 0.95 and 2.3/100 person-years, respectively. Progression to PDR and/or CSME was furthermore associated with a higher level of glycosylated haemoglobin, longer duration of the diabetes and use of antihypertensive treatment. Conclusion: Increasing severity of retinopathy as recorded by this modification of the alternative classification of the Wisconsin Study was significantly associated with increased risk of progression to retinopathy requiring treatment.

Burden of illness of diabetic macular edema: literature review

“…At 10 years, the incidence of DME was 20.1% in the younger-onset patients using insulin, 25.4% in the older-onset patients using insulin, and 13.9% in the older-onset group not using insulin 29 . A Swedish study found a similar pattern, where the 1-year incidence of CSDME was 2.4%, 4.5% and 1.4% in younger-onset patients, older-onset patients using insulin, and older-onset patients not using insulin, respectively 24 . The incidence of DME was also found to be associated with higher level of glycosylated hemoglobin and more severe retinopathy at the baseline examination [28][29][30] .…”

“…As with prevalence, incidence of DME was strongly associated with time since diabetes diagnosis. In Sweden, the 1-year incidence of CSDME was 2.3% per year for the overall diabetic population 24 . In the UK, the 2-year incidence of CSDME was 4.79% 12 .…”

Multifocal Electroretinograms Predict Onset of Diabetic Retinopathy in Adult Patients with Diabetes

“…10 Furthermore, PDR has been linked to neuropathy, decreased visual acuity, elevated triglycerides, type 1 diabetes, and previous levels of retinopathy. 11,12 PDR has also been linked with higher HbA1c percentage levels, 13 and a reduction in HbA1c percentage reduces the need for and risks associated with laser photocoagulation. 14 Changes in the retina are, however, detectable at much earlier stages, and studies have begun to focus on candidate predictive factors for earlier retinopathy development.…”

How the diabetic eye loses vision

“…In addition, the rate of progression to PDR and/or CSME, increases more rapidly with more advanced retinopathy. Patients with moderate NPDR have a 50% risk of vision loss due to PDR or CSME within 3 years [23], while approximately 50% of patients who had severe NPDR progressed within a year to PDR and/or CSME. Even with only mild NPDR at baseline, the 3-year risk for progression to PDR, and/or CSME, was 25%.…”