Patients with diabetic retinopathy may fall into 3 clinical subtypes

Patients with severe nonproliferative diabetic retinopathy are at an increased risk of developing vision-threatening forms of diabetic retinopathy and may fall in into 3 different clinical subtypes including being at an increased risk of clinically significant macular edema, an increased risk of proliferative diabetic retinopathy, and an increased risk of developing both, according to a presentation at the 2020 ASRS Virtual Meeting.

“Patients went on to develop one or the other and quite rarely both of those diseases,” said Geeta A. Lalwani, MD during her presentation. “So obviously now the question is how do we predict this? Why is this happening? It’s not nearly because of the severity of their diabetic retinopathy.”

Dr Lalwani said these finding speaks to the value of screening programs.

“Blindness from diabetic retinopathy is preventable. If studies like this can help us identify patients at higher risk of progression, we could perhaps intervene earlier to prevent vision loss,” Dr Lalwani told Ophthalmology360. 

In the study data and images from 22,116 patients with diabetes were analyzed and diabetic retinopathy and clinically significant macular edema were assessed using 7-field color fundus photographs by professional graders.

The time to first ≥2-step worsening was 2.7% at year 2 and 7.1% at year 4 for all eyes, with the rate of worsening greatest among eyes that were considered to be moderate to severe nonproliferative diabetic retinopathy at baseline.

In patients with moderate to severe nonproliferative diabetic retinopathy at baseline, rate for time to first ≥2-step worsening was 11.6% at year 2 and 26.4% at year 4.

Reference
Lalwani G, et al. Insights into the progression of diabetic retinopathy severity among primary care patients with diabetes in the United States. Presented at: 2020 ASRS Virtual Meeting.