Abstract
Diabetic retinopathy (DR) is a frequent complication of diabetes and, through its vision-threatening complications, i.e., macular edema and proliferative retinopathy, may lead to blindness. It is, therefore, of major relevance to identify the presence of retinopathy in diabetic patients and, when present, to identify the eyes that have the greatest risk of progression and greatest potential to benefit from treatment. In the present paper, we suggest the development of a simple to use alternative to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system, establishing disease severity as a necessary step to further evaluate and categorize the different risk factors involved in the progression of diabetic retinopathy. It needs to be validated against the ETDRS classification and, ideally, should be able to be performed automatically using data directly from the examination equipment without the influence of subjective individual interpretation. We performed the characterization of 105 eyes from 105 patients previously classified by ETDRS level by a Reading Centre using a set of rules generated by a decision tree having as possible inputs a set of metrics automatically extracted from Swept-source Optical Coherence Tomography (SS-OCTA) and Spectral Domain- OCT (SD-OCT) measured at different localizations of the retina. When the most relevant metrics were used to derive the rules to perform the organization of the full pathological dataset, taking into account the different ETDRS grades, a global accuracy equal to 0.8 was obtained. In summary, it is now possible to envision an automated classification of DR progression using noninvasive methods of examination, OCT, and SS-OCTA. Using this classification to establish the severity grade of DR, at the time of the ophthalmological examination, it is then possible to identify the risk of progression in severity and the development of vision-threatening complications based on the predominant phenotype.
Highlights
Diabetic retinopathy (DR) is a frequent complication of diabetes and, through its vision-threatening complications, i.e., macular edema and proliferative retinopathy, may lead to blindness
We have identified three major phenotypes of DR progression: One, the neurogenerative phenotype characterized by slow progression, where neurodegeneration is the only identified alteration and the retinal changes may be only a manifestation of the systemic neuropathy; a second one, the leaky phenotype characterized by the added occurrence of edema resulting from the breakdown of the blood–retinal barrier which may occur at any time in the disease progression, even in the absence of relevant microvascular pathology and, a third one, the ischemic phenotype, identified by increased microaneurysm turnover and the presence of active microvascular lesions
We review the Early Treatment Diabetic Retinopathy Study (ETDRS) current nonproliferative retinopathy classification to grade retinopathy severity of the ischemic phenotype and suggest the development of a simple to use alternative to the ETDRS grading system, which establishes disease severity as a necessary step to further evaluate and categorize the different risk factors involved in the progression of diabetic retinopathy
Summary
Diabetic retinopathy (DR) is a frequent complication of diabetes and, through its vision-threatening complications, i.e., macular edema and proliferative retinopathy, may lead to blindness. Nonproliferative retinopathy progresses silently, without vision loss from mild to moderate to severe stages. The progression of nonproliferative retinopathy to vision-threatening stages, proliferative retinopathy, and macular edema with vision loss vary from individual to individual. In any case, predicting which people with nonproliferative retinopathy are at a high risk for progression to vision loss remains a challenge. It is, of major relevance to identify the presence of retinopathy in diabetic patients and, when present, to identify the eyes that have the greatest risk of progression and greatest potential to benefit from treatment
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
