Retinopathy Phenotypes in Type 2 Diabetes with Different Risks for Macular Edema and Proliferative Retinopathy.

Ines P Marques,José Cunha-Vaz,António C-V Martinho,Torcato Santos,João Figueira,Ana L Messias,Maria H Madeira

doi:10.3390/jcm9051433

Abstract

Our group reported that three diabetic retinopathy (DR) phenotypes: A, characterized by low microaneurysm turnover (MAT < 6) and normal central retinal thickness (CRT); B, low MAT (<6) and increased CRT, and C, high MAT (≥6), present different risks for development of macular edema (DME) and proliferative retinopathy (PDR). To test these findings, 212 persons with type 2 diabetes (T2D) and mild nonproliferative retinopathy (NPDR), one eye per person, were followed for five years with annual visits. Of these, 172 completed the follow-up or developed an outcome: PDR or DME (considering both clinically significant macular edema (CSME) and center-involved macular edema (CIME)). Twenty-seven eyes (16%) developed either CSME (14), CIME (10), or PDR (4), with one eye developing both CSME and PDR. Phenotype A showed no association with development of vision-threatening complications. Seven eyes with phenotype B and three with phenotype C developed CIME. Phenotype C showed higher risk for CSME development, with 17.41 odds ratio (p = 0.010), compared with phenotypes A + B. All eyes that developed PDR were classified as phenotype C. Levels of HbA1c and triglycerides were increased in phenotype C (p < 0.001 and p = 0.018, respectively). In conclusion, phenotype C identifies eyes at higher risk for development of CSME and PDR, whereas phenotype A identifies eyes at very low risk for vision-threatening complications.

Highlights

Diabetic retinopathy (DR) is one of the major complications of diabetes and leading cause of vision loss and blindness in the world, among working-age adults in the United States [1]
Using noninvasive methods, we have identified three different phenotypes of nonproliferative DR (NPDR), based on microaneurysm turnover (MAT) and central retinal thickness (CRT), that appear to be related with different risks for the development of clinically significant macular edema
The patients in the study here reported were included according to specified inclusion and exclusion criteria and they were followed for a period of five years or until the time of development of proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME), considering clinically significant macular edema (CSME) and center involved macular edema (CIME)

Summary

Introduction

Diabetic retinopathy (DR) is one of the major complications of diabetes and leading cause of vision loss and blindness in the world, among working-age adults in the United States [1]. This serious ophthalmic condition creates significant disabilities that threatens independence and impact on life quality [2]. It is generally accepted that diabetes duration and level of metabolic control play a role. Still, these risk factors per se cannot explain the variability observed in DR evolution in diabetic individuals [4]. Whereas several individuals with diabetes do not develop vision-threatening retinal changes, maintaining good visual acuity after many years of diagnosis, others show progression of DR even after only a few years of diabetes, leading to vision loss

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