Abstract
Aims/hypothesisDiabetic retinopathy is characterised by morphological lesions related to disturbances in retinal blood flow. It has previously been shown that the early development of retinal lesions temporal to the fovea may predict the development of treatment-requiring diabetic maculopathy. The aim of this study was to map accurately the area where lesions could predict progression to vision-threatening retinopathy.MethodsThe predictive value of the location of the earliest red lesions representing haemorrhages and/or microaneurysms was studied by comparing their occurrence in a group of individuals later developing vision-threatening diabetic retinopathy with that in a group matched with respect to diabetes type, age, sex and age of onset of diabetes mellitus who did not develop vision-threatening diabetic retinopathy during a similar observation period.ResultsThe probability of progression to vision-threatening diabetic retinopathy was higher in a circular area temporal to the fovea, and the occurrence of the first lesions in this area was predictive of the development of vision-threatening diabetic retinopathy. The calculated peak value showed that the risk of progression was 39.5% higher than the average. There was no significant difference in the early distribution of lesions in participants later developing diabetic maculopathy or proliferative diabetic retinopathy.Conclusions/interpretationThe location of early red lesions in diabetic retinopathy is predictive of whether or not individuals will later develop vision-threatening diabetic retinopathy. This evidence should be incorporated into risk models used to recommend control intervals in screening programmes for diabetic retinopathy.
Highlights
Diabetic retinopathy is a frequent cause of blindness in the Western world [1]
The probability of progression to vision-threatening diabetic retinopathy is shown in Fig. 4 as a function of the location of the first red lesions observed in the dataset
The average risk of progression was outside the lower limit of the 99% CI of the risk of progression, implying that the location of the lesions was a risk factor for progression to vision-threatening diabetic retinopathy
Summary
Diabetic retinopathy is a frequent cause of blindness in the Western world [1]. The disease is characterised by morphological lesions related to disturbances in retinal blood flow. The lesions display a regional distribution, with hyperperfusion and breakdown of the blood–retina barrier in the macular area and capillary occlusion in the retinal periphery that stimulates new vessel formation [2]. These regional differences may be due to differences in how blood flow is disturbed in different retinal areas [3]. The study was not able to exclude the fact that the development of lesions within areas other than the ones selected for the study might better predict progression to vision-threatening retinopathy. Another previous study has suggested that the regional distribution of diabetic retinopathy lesions might be included as a variable for optimising the control interval during screening for diabetic retinopathy [6], but this assumption has not been tested in detail
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