Abstract
PURPOSE: To evaluate the effect of diabetic retinopathy (DR) lesion type (hemorrhages and/or microaneurysms, intraretinal microvascular abnormalities, new vessels elsewhere, and venous beading), severity, and distribution on disease worsening based on the Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale. METHODS: Post hoc analysis of a multicenter observational study of 544 eyes with nonproliferative DR and an Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale score of Level 35 to 53. Disease worsening was defined as Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale worsening by ≥2 steps from baseline or receipt of DR treatment over 4 years. DR lesions were evaluated based on the entire visible area in the ultrawide field color (UWF-color) and UWF-fluorescein angiography images. RESULTS: A significantly greater risk of disease worsening was associated with the presence of more severe lesion grades outside the Early Treatment Diabetic Retinopathy Study fields for hemorrhages and/or microaneurysms (hazard ratio: 1.74 [95% confidence interval, 1.28-2.36]) on UWF-color and for hemorrhages and/or microaneurysms (1.90 [1.38-2.61]), intraretinal microvascular abnormalities (1.68 [1.13-2.49]), and new vessels elsewhere (1.99 [1.36-2.93]) on UWF-fluorescein angiography. CONCLUSION: These results suggest that features on UWF-color and UWF-fluorescein angiography may provide additional prognostic value in determining the risk of disease worsening. The use of UWF-fluorescein angiography improves identification of DR lesions and disease progression. However, the optimal method of disease risk assessment on UWF imaging still needs to be determined.