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The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

Lee, C. S., Lee, A. Y., Baughman, D., Sim, D., Akelere, T., Brand, C., Crabb, D. P. ORCID: 0000-0001-8754-3902, Denniston, A. K., Downey, L., Fitt, A., Khan, R., Mahmood, S., Mandal, K., Mckibbin, M., Menon, G., Lobo, A., Kumar, B. V., Natha, S., Varma, A., Wilkinson, E., Mitry, D., Bailey, C., Chakravarthy, U., Tufail, A. and Egan, C. (2017). The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy. American Journal of Ophthalmology, 180, pp. 64-71. doi: 10.1016/j.ajo.2017.05.020

Abstract

Purpose
To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH).

Design
Multicenter, national cohort study.

Methods
Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity.

Results
Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25–2.49, P = .0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39–10.62, P = .0095).

Conclusions
Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH.

Publication Type: Article
Additional Information: © Elsevier 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Subjects: R Medicine > RC Internal medicine
R Medicine > RE Ophthalmology
Departments: School of Health Sciences > Optometry & Visual Science
URI: http://openaccess.city.ac.uk/id/eprint/21783
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