Cecilia S Lee1, Aaron Y Lee2, Douglas Baughman1, Dawn Sim3, Toks Akelere4, Christopher Brand5, David P Crabb6, Alastair K Denniston7, Louise Downey8, Alan Fitt9, Rehna Khan10, Sajad Mahmood11, Kaveri Mandal12, Martin Mckibbin13, Geeta Menon14, Aires Lobo3, B Vineeth Kumar15, Salim Natha12, Atul Varma16, Elizabeth Wilkinson17, Danny Mitry18, Clare Bailey19, Usha Chakravarthy20, Adnan Tufail21, Catherine Egan21. 1. Department of Ophthalmology, University of Washington, Seattle, Washington. 2. Department of Ophthalmology, University of Washington, Seattle, Washington; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: leeay@uw.edu. 3. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. 4. Hinchingbrooke Health Care NHS Trust, Huntingdon, United Kingdom. 5. Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. 6. City, University of London, Division of Optometry & Visual Science, London, United Kingdom. 7. University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. 8. Hull Royal Infirmary, Department of Ophthalmology, Hull, United Kingdom. 9. Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom. 10. Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom. 11. Manchester Royal Eye Hospital, Manchester, United Kingdom. 12. Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom. 13. Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom. 14. Frimley Park Hospital, Frimley, United Kingdom. 15. Royal Hallamshire Hospital, Sheffield, United Kingdom. 16. Mid Yorkshire Hospitals NHS Trust, Yorkshire, United Kingdom. 17. Northern Devon Healthcare NHS Trust, Devon, United Kingdom. 18. The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom. 19. Bristol Eye Hospital, Bristol, United Kingdom. 20. Belfast Health and Social Care Trust, Belfast, United Kingdom. 21. Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.
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. Published by Elsevier Inc.
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. Published by Elsevier Inc.
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