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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.
Am J Ophthalmol. 2017 Aug; 180:64-71.AJ

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.

Authors+Show Affiliations

Department of Ophthalmology, University of Washington, Seattle, Washington.Department of Ophthalmology, University of Washington, Seattle, Washington; Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: leeay@uw.edu.Department of Ophthalmology, University of Washington, Seattle, Washington.Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.Hinchingbrooke Health Care NHS Trust, Huntingdon, United Kingdom.Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.City, University of London, Division of Optometry & Visual Science, London, United Kingdom.University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.Hull Royal Infirmary, Department of Ophthalmology, Hull, United Kingdom.Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, United Kingdom.Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom.Manchester Royal Eye Hospital, Manchester, United Kingdom.Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom.Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom.Frimley Park Hospital, Frimley, United Kingdom.Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.Royal Hallamshire Hospital, Sheffield, United Kingdom.Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, United Kingdom.Mid Yorkshire Hospitals NHS Trust, Yorkshire, United Kingdom.Northern Devon Healthcare NHS Trust, Devon, United Kingdom.The NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom.Bristol Eye Hospital, Bristol, United Kingdom.Belfast Health and Social Care Trust, Belfast, United Kingdom.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.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.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

28572062

Citation

Lee, Cecilia S., et al. "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, vol. 180, 2017, pp. 64-71.
Lee CS, Lee AY, Baughman D, et al. The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy. Am J Ophthalmol. 2017;180:64-71.
Lee, C. S., Lee, A. Y., Baughman, D., Sim, D., Akelere, T., Brand, C., Crabb, D. P., 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., ... 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, 64-71. https://doi.org/10.1016/j.ajo.2017.05.020
Lee CS, et al. The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy. Am J Ophthalmol. 2017;180:64-71. PubMed PMID: 28572062.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy. AU - Lee,Cecilia S, AU - Lee,Aaron Y, AU - Baughman,Douglas, AU - Sim,Dawn, AU - Akelere,Toks, AU - Brand,Christopher, AU - Crabb,David P, AU - Denniston,Alastair K, AU - Downey,Louise, AU - Fitt,Alan, AU - Khan,Rehna, AU - Mahmood,Sajad, AU - Mandal,Kaveri, AU - Mckibbin,Martin, AU - Menon,Geeta, AU - Lobo,Aires, AU - Kumar,B Vineeth, AU - Natha,Salim, AU - Varma,Atul, AU - Wilkinson,Elizabeth, AU - Mitry,Danny, AU - Bailey,Clare, AU - Chakravarthy,Usha, AU - Tufail,Adnan, AU - Egan,Catherine, AU - ,, Y1 - 2017/05/29/ PY - 2017/02/10/received PY - 2017/04/13/revised PY - 2017/05/22/accepted PY - 2017/6/3/pubmed PY - 2017/8/5/medline PY - 2017/6/3/entrez SP - 64 EP - 71 JF - American journal of ophthalmology JO - Am J Ophthalmol VL - 180 N2 - 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. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/28572062/The_United_Kingdom_Diabetic_Retinopathy_Electronic_Medical_Record_Users_Group:_Report_3:_Baseline_Retinopathy_and_Clinical_Features_Predict_Progression_of_Diabetic_Retinopathy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(17)30222-2 DB - PRIME DP - Unbound Medicine ER -