ASRS 2024: Diabetic retinopathy lesions and assessing disease severity over time

This year, the American Society of Retina Specialists held its annual meeting in Stockholm, Sweden. Ahead of the conference, Paulo Antonio Silva, MD, sat down with Modern Retina to discuss his presentation. In this video, Prof Silva discusses diabetic retinopathy lesion types and distribution on ultra-widefield imaging and the risk for disease worsening over time.

Editor's note: The below transcript has been lightly edited for clarity.

Sydney Crago: Hi, I'm Sydney Crago, Editor of Modern Retina, and I'm here today with Dr Paulo Antonio Silva to talk a little bit about the upcoming ASRS meeting in Stockholm. Dr Silva, Can you tell me a little bit about what you'll be presenting at ASRS?

Paulo Antonio Silva, MD: So we're presenting a post-hoc analysis of DRCR protocol double A. So this study aims to look at the effect of the distribution, severity of different types of diabetic retinopathy lesions on its impact on the ETDRS diabetic retinopathy severity scale, how it impacts progression. We specifically looked at hemorrhages and microaneurysms, intraretinal microvascular abnormalities, venous feeding and new vessels.

SC: Can you tell me a little bit about how the imaging you're using is empowering you to do this research?

PS: Yeah, so this was a post-hoc analysis of the DRCR protocol double A. We looked at 544 eyes with non-perfusion retinopathy. So all imaging, or baseline and follow-up imaging, were performed using ultra-widefield color and ultra-widefield FA images. These ultra-widefield color and FA images reevaluated within, for severity levels of the different lesions within the ETDRS fields, as well as outside the ETDRS fields.

SC: How long was the follow up from their initial diagnosis or visit?

PS: We follow patients up longitudinally over 4 years. We defined progression in this study as a two-step progression on the ETDRS severity scale, or receipt of treatment for diabetic retinopathy, for over the 4-year treatment interval, over the 4-year study period.

SC: And then, what would be the main takeaway from your presentation?

PS: Yeah, so the key findings of the study was that the distribution of lesions did not affect retinopathy severity progression. This meant that both the posterior pole and peripheral lesions had similar risk for progression. Furthermore, if we identified the severity level being much more advanced in the periphery as compared to only evaluating the posterior pole or the ETDRS fields, the risk was almost two-fold higher. This meant that the information that we gain from ultra-widefield color and ultra-widefield FA images improves our ability to predict which eyes get worse, which eyes are higher risk for progression.