Ultra-widefield fluorescein angiography may aid in diabetic retinopathy assessment

Greater retinal nonperfusion and predominantly peripheral lesions identified at baseline using ultra-widefield fluorescein angiography were found to be associated with an increased risk of diabetic retinopathy worsening over time.

Study design

This was a prospective, multicenter, longitudinal observational study of 508 eyes with nonproliferative diabetic retinopathy (DR) and gradable nonperfusion on ultra-widefield fluorescein angiography (UWF-FA) at baseline. Annual images and FAs were graded for DR, nonperfused area, nonperfusion index, and presence of predominantly peripheral lesions using a centralized reading center. Associations between baseline UWF-FA nonperfusion extent and disease worsening were studied, with worsening defined as either an increase of at least two steps on the Diabetic Retinopathy Severity Scale (DRSS) or the receipt of treatment for DR.

Outcomes

A multivariable analysis adjusted for baseline DRSS score and baseline systemic risk factors showed that greater nonperfusion index (HR, 1.11; 95% CI, 1.02–1.22; P = 0.02) and the presence of predominantly peripheral lesions as measured by FA (HR, 1.89; 95% CI, 1.35–2.65; P < 0.001) were associated with disease worsening.

Limitations

There are limitations to manual grading of non-perfusion on wide-field FA. In addition, 23% of patients dropped out of the study before the end of the 4-year study period.

Clinical significance

Diabetic retinopathy patients with wide-field FA findings of nonperfusion and predominantly peripheral lesions may need to be monitored more closely, as they are at higher risk of diabetic retinopathy progression and/or need for treatments.