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  • Predominantly Peripheral Lesions and DR Progression: Role of UWF-FA

    By Jean Shaw
    Selected and reviewed by Neil M. Bressler, MD, and Deputy Editors
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    Journal Highlights

    JAMA Ophthalmology, October 2022

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    In a study from the DRCR.net, Marcus et al. aimed to determine whether detecting predominantly peripheral lesions (PPLs) on ultra-widefield imag­ing aids in predicting the progression of diabetic retinopathy (DR). They found that the presence of PPLs on ultra-widefield fluorescein angiography (UWF-FA) is associated with DR pro­gression. A similar association was not found with UWF-color imaging.

    For this prospective longitudinal study, known as Protocol AA, research­ers at 37 clinical sites enrolled 388 participants who were at least 18 years old, had type 1 or 2 diabetes, and had at least one eye with nonproliferative DR (NPDR). The analysis cohort consisted of 544 study eyes of 367 participants.

    Standard 7-field ETDRS images, UWF-color images, and UWF-FA images were taken at baseline. Follow­ing that, UWF-color images were taken during four years of follow-up, and UWF-FA images were taken at the one-year and four-year visits. The primary outcome measure was the progression of disease, defined as either worsening by 2 or more steps on the Diabetic Ret­inopathy Severity Score (DRSS) scale or receipt of treatment for DR during follow-up.

    All told, 542 eyes had gradable color and FA images. Of these, PPLs were detected in both sets of images in 136 eyes (25%) and were absent in 210 eyes (39%). PPLs were evident only on UWF-color imaging in 85 eyes (16%) and only on UWF-FA in 111 (20%).

    When all eyes were stratified by degree of disease at baseline, the four-year disease worsening rates were 45% for eyes with mild NPDR, 40% for eyes with moderate NPDR, 26% for eyes with moderately severe NPDR, and 43% for eyes with severe NPDR. Dis­ease worsening was not associated with the presence of PPLs on UWF-color at baseline but was associated with their presence on UWF-FA at baseline. This association was present within DRSS subgroups and with multiple individual types of PPLs.

    Based on these data, the researchers said, “findings on UWF-color are not interchangeable with findings on UWF-FA.” Moreover, they said, the study results “support the use of UWF-FA for future DR staging systems and clini­cal care to more accurately determine prognosis in NPDR eyes.” (Also see companion study by Silva et al., as well as related commentary by Imran H. Usuf, MB ChB(Hons), MRes, MRCP, DPhil, FRCOphth, and Andrew J. Lotery, MD, FRCOphth, in the same issue.)

    The original article can be found here.