Prediction, by retinal location, of the onset of diabetic edema in patients with nonproliferative diabetic retinopathy

• Published in: Investigative ophthalmology & visual science Vol. 52; no. 9; pp. 6825 - 6831
• Main Authors: Harrison, Wendy W, Bearse, Jr, Marcus A, Schneck, Marilyn E, Wolff, Brian E, Jewell, Nicholas P, Barez, Shirin, Mick, Andrew B, Dolan, Bernard J, Adams, Anthony J
• Format: Journal Article
• Language: English
• Published: United States Association for Research in Vision and Ophthalmology, Inc 29-08-2011
• Subjects: Adult; Age of Onset; Aged; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Retinopathy - complications; Diabetic Retinopathy - diagnosis; Diabetic Retinopathy - epidemiology; Diagnosis, Differential; Disease Progression; Electroretinography; Female; Fluorescein Angiography; Follow-Up Studies; Fundus Oculi; Glycated Hemoglobin A - metabolism; Humans; Male; Middle Aged; Papilledema - diagnosis; Papilledema - epidemiology; Papilledema - etiology; Predictive Value of Tests; Retina - pathology; Retina - physiopathology; Risk Assessment - methods; Risk Factors; Tomography, Optical Coherence; United States - epidemiology; Young Adult
• ISSN: 1552-5783; 0146-0404; 1552-5783
• DOI: 10.1167/iovs.11-7533

To formulate a model to predict the location of the onset of diabetic retinal edema (DE) in adults with diabetic retinopathy (DR), at risk for DE.
In all, 46 eyes from 23 patients with DR were included. Subjects were followed semiannually until DE developed or the study concluded. The presence or absence of DE within the central 45 ° at the final visit was the outcome measure, and data from the prior visit were used as baseline. A logistic regression model was formulated to assess the relationship between DE development and: multifocal electroretinogram (mfERG) implicit time (IT) Z-score, mfERG amplitude (Amp) Z-score, sex, diabetes duration, diabetes type, blood glucose, HbA1c, age, systolic (SBP) and diastolic blood pressure, and grade of retinopathy. A total of 35 retinal zones were constructed from the mfERG elements and each was graded for DE. Data from 52 control subjects were used to calculate the maximum IT and minimum Amp Z-scores for each zone. Receiver operating characteristic curves from a fivefold cross-validation were used to determine the model's predictive properties.
Edema developed in 5.2% of all retinal zones and in 35% of the eyes. The mfERG Amp, mfERG IT, SBP, and sex were together predictive of edema onset. Combined, these factors produce a model that has 84% sensitivity and 76% specificity.
Together mfERG, SBP, and sex are good predictors of local edema in patients with DR. The model is a useful tool for assessing risk for edema development and a candidate measure to evaluate novel therapeutics directed at DE.