Ultrawide Field Imaging in Diabetic Retinopathy: Exploring the Role of Quantitative Metrics

Ultrawide field imaging (UWF) has allowed the visualization of a significantly greater area of the retina than previous standard approaches. In diabetic retinopathy (DR), significantly more lesions are seen on UWF imaging compared to the seven-standard ETDRS fields. In addition, some eyes have lesions that are located predominantly in the peripheral retina that are associated with an increased risk of DR progression. The current DR severity scales are still largely based on clinically visible retinal microvascular lesions and do not incorporate retinal periphery, neuroretinal, or pathophysiologic changes. Thus, current scales are not well suited for documenting progression or regression in eyes with very early or advanced DR, nor in the setting of vascular endothelial growth factor inhibitors (antiVEGF). In addition, the categorical system is highly subjective, and grading is variable between different graders based on experience level and training background. Recently, there have been efforts to quantify DR lesions on UWF imaging in an attempt to generate objective metrics for classification, disease prognostication and prediction of treatment response. The purpose of this review is to examine current quantitative metrics derived from UWF fluorescein angiograms and UWF color imaging to determine their feasibility in any potential future DR classification.

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Association of VEGF Gene Polymorphisms with Susceptibility to Diabetic Retinopathy: A Systematic Review and Meta-Analysis

Hormone and Metabolic Research ◽

10.1055/a-1143-6024 ◽

2020 ◽

Vol 52 (05) ◽

pp. 264-279

Author(s):

Xiaorong Li ◽

Juping Liu ◽

Qianhui Yang ◽

Yan Zhang ◽

Xiaomin Zhang

Keyword(s):

Diabetic Retinopathy ◽

Gene Polymorphisms ◽

Meta Analysis ◽

Vascular Endothelial ◽

Nucleotide Polymorphisms ◽

Vegf Gene ◽

Asian Populations ◽

Increased Risk ◽

Endothelial Growth Factor

AbstractThe associations between vascular endothelial growth factor (VEGF) gene polymorphisms and risk of type 2 diabetic retinopathy (DR) – proliferative diabetic retinopathy (PDR), and nonproliferative diabetic retinopathy (NPDR) – remain unclear. A systematic search and meta-analysis using odds ratio (OR) with 95% confidence interval (CI) was performed to evaluate the association. Our study concluded 26 studies containing 10 single nucleotide polymorphisms (SNPs). In Asian populations, rs3025039 polymorphism was associated with DR risk, while in overall populations and Caucasians, the DR risk was increased by association with rs2010963. There was a significant association between rs25648 and rs833061 and DR risk in Caucasians. DR risks were found to be significantly associated between rs3025021, rs13207351, and rs2146323 in either overall populations, Caucasians or Asians. Besides, in overall and Asian populations, rs699947 and rs3025039 were associated with PDR risk. rs1570360, rs3025039, and rs833061 played a key role in PDR etiology in Caucasians. rs2010963 was associated with increased risk of PDR in overall populations. A significant association between rs699947, rs3025039, and rs833061 and NPDR risk in overall populations and Asians was found. A significant association was observed between rs2010963 and increased NPDR risk in overall and Caucasian populations. This study provides a new insight into the parthenogenesis of diabetic retinopathy. Targeting VEGF SNPs may be a potential of therapeutic approach for the treatment of DR, PDR, and NPDR.

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Relationships among Retinal Nonperfusion, Neovascularization, and Vascular Endothelial Growth Factor Levels in Quiescent Proliferative Diabetic Retinopathy

Journal of Clinical Medicine ◽

10.3390/jcm9051462 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1462

Author(s):

Ho Ra ◽

Jae Hyun Park ◽

Jin Uk Baek ◽

Jiwon Baek

Keyword(s):

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Aqueous Humor ◽

Proliferative Diabetic Retinopathy ◽

Peripheral Retina ◽

Vascular Endothelial ◽

Disc Area ◽

Endothelial Growth Factor ◽

Vegf Level

Purpose: To investigate the relationships among the retinal nonperfusion (NP) area, neovascularization (NV) area, and aqueous humor vascular endothelial growth factor (VEGF) levels in quiescent proliferative diabetic retinopathy (PDR). Methods: Forty-seven eyes from 47 patients with treatment-naïve PDR that did not show macular edema or vitreous hemorrhage were enrolled. NP area, NV number, and NV area were quantitatively measured using ultra-widefield fluorescein angiography in an automated manner. Aqueous humor VEGF level was measured using a bead assay. Results: The NP areas of the total, posterior pole, peripheral retinae, and NV area positively correlated with each other (all p < 0.034). NV number correlated with total NP area, peripheral NP area, and NV area (all p ≤ 0.001). VEGF levels were significantly positively correlated with total, posterior polar, and peripheral NP areas and NV area (r = 0.575, 0.422, 0.558, and 0.362, respectively; all p ≤ 0.012). In eyes with NV in the disc area, the VEGF level was higher compare to eyes without NV in the disc area (208.89 ± 192.77 pg/mL vs. 103.34 ± 132.66, p = 0.010). A multiple linear regression model using NP area, NV area, and NVD demonstrated good prediction for VEGF level (R2 = 0.417, p < 0.001) and revealed a significant contribution of the peripheral NP area in predicting the VEGF level (β = 0.497, p = 0.002). Conclusions: Aqueous humor VEGF levels in quiescent PDR eyes were associated with NP and NV areas, which had positive correlations with each other. In addition, the NP area of the peripheral retina was the most important predictor of VEGF level.

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Peripheral Lesions Identified on Ultrawide Field Imaging Predict Increased Risk of Diabetic Retinopathy Progression over 4 Years

Ophthalmology ◽

10.1016/j.ophtha.2015.01.008 ◽

2015 ◽

Vol 122 (5) ◽

pp. 949-956 ◽

Cited By ~ 105

Author(s):

Paolo S. Silva ◽

Jerry D. Cavallerano ◽

Nour Maya N. Haddad ◽

Hanna Kwak ◽

Kelli H. Dyer ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Increased Risk ◽

Field Imaging ◽

Ultrawide Field Imaging

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Comparison of Ultrawide Field Imaging and Standard Imaging in Assessment of Early Treatment Diabetic Retinopathy Severity Scale

Ophthalmology Science ◽

10.1016/j.xops.2021.100029 ◽

2021 ◽

pp. 100029

Author(s):

Amitha Domalpally ◽

Nancy Barrett ◽

James Reimers ◽

Barbara Blodi

Keyword(s):

Diabetic Retinopathy ◽

Early Treatment ◽

Severity Scale ◽

Field Imaging ◽

Ultrawide Field Imaging

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Relationship between Serum Vascular Endothelial Growth Factor Levels and Stages of Diabetic Retinopathy and Other Biomarkers

Journal of Ophthalmology ◽

10.1155/2020/8480193 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Nakhleh E. Abu-Yaghi ◽

Nafez M. Abu Tarboush ◽

Ala M. Abojaradeh ◽

Amal S. Al-Akily ◽

Esra’a M. Abdo ◽

...

Keyword(s):

Vascular Endothelial Growth Factor ◽

Diabetic Retinopathy ◽

Growth Factor ◽

Glycosylated Hemoglobin ◽

Density Lipoprotein ◽

Significant Negative Correlation ◽

Vascular Endothelial ◽

Endothelial Growth Factor ◽

Dm Type 2

Aim. This study aims to measure serum vascular endothelial growth factor (VEGF) levels in a sample of Jordanian patients and to determine their relationship with the different stages of diabetic retinopathy. It also explores the correlation between VEGF concentrations and different biochemical and demographic findings. Materials and Methods. A total of 167 adults participated in the study. Participants were divided into two main categories: patients with diabetes mellitus (DM) type 2 without diabetic retinopathy (DR) (N = 62) and patients with DM type 2 affected by DR (N = 105). DR patients were further subclassified into nonproliferative (N = 41) and proliferative (N = 64). Basic laboratory tests were measured to correlate with VEGF levels. Irisin, a hormone linked to diabetic retinopathy was also measured and correlated with VEGF. Results. Serum VEGF was found to positively correlate with the severity of diabetic retinopathy. The means of VEGF serum concentrations were 60 pg/mL for controls, 133 pg/mL for nonproliferative DR patients, and 229 pg/mL for proliferative DR patients. We found a significant positive correlation with glycosylated hemoglobin (HbA1c), and a significant negative correlation with high-density lipoprotein (HDL) levels, age, and irisin. Conclusion. In this cohort of Jordanian diabetics, serum VEGF concentrations strongly correlated with the presence and stages of diabetic retinopathy, suggesting it as an appropriate indicator for diabetic retinopathy early detection and management in this society. VEGF levels also significantly correlated with HbA1c, HDL, and irisin levels. Further studies are encouraged to explore these relationships in other ethnic groups and with different diabetic complications.

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