Ophthalmology. Retina · 2025
Visual Field Changes in Diabetic Retinopathy: Natural History and after Pan-Retinal Photocoagulation in the Diabetic Retinopathy Study and the ETDRS.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Lee Debora H, Vitale Susan, Agrón Elvira, Keenan Tiarnan D L, Cukras Catherine A, Chew Emily Y
Аннотация
OBJECTIVE: To examine visual field (VF) changes in untreated diabetic retinopathy (DR) and compare them to those in DR treated with pan-retinal photocoagulation (PRP).
DESIGN: Post hoc analyses of the DR Study (DRS) and ETDRS, historical multicenter randomized controlled trials designed to assess the treatment effects of argon laser PRP for DR.
PARTICIPANTS: A total of 1660 DRS eyes (830 participants) with severe nonproliferative DR (NPDR) or proliferative DR (PDR), and 5416 ETDRS eyes (2708 participants) with mild-severe NPDR or early PDR.
METHODS: Each DRS and ETDRS participant had 1 eye randomized to immediate PRP and the fellow eye to deferred PRP. Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.
MAIN OUTCOME MEASURES: The outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.
RESULTS: Among untreated eyes (n = 830 [DRS] and n = 2706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. Among untreated eyes, the presence of macular edema (ME) was associated with a VFS change of -12.9 (-25.4 to -0.5) and -6.2 (-10.4 to -1.9) in the DRS and ETDRS, respectively. The difference in VFS between PRP-treated versus untreated eyes was significant at 4 months (-31.4 [95% CI, -38.6 to -24.2]), but no longer apparent by year 3 (-1.4 [-17.0 to 14.1]) in the paired DRS analyses.
CONCLUSIONS: The natural history of untreated DR involved significant VF decline over time. Increased DR severity and presence of ME were associated with greater field loss. Pan-retinal photocoagulation was associated with a rapid initial decline in the VF; however, VFs in PRP-treated versus untreated eyes became similar by year 3.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
DESIGN: Post hoc analyses of the DR Study (DRS) and ETDRS, historical multicenter randomized controlled trials designed to assess the treatment effects of argon laser PRP for DR.
PARTICIPANTS: A total of 1660 DRS eyes (830 participants) with severe nonproliferative DR (NPDR) or proliferative DR (PDR), and 5416 ETDRS eyes (2708 participants) with mild-severe NPDR or early PDR.
METHODS: Each DRS and ETDRS participant had 1 eye randomized to immediate PRP and the fellow eye to deferred PRP. Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.
MAIN OUTCOME MEASURES: The outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.
RESULTS: Among untreated eyes (n = 830 [DRS] and n = 2706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. Among untreated eyes, the presence of macular edema (ME) was associated with a VFS change of -12.9 (-25.4 to -0.5) and -6.2 (-10.4 to -1.9) in the DRS and ETDRS, respectively. The difference in VFS between PRP-treated versus untreated eyes was significant at 4 months (-31.4 [95% CI, -38.6 to -24.2]), but no longer apparent by year 3 (-1.4 [-17.0 to 14.1]) in the paired DRS analyses.
CONCLUSIONS: The natural history of untreated DR involved significant VF decline over time. Increased DR severity and presence of ME were associated with greater field loss. Pan-retinal photocoagulation was associated with a rapid initial decline in the VF; however, VFs in PRP-treated versus untreated eyes became similar by year 3.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.