After discovering, earlier this year, that the presence of peripheral lesions increased the risk of rapid diabetic retinopathy progression, researchers from the Joslin Diabetes Center’s Beetham Eye Institute further discovered that these lesions also closely correlate with retinal non-perfusion caused by loss of small blood vessels or capillaries.  

	The study findings mechanistically tie predominantly peripheral lesions to the development of proliferative diabetic retinopathy, Dr. Chous says. Photo: Paul A. Chous, OD.

This follow up study, published recently in Ophthalmology, used ultra-widefield (UWF) imaging to examine the eyes of 37 patients with diabetes and varying levels of retinopathy. They found that the areas of non-perfusion, identified by UWF retinal angiography, matched up closely with the peripheral lesions identified with normal UWF imaging. 

The researchers hope this discovery could one day allow clinicians to use peripheral lesions to estimate the extent and location of non-perfusion damage, as well as the risk of disease progression, without having to use UWF angiography in every case. 

A related trial by the Diabetic Retinopathy Clinical Research Network is now underway, and if it confirms this study’s findings, the Joslin researchers suspect the diabetic eye disease grading system will be updated to reflect these risk factors and imaging approaches, Lloyd Paul Aiello, MD, PhD, director of the Beetham Institute, professor of ophthalmology at Harvard Medical School and senior author on the paper, said in a press release.

“The bottom line is that we cannot solely focus on the posterior pole in diabetes, but must pay close attention to the peripheral retina because abnormalities there substantially increase patient risk of blinding eye disease,” says Paul A. Chous, OD, who has a private practice in Tacoma, Wash.

Silva PS, Dela Cruz AJ, Ledesma MG, et al. Diabetic retinopathy severity and peripheral lesions are associated with nonperfusion on ultrawide field angiography. Ophthalmology. 2015 Sep:pii:S0161-6420(15)00773-3. [Epub ahead of print].