DIABETIC RETINOPATHY PHENOTYPES ON ULTRAWIDE FIELD RETINAL IMAGING IN AN INDIAN POPULATION

Purpose: To study the distribution of lesions of diabetic retinopathy (DR), cotton wool spots, and scattered exudates on ultrawide field images (UWFI) to better define DR phenotypes in Indians. Methods: This multicenter cross-sectional observational study on UWFI in individuals with DR was conducted across four tertiary eye care centers in South India. The Early Treatment Diabetic Retinopathy Study grid was superimposed on the UWFI, and each image was analyzed for the distribution of the retinal lesions. Results: Out of a total of 1,002 eyes of 1,002 patients with gradable images, 459 eyes (46%) had predominantly peripheral retinal lesions, of which hemorrhages/microaneurysms (86.1%) were the most frequent lesions. Only 5.5% of eyes had retinal neovascularization limited to outside the seven-field. Strong agreement was demonstrated in the grading of retinopathy using Early Treatment Diabetic Retinopathy Study and UWFI (κ = 0.9). Approximately 15.3% eyes had a higher grade of DR when graded on UWFI compared with seven-field Early Treatment Diabetic Retinopathy Study grid. Scattered exudates and cotton wool spots on UWFI are prevalent in Indian eyes with DR. Scattered exudates on UWFI were more prevalent in eyes with predominantly peripheral lesions and were associated with increasing severity of DR. Conclusion: The presence of predominantly peripheral lesions and scattered exudates on UWFI are associated with increasing DR severity in Indians, and these findings need to be considered in new classifications of DR.