Visual outcome in moderate and severe proliferative diabetic retinopathy.

Four hundred eyes with moderate or severe proliferative diabetic retinopathy, initial good vision, and an average follow-up of 44.3 months were studied. Final visual acuity was 20/40 or better in 33% of these eyes, 20/50 to 5/200 in 32%, and 5/200 or worse in 35%. A poor visual prognosis was correlated with a traction detachment or relatively poor visual acuity at initial examination. No correlation was found between the length of follow-up and final visual prognosis. General guide-lines are available for the management of these patients' conditions.

Unilateral proliferative diabetic retinopathy. I. Initial findings.

The combination of unilateral proliferative diabetic retinopathy (PDR) in one eye and nonproliferative diabetic retinopathy (NPDR) in the fellow eye was observed in 10.1% of patients with PDR. Most patients were between the ages of 50 and 70 years; the majority had adultonset diabetes mellitus. Unilateral aphakia and anisometropia of greater than 1 diopter were both infrequently seen. The incidence of glaucoma was unremarkable. Unilateral elevated-but not necessarily abnormal-intraocular pressure was found in a significantly larger proportion of eyes with NPDR (20%) than with PDR (12%). Most patients had moderate to severe angiopathy or exudation in the eye with NPDR and modest PDR in the fellow eye; however, one third had moderate to severe PDR. In only 2% of the patients was visual acuity less than 20/200 on initial examination.

Unilateral proliferative diabetic retinopathy. II. Clinical course.

One hundred thirty-six patients with proliferative diabetic retinopathy (PDR) in one eye and nonproliferative diabetic retinopathy (NPDR) in the fellow eye on initial examination were followed up for at least three months. Eight percent of the eyes with NPDR were eliminated from further consideration by treatment within the first three months. Proliferative diabetic retinopathy developed in 58% of the remaining eyes with NPDR, usually within two years of the initial examination. Proliferative diabetic retinopathy developed in a significantly greater percentage of diabetics who were younger than 40 years than in diabetics older than 60 years. Poor visual prognosis among eyes that initially had NPDR was associated with advanced angiopathy or exudation on initial examination and also may have been associated with the subsequent development of PDR. Neither the development of PDR nor the final visual acuity in these eyes could be correlated with vascular disease outside the eye, the degree of PDR in the fellow eye, or the presence of higher intraocular pressure in the eye with NPDR on initial examination. Forty-one percent of the eyes with unilateral PDR were eliminated from consideration by prompt treatment. Most remaining eyes with PDR also showed progressive fundus pathologic conditions.

Computer-enhanced studies of diabetic retinopathy: I.

A computer program designed according to the needs of clinical investigators has recently been implemented. This ambitious undertaking allows the ophthalmologist direct interfacing and control over all his data, presently 3,252 diabetic patient records, and thus harnesses his hypothesis-testing intuitions with the memory, speed, and flexibility of modern-day computers. There are three program modes: QUERY, a disease-independent language by which the clinician selects his population; SELECT, the actual computer selection, and DISPLAY: where general statistical maneuvers, relationships among disease parameters, ancillary data compilations, and printouts are performed. Being computer-independent and disease-independent, and adaptable to most needs of clinical investigators, this computer program brings a refreshingly new approach to the study of disease.

Computer-enhanced studies of diabetic retinopathy: II.

Data from 5,818 eyes with diabetic retinopathy were entered into a computer. Retrieval was either panoramic, encompassing the whole bank, or directed to small groups for in-depth investigation. In this study, panoramic retrieval pertains to the relative frequency of nonproliferative and proliferative diabetic retinopathy, to insulin dependence, and to the visual prognosis associated with these variables. Small-group studies examined traction detachment and vitreous hemorrhage in relation to visual prognosis and postmortem data related to age at death and "final vision".

Natural history of vitreous hemorrhage in diabetic retinopathy.

Eighty-five eyes with severe vitreous hemorrhage on initial visit were followed for three to ten years without treatment. A comparison of initial and final visual acuities showed vision to have worsened in 36 eyes (42%), improved in 25 eyes (30%) and remained unchanged in 24 eyes (28%). Vision in 60 eyes was 5/200 or worse when last examined. Of 42 eyes followed three to six years (group 1), the low vision in 24 eyes (57%) was due to vitreous hemorrhage, while of 18 eyes that were followed seven to ten years (group 2), six (33%) had low vision due to vitreous hemorrhage. Traction detachments were found in five eyes (28%) in group 2 as compared with three (7%) in group 1. The prognosis for clearing of the hemorrhage was better when the fundus reflex was brighter and the retina adjacent to the ora serrata was visible. Clearing occurred sooner when the hemorrhage was retrohyaloid rather than in the vitreous gel. The study showed that ultimately 68% of the eyes had a visual acuity of 5/200 or worse.

Diabetic traction detachment.

One hundred thirty-six of 124 patients with diabetic traction detachment (TD) were observed for an average of 4.6 years (range, 3.0 to 9.4 years) with no surgical intervention. Visual acuity was maintained or improved in 51 of these eyes; 71 continued to be 20/200 or better. Diabetic TDs remained stable for long periods, those of more severe grade being more stable. At final examination, 60% (81/136) were graded at the same anatomic level (36/136) or an improved level (45/136). Spontaneous reattachment occurred in 20% (27/136); 78% (21/27) of these eyes had small detachments (TD1). The status of the vitreous and the vitreoretinal adhesion determined both the degree of detachment and the incidence of spontaneous reattachment.