The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy.

PURPOSE: To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH). DESIGN: Multicenter, national cohort study. METHODS: Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity. RESULTS: Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25-2.49, P = .0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39-10.62, P = .0095). CONCLUSIONS: Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH.

Multifocal intraocular lenses in the setting of glaucoma.

PURPOSE OF REVIEW: The purpose of this review is to collate evidence and make recommendations regarding the use of multifocal intraocular lenses in patients with glaucoma. RECENT FINDINGS: Multifocal intraocular implants have been in use since the 1980s. Several studies have been done comparing their advantages and disadvantages compared with conventional monofocal intraocular implants. Most of these studies have looked at patients with cataract and no ocular comorbities. Reports of their use in eyes with concurrent disease are scarce. We review the available evidence and the potential benefits and pitfalls of using multifocal intraocular lenses in glaucomatous eyes. A recently published Cochrane review identified eight trials which had stringent criteria to recruit patients. These studies excluded all patients with concurrent eye diseases. No recent publications are available specifically evaluating the use of multifocal intraocular lenses in patients with glaucoma. SUMMARY: Firm recommendations cannot be made on the use of multifocal intraocular lenses in patients with glaucoma as large studies have not been done to evaluate their benefit. Currently, the decision of whether to use multifocal intraocular lenses in patients with glaucoma has to be made on an individual basis.