Ethnic Variation in Diabetic Retinopathy Lesion Distribution on Ultra-widefield Imaging

Ye He; Aditya Verma; Muneeswar G Nittala; Swetha Bindu Velaga; Houri Esmaeilkhanian; Xiaorong Li; Long Su; Xiao Li; Chaitra Jayadev; Irena Tsui; Pradeep Prasad; Srinivas R Sadda

doi:10.1016/j.ajo.2022.10.023

Ethnic Variation in Diabetic Retinopathy Lesion Distribution on Ultra-widefield Imaging

Am J Ophthalmol. 2023 Mar:247:61-69. doi: 10.1016/j.ajo.2022.10.023. Epub 2022 Nov 9.

Authors

Affiliations

¹ From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
² From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA.
³ From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
⁴ Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
⁵ The Second Hospital of Tianjin Medical University (L.S., X.L.), Tianjin, China; Narayana Nethralaya Eye Institute (C.J.), Bangalore, India.
⁶ Tianjin Key Laboratory of Retinal Functions and Diseases (Y.H., X.L., X.L.), Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China; The Second Hospital of Tianjin Medical University (L.S., X.L.), Tianjin, China; Narayana Nethralaya Eye Institute (C.J.), Bangalore, India.
⁷ From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Stein Eye Institute (I.T., P.P.), Los Angeles, California, USA.
⁸ Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA; Stein Eye Institute (I.T., P.P.), Los Angeles, California, USA; Department of Ophthalmology (P.P.), Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, California, USA.
⁹ From the Doheny Eye Institute (Y.H., A.V., M.G.N., S.B.V., H.E., I.T., S.R.S.), David Geffen School of Medicine, University of California Los Angeles, Pasadena, California, USA; Department of Ophthalmology (Y.H., H.E., I.T., P.P., S.R.S.), David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA. Electronic address: [email protected].

PMID: 36368347
DOI: 10.1016/j.ajo.2022.10.023

Abstract

Purpose: To evaluate whether the distribution of diabetic retinopathy (DR) lesions differs among various ethnicities.

Design: Multi-center, retrospective cohort study.

Methods: We accrued a cohort of 226 eyes with DR consisting of 51 East Asian eyes, 102 South Asian eyes, 30 Caucasian eyes, and 43 Latino eyes, all evaluated with ultrawide field pseudocolor images. Images were manually annotated for DR lesions and were classified as having predominantly peripheral lesions (PPL) or predominantly central lesions (PCL) using 4 quantitative methods. The percent distribution of PCL to PPL was compared among different ethnicities.

Results: Using a single-field lesion frequency-based method, East Asian eyes more frequently demonstrated a PPL distribution (86.3%), whereas South Asian eyes more frequently demonstrated a PCL distribution (64.7%). These findings were also observed when considering only the subset of treatment-naïve eyes. Furthermore, in treatment-naïve eyes without proliferative DR, the percent distribution of PPL to PCL in East Asian eyes was significantly different when compared to other ethnicities (P < .0001 South Asian, P = .035 Caucasian, P = .0003 Latino). The majority of patients (60%-78%) in all ethnic groups had moderate nonproliferative diabetic retinopathy(NPDR), and the same difference between East Asian and South Asian eyes was observed in this subgroup.

Conclusions: The distribution of DR lesions appears to vary among different ethnicities. DR lesions tend to be distributed more peripherally in East Asian eyes compared to other ethnic groups, particularly South Asian eyes, which tend to have more central disease. The prognostic implications of these ethnic differences in DR lesion distribution require further investigation.

MeSH terms

Diabetes Mellitus* / pathology
Diabetic Retinopathy*
Diagnostic Imaging
Humans
Retina / pathology
Retrospective Studies
Severity of Illness Index