Debora H Lee, Susan Vitale, Elvira Agrón, Tiarnan D L Keenan, Catherine A Cukras, Emily Y Chew
{"title":"糖尿病视网膜病变的视野变化：糖尿病视网膜病变研究（DRS）和早期治疗糖尿病视网膜病变研究（ETDRS）的自然历史和全视网膜光凝后","authors":"Debora H Lee, Susan Vitale, Elvira Agrón, Tiarnan D L Keenan, Catherine A Cukras, Emily Y Chew","doi":"10.1016/j.oret.2025.04.021","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine visual field (VF) changes in untreated diabetic retinopathy (DR) and compare them to those in DR treated with pan-retinal photocoagulation (PRP).</p><p><strong>Design: </strong>Post hoc analyses of the DR Study (DRS) and ETDRS, historical multicenter randomized controlled trials designed to assess the treatment effects of argon laser PRP for DR.</p><p><strong>Participants: </strong>A total of 1660 DRS eyes (830 participants) with severe nonproliferative DR (NPDR) or proliferative DR (PDR), and 5416 ETDRS eyes (2708 participants) with mild-severe NPDR or early PDR.</p><p><strong>Methods: </strong>Each DRS and ETDRS participant had 1 eye randomized to immediate PRP and the fellow eye to deferred PRP. Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.</p><p><strong>Main outcome measures: </strong>The outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.</p><p><strong>Results: </strong>Among untreated eyes (n = 830 [DRS] and n = 2,706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. Among untreated eyes, the presence of macular edema (ME) was associated with a VFS change of -12.9 (-25.4 to -0.5) and -6.2 (-10.4 to -1.9) in the DRS and ETDRS, respectively. The difference in VFS between PRP-treated versus untreated eyes was significant at 4 months (-31.4 [95% CI, -38.6 to -24.2]), but no longer apparent by year 3 (-1.4 [-17.0 to 14.1]) in the paired DRS analyses.</p><p><strong>Conclusions: </strong>The natural history of untreated DR involved significant VF decline over time. Increased DR severity and presence of ME were associated with greater field loss. Pan-retinal photocoagulation was associated with a rapid initial decline in the VF; however, VFs in PRP-treated versus untreated eyes became similar by year 3.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. 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Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.</p><p><strong>Main outcome measures: </strong>The outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.</p><p><strong>Results: </strong>Among untreated eyes (n = 830 [DRS] and n = 2,706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. 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引用次数: 0
摘要
目的：观察未经治疗的糖尿病视网膜病变（DR）的视野变化，并与泛视网膜光凝治疗（PRP）进行比较。设计：对糖尿病视网膜病变研究（DRS）和早期治疗糖尿病视网膜病变研究（ETDRS）进行事后分析，旨在评估使用氩激光PRP作为dr治疗的历史多中心随机对照试验。参与者：共有1660只DRS眼（830名参与者）患有严重非增殖性糖尿病视网膜病变（NPDR）或增殖性糖尿病视网膜病变（PDR）， 5416只ETDRS眼（2708名参与者）患有轻度-重度NPDR或早期PDR。方法：每个DRS和ETDRS参与者有一只眼睛随机分配到即时PRP，另一只眼睛随机分配到延迟PRP。使用DRS中的IV/4e刺激和ETDRS中的I/4e刺激，以Goldmann周长获得视野评分（VFS）。在延迟PRP组中，后来接受PRP的眼睛在治疗开始时被切除。主要结果测量：(1)平均VFS和(2)基线VFS随时间变化的结果通过重复测量的多变量回归模型进行估计。结果：在未治疗的眼睛（n=830 [DRS], n=2706 [ETDRS]）中，VFS在6年（DRS）时较基线变化为-152.0 (95% CI -215.4, -88.5)，在7年（ETDRS）时为-79.2（-90.9,-67.6）。与未治疗的NPDR眼相比，未治疗的PDR +高危特征（HRC）眼DRS和ETDRS的VFS变化分别为-50.2（-65.9,-34.6）和-38.3（-69.2,-9.5）。在未治疗的眼睛中，黄斑水肿（ME）的存在与DRS和ETDRS的VFS变化相关，分别为-12.9（-25.4,-0.5）和-6.2（-10.4,-1.9）。在配对DRS分析中，prp治疗组与未治疗组的VFS在4个月时差异显著[-31.4 (95% CI -38.6, -24.2)]，但在第3年不再明显[-1.4(-17.0,14.1)]。结论：未经治疗的DR的自然史涉及随着时间的推移，视野明显下降。DR严重程度的增加和ME的存在与更大的田间损失相关。PRP与视野最初迅速下降有关；然而，prp治疗组与未治疗组的视野在第3年变得相似。
Visual Field Changes in Diabetic Retinopathy: Natural History and after Pan-Retinal Photocoagulation in the Diabetic Retinopathy Study and the ETDRS.
Objective: To examine visual field (VF) changes in untreated diabetic retinopathy (DR) and compare them to those in DR treated with pan-retinal photocoagulation (PRP).
Design: Post hoc analyses of the DR Study (DRS) and ETDRS, historical multicenter randomized controlled trials designed to assess the treatment effects of argon laser PRP for DR.
Participants: A total of 1660 DRS eyes (830 participants) with severe nonproliferative DR (NPDR) or proliferative DR (PDR), and 5416 ETDRS eyes (2708 participants) with mild-severe NPDR or early PDR.
Methods: Each DRS and ETDRS participant had 1 eye randomized to immediate PRP and the fellow eye to deferred PRP. Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.
Main outcome measures: The outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.
Results: Among untreated eyes (n = 830 [DRS] and n = 2,706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. Among untreated eyes, the presence of macular edema (ME) was associated with a VFS change of -12.9 (-25.4 to -0.5) and -6.2 (-10.4 to -1.9) in the DRS and ETDRS, respectively. The difference in VFS between PRP-treated versus untreated eyes was significant at 4 months (-31.4 [95% CI, -38.6 to -24.2]), but no longer apparent by year 3 (-1.4 [-17.0 to 14.1]) in the paired DRS analyses.
Conclusions: The natural history of untreated DR involved significant VF decline over time. Increased DR severity and presence of ME were associated with greater field loss. Pan-retinal photocoagulation was associated with a rapid initial decline in the VF; however, VFs in PRP-treated versus untreated eyes became similar by year 3.
Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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