Visual outcome after laser treatment for diabetic retinopathy

Aims To identify factors that predict visual outcome after laser treatment for sight threatening diabetic retinopathy (STDR) in routine care. Patients and Methods We studied consecutive patients from a single diabetes centre who had laser photocoagulation by a single operator (LBY) which was commenced between 1991 and 1996. Follow‐up data were obtained until the start of 1998. Potential predictors investigated were age, sex, duration and type of diabetes, HbA1C, systolic and diastolic blood pressures, lipids, initial visual acuity (VA), urine albumin/creatinine ratio (UACR), serum creatinine and presence of macrovascular disease (MVD). Results Complete data were available for 137 (91.3%) of the 150 patients (median age 59 years, 35% female, 258 treated eyes). 140 eyes (54.3%) had maculopathy alone, 57 (22.1%) proliferative retinopathy alone and 61 (23.6%) had mixed retinopathy. Final VA (3‐48 months post photocoagulation) was better than or equal to 6/12 in 81.4% maculopathy, 82.5% proliferative and 54.1% mixed eyes. Initial VA was the strongest predictor of final VA (maculopathy r = 0.66, p = 0.01, proliferative r = 0.44, p = 0.01, mixed r = 0.30, p = 0.05). 70% of maculopathy eyes, 61.4% of proliferative eyes and 42.6% of mixed eyes were unchanged or improved. Deterioration was additionally predicted by: maculopathy – increasing age & female sex; proliferative retinopathy – high UACR & concurrent MVD; mixed disease – type 2 DM. Conclusions In a routine care environment laser treatment of STDR can maintain very good vision. Initiating treatment before visual acuity drops is the most important factor in preventing blindness. Copyright © 2002 John Wiley & Sons, Ltd.