Clinical Applicability of Assessing Peripheral Nonperfusion on Ultra-Widefield Angiography: Predicting Proliferative Diabetic Retinopathy

Retinal ischemia has long been recognized as a driving force behind the onset and worsening of proliferative diabetic retinopathy (PDR). In the Early Treatment Diabetic Retinopathy Study (ETDRS), increased capillary loss within the posterior pole on fluorescein angiograms was strongly associated with higher risk for PDR. Nonetheless, the ETDRS Group concluded that fluorescein angiography did not add substantively to the predictive power of color fundus photograph grading alone to determine future risk of retinopathy worsening. However, it was not until recently when ultra-widefield fluorescein angiography became available that nonperfusion out to the retinal far periphery could be readily and reliably documented. Ultra-widefield fluorescein angiograms reveal that peripheral nonperfusion is a common finding in eyes with diabetic retinopathy (DR).1 Nonetheless, it is not yet clear whether ultra-widefield fluorescein angiography provides any indispensable capability in the risk stratification of patients with diabetic eye disease.