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Peripheral retinal ischaemia, as evaluated by ultra-widefield fluorescein angiography, is associated with diabetic macular oedema
  1. Matthew M Wessel,
  2. Nandini Nair,
  3. Grant D Aaker,
  4. Joshua R Ehrlich,
  5. Donald J D'Amico,
  6. Szilárd Kiss
  1. Department of Ophthalmology, Weill Cornell Medical College. 1305 York Avenue, 11th Floor, New York, New York, USA
  1. Correspondence to Dr Szilárd Kiss, Department of Ophthalmology, Weill Cornell Medical College, 1305 York Avenue, 11th Floor, New York, NY 10021; szk7001{at}


Purpose To determine the relationship between retinal ischaemia and the presence of macular oedema (DMO) in patients with diabetic retinopathy (DR) using ultra-widefield fluorescein angiography (UWFA) imaging.

Methods A retrospective review of 122 eyes of 70 treatment-naïve diabetic patients who underwent diagnostic UWFA using the Optos 200Tx imaging system. Two independent, masked graders quantified the area of retinal ischaemia. Based on clinical examination and optical coherence tomography (OCT), each patient was given a binary classification as either having DMO or no DMO. McNemar's test (with Yates' correction as indicated) and a two-sample test of proportions were used to determine the relationship between DMO and ischaemia for binary and proportional data, respectively. Linear and logistic models were constructed using generalised estimating equations to test relationships between independent variables, covariates and outcomes while controlling for inter-eye correlation, age, gender, haemoglobin A1c, mean arterial pressure and dependence on insulin.

Results Seventy-six eyes (62%) exhibited areas of retinal ischaemia. There was a significant direct correlation between DMO and peripheral retinal ischaemia as seen on UWFA (p<0.001). In addition, patients with retinal ischaemia had 3.75 times increased odds of having DMO compared with those without retinal ischaemia (CI 1.26 to 11.13, p<0.02).

Conclusion Retinal ischaemia is significantly correlated with DMO in treatment-naïve patients with DR. UWFA is a useful tool for detecting peripheral retinal ischaemia, which may have direct implications in the diagnosis, follow-up and treatment such as targeted peripheral photocoagulation.

  • Ultra-wide field imaging
  • fluorescein angiography
  • diabetes
  • diabetic retinopathy
  • diabetic macular oedema
  • retina
  • epidemiology
  • retina

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  • Funding The study was made possible in part by the generous support of a departmental Research to Prevent Blindness grant. The ophthalmology department at Weill Cornell has received research funding from the manufacturer of the ultra-widefield imaging device (Optos, PLC). However, the data and analysis presented in this study has no relationship to that research funding.

  • Competing interests SK serves as a consultation to Optos, PLC. No additional competing interests declared.

  • Ethics approval This study was approved by the Weill Cornell Medical College–New York Presbyterian Hospital institutional review board (IRB) according to local IRB guidelines. Health Insurance Portability and Accountability Act (HIPPA) compliance was maintained. Care of the patients in this study was in accordance with the Declaration of Helsinki and all federal and state laws. Because the study is a retrospective analysis with no personal medical information or personal identifiers, no individual consent was sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available on request from SK; szk7001{at}

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