Objective:
To evaluate the predictive power of functional testing versus structural imaging in forecasting progression to vision-threatening diabetic retinopathy (DR).
Key Findings:
- ERG combined with pupillometry outperformed structural imaging in predicting progression to vision-threatening complications.
- The RETeval DR score was the strongest predictor, with a score of ≥26.9 indicating a 5.6x higher risk of progression.
- Flicker ERG timing ≥34.6 ms was linked to a 4.6x higher risk.
- OCTA showed that a foveal avascular zone area of ≥0.285 mm² had a 3.8x higher risk.
- UWF-FA ischemia index ≥0.125 indicated a 5.3x higher risk.
Interpretation:
The study suggests that functional testing, particularly ERG, is crucial for early detection and management of diabetic retinopathy, potentially allowing for better risk stratification and personalized follow-up.
Limitations:
- Relatively small sample size of the prospective cohort.
- Need for further validation in larger, diverse populations.
Conclusion:
Integrating objective functional assessments into routine diabetic retinopathy management is recommended to enhance risk stratification and personalize follow-up intervals.
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