Evidence mapPaperPMID 40930557Full record

ArticleBMJ open2025

Quantitative retinal morphology and mortality in individuals with proliferative diabetic retinopathy: a retrospective cohort study in a large real-world population.

Abdullah Zafar Khan, Ana Paula Ribeiro Reis, Abraham Olvera-Barrios, Yukun Zhou, Dominic J Williamson, Robbert R Struyyen, Hagar Khalid, Catherine Egan, Alastair K Denniston, Pearse A Keane and 1 more

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Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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5 · Who and what money

Authors and funding

11 authors.

Abdullah Zafar KhanUniversity College London, London, UK.
Ana Paula Ribeiro ReisUniversity College London, London, UK.ORCID http://orcid.org/0000-0001-5570-5794
Abraham Olvera-BarriosUniversity College London, London, UK.
Yukun ZhouUniversity College London, London, UK.
Dominic J WilliamsonUniversity College London, London, UK.
Robbert R StruyyenUniversity College London, London, UK.
Hagar KhalidNIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Catherine EganUniversity College London, London, UK.
Alastair K DennistonNIHR Birmingham Biomedical Research Centre, Birmingham, UK.
Pearse A Keane *University College London, London, UK.
Siegfried K Wagner *University College London, London, UK s.wagner@ucl.ac.uk.ORCID http://orcid.org/0000-0003-4915-4353

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo investigate whether quantitative retinal markers, derived from multimodal retinal imaging, are associated with increased risk of mortality among individuals with proliferative diabetic retinopathy (PDR), the most severe form of diabetic retinopathy.

designLongitudinal retrospective cohort analysis.

settingThis study was nested within the AlzEye cohort, which links longitudinal multimodal retinal imaging data routinely collected from a large tertiary ophthalmic institution in London, UK, with nationally held hospital admissions data across England.

participantsA total of 675 individuals (1129 eyes) with PDR were included from the AlzEye cohort. Participants were aged ≥40 years (mean age 57.3 years, SD 10.3), and 410 (60.7%) were male. OUTCOME MEASURES: The primary outcome was all-cause mortality. Quantitative retinal markers were derived from fundus photographs and optical coherence tomography using AutoMorph and Topcon Advanced Boundary Segmentation, respectively. We used unadjusted and adjusted Cox-proportional hazards models to estimate hazard ratios (HR) for the association between retinal features and time to death.

resultsAfter adjusting for sociodemographic factors, each 1-SD decrease in arterial fractal dimension (HR: 1.54, 95% CI: 1.18 to 2.04), arterial vessel density (HR: 1.59, 95% CI: 1.15 to 2.17), arterial average width (HR: 1.35, 95% CI: 1.02 to 1.79), central retinal arteriolar equivalent (HR: 1.39, 95% CI: 1.05 to 1.82) and ganglion cell-inner plexiform layer (GC-IPL) thickness (HR: 1.61, 95% CI: 1.03 to 2.50) was associated with increased mortality risk. When also adjusting for hypertension, arterial fractal dimension (HR: 1.45, 95% CI: 1.08 to 1.92), arterial vessel density (HR: 1.47, 95% CI: 1.05 to 2.08) and GC-IPL thickness (HR: 1.56, 95% CI: 1.03 to 2.38) remained significantly associated with mortality.

conclusionsSeveral quantitative retinal markers, relating to both microvascular morphology and retinal neural thickness, are associated with increased mortality among individuals with PDR. The role of retinal imaging in identifying those individuals with PDR most at risk of imminent life-threatening sequelae warrants further investigation.

Indexed as

Diabetic RetinopathyRetinaRetinal VesselsAdultAgedFemaleHumansLongitudinal StudiesMaleMiddle AgedPhotographyProportional Hazards ModelsRetrospective StudiesRisk FactorsTomography, Optical CoherenceDIABETES & ENDOCRINOLOGYDiabetic retinopathyHealth informaticsMedical retina

Identifiers

PMID40930557
PMCPMC12421592

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.