Evidence map›Paper›PMID 40345532›Full record

Trial reportOphthalmology. Retina2025

Visual Field Changes in Diabetic Retinopathy: Natural History and after Pan-Retinal Photocoagulation in the Diabetic Retinopathy Study and the ETDRS.

Debora H Lee, Susan Vitale, Elvira Agrón, Tiarnan D L Keenan, Catherine A Cukras, Emily Y Chew

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Ophthalmology. Retina, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Debora H LeeDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Susan VitaleDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Elvira AgrónDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Tiarnan D L KeenanDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Catherine A CukrasDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
Emily Y ChewDivision of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, Maryland. Electronic address: echew@nei.nih.gov.

Funding

Medical Retina FellowshipZIEEY000487 · NEI · NATIONAL EYE INSTITUTE · PI KEENAN, TIARNAN · 2009 to 2025
$6.6M
Intramural NIH HHS Z99 EY999999Intramural NIH HHS ZIE EY000487
6 · The paper itself

Abstract

objectiveTo examine visual field (VF) changes in untreated diabetic retinopathy (DR) and compare them to those in DR treated with pan-retinal photocoagulation (PRP).

designPost hoc analyses of the DR Study (DRS) and ETDRS, historical multicenter randomized controlled trials designed to assess the treatment effects of argon laser PRP for DR.

participantsA total of 1660 DRS eyes (830 participants) with severe nonproliferative DR (NPDR) or proliferative DR (PDR), and 5416 ETDRS eyes (2708 participants) with mild-severe NPDR or early PDR.

methodsEach DRS and ETDRS participant had 1 eye randomized to immediate PRP and the fellow eye to deferred PRP. Visual field scores (VFSs) were obtained with the Goldmann perimeter using the IV/4e stimulus in the DRS and the I/4e stimulus in the ETDRS. Eyes in the deferred PRP arm that later received PRP were censored at treatment initiation.

main outcome measuresThe outcomes of mean VFS and change from baseline VFS over time were estimated with multivariable regression models with repeated measures.

resultsAmong untreated eyes (n = 830 [DRS] and n = 2706 [ETDRS]), VFS change from baseline was -152.0 (95% confidence interval [CI], -215.4 to -88.5) at 6 years (DRS) and -79.2 (-90.9 to -67.6) at 7 years (ETDRS). Compared with untreated eyes with NPDR, untreated eyes with PDR + high-risk characteristics had VFS change of -50.2 (-65.9 to -34.6) and -38.8 (-69.2 to -8.5) in the DRS and ETDRS, respectively. Among untreated eyes, the presence of macular edema (ME) was associated with a VFS change of -12.9 (-25.4 to -0.5) and -6.2 (-10.4 to -1.9) in the DRS and ETDRS, respectively. The difference in VFS between PRP-treated versus untreated eyes was significant at 4 months (-31.4 [95% CI, -38.6 to -24.2]), but no longer apparent by year 3 (-1.4 [-17.0 to 14.1]) in the paired DRS analyses.

conclusionsThe natural history of untreated DR involved significant VF decline over time. Increased DR severity and presence of ME were associated with greater field loss. Pan-retinal photocoagulation was associated with a rapid initial decline in the VF; however, VFs in PRP-treated versus untreated eyes became similar by year 3. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Indexed as

Diabetic RetinopathyLaser CoagulationRetinaVisual AcuityVisual FieldsAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedDiabetic macular edemaNatural historyPan-retinal photocoagulationProliferative diabetic retinopathyVisual fields

Identifiers

PMID40345532
PMCPMC13474406

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Registered trials

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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 OpenQuestion graph.