Original ArticlesCauses of severe visual loss in the early treatment diabetic retinopathy study: ETDRS report no. 24
Section snippets
Patients and methods
From April 1980 to July 1985, the ETDRS enrolled 3,711 patients with diabetes whose eyes met the following criteria: (1) no macular edema, visual acuity of 20/40 or better, and moderate or severe nonproliferative diabetic retinopathy or early proliferative diabetic retinopathy, or (2) macular edema, visual acuity of 20/200 or better, and mild, moderate, or severe nonproliferative or early proliferative diabetic retinopathy. Patients with favorable prognosis for survival and follow-up for at
Results
A total of 257 eyes (219 persons) developed severe visual loss. In 149 eyes (127 persons), severe visual loss persisted, and in 91, visual acuity improved. Seventeen of the 257 eyes with severe visual loss had insufficient follow-up and were not included in our analysis (Table 1). The Figure 1 shows the distribution of visual acuity 1 to 5 years after the first occurrence of visual acuity less than 5/200. After the occurrence of severe visual loss, about one third of eyes recovered to 5/200 or
Discussion
Vitreous or preretinal hemorrhage was the most common cause of severe visual loss in the ETDRS, accounting for 125 of 240 eyes. Perhaps surprisingly, no recovery from severe visual loss was observed in 61 of these 125 eyes. One explanation for persistence of severe visual loss in these eyes may be coexistent disease in addition to the hemorrhage. Review of fundus photographs by one of us (D.S.F.) showed that 17 (27.9%) of these 61 eyes harbored a coexistent retinal detachment and three
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