Analysis of DR Progression to Identify Risks and Need for Treatment

Analysis of DR Progression to Identify Risks and Need for Treatment

The goal of this observational study is to understand whether vascular and structural changes in the eyes caused by diabetes can help predict which people are more likely to experience worsening diabetic retinopathy (a diabetes-related eye disease) and how these eye changes are related to cardiovascular complications.

The study will include about 1,000 people with type 2 diabetes, aged 35 to 90 years, and will take place over twelve months. It may also include a retrospective component, where existing medical and imaging data collected from previous visits (within the last 1 to 5 years) will be analyzed.

The main questions it aims to answer are:

• Can eye vessel and tissue changes, observed through modern imaging techniques and clinical data, help better describe and predict which cases of diabetic retinopathy will become more severe?
• Can these same eye changes help predict the presence and risk of cardiovascular problems-such as heart disease or stroke-in people living with type 2 diabetes?

Diabetic Retinopathy (DR) is a leading cause of vision loss in adults with type 2 diabetes (T2D) and is associated with systemic complications, including cardiovascular disease. Early identification of patients at high risk of DR progression and cardiovascular events is critical to optimizing clinical management. Retinal imaging biomarkers, combined with clinical and demographic data, provide an opportunity to better understand disease mechanisms, predict progression of DR and associated cardiovascular complications, and guide personalized interventions.

The aim of this study is to investigate the influence of central versus peripheral retinal lesions on DR progression and staging, characterize associations between retinal biomarkers and cardiovascular risk factors and major adverse cardiovascular events (MACE), and contribute to the understanding of pathophysiological mechanisms underlying DR in T2D patients. The study will also generate a high-quality, harmonized database to support the development of artificial intelligence (AI) models.

This study aims to determine the extent to which central and peripheral retinal lesions, together with quantitative imaging biomarkers, contribute to the progression and staging of DR and the occurrence of cardiovascular complications in patients with T2D. Additionally, in the scope of the ALERT project (supported by Fundação para Ciência e Tecnologia (FCT); COMPETE2030-FEDER-00921900), the data of this clinical study will be used to create a harmonized, high-quality database for the development of exploratory interpretable artificial intelligence models for predicting DR progression and stage as well as predict the values of cardiovascular risk factors, and the risk of developing cardiovascular complications.

Inclusion Criteria:

• Diagnosed with type 2 diabetes according to the 1985 WHO criteria.
• Age between 35 and 90 years.
• Retrospective visit or referenced patients. For the retrospective visit, a documented follow-up of 1-5 years is required, with at least one clinical visit. For the referenced patients, it is required that they have either diabetic retinopathy at the baseline visit, the presence of at least one cardiovascular risk factor at the baseline visit, or cardiovascular complications at the baseline visit.
• Signed informed consent.

Exclusion Criteria:

• Previous laser photocoagulation or intravitreal injections (consider if corticosteroids were administered).
• Presence of clinically significant macular edema (CSME) with vision loss or requiring immediate treatment.
• Proliferative diabetic retinopathy.
• Any ocular surgery within the previous 3 months.
• Renal Replacement Therapy (Hemodialysis, Peritoneal Dialysis).
• Severe systemic illness, subject to investigator's judgment.