Diabetic Retinopathy Phenotype Updates

Hi Elaine Wooler I know at the last CRG meeting we mentioned a new framework / spreadsheet for content requests, but I can't seem to find where it is located (I may not be looking in the right places on the Confluence and if that's the case, my apologies!). If you can share that, we would be happy to fill it in accordingly for a set of new requests related to diabetic retinopathy phenotypes. In the meantime, I am sharing the proposed new concepts, their definitions, and peer-reviewed literature references, similar to what we did last time for a series of retina condition codes. I am also adding Cindy Cai to this thread as she is our retina domain expert and led the group that identified these. I inserted a link to a document but in case it's easier to read directly in the forum, I'm also copying directly into the thread here (although it seems like the numbering went awry after copying, but the concepts are all there): 

Diabetic Retinopathy Concepts

1. Neovascularization

ICD-10-CM code: H35.05 (neovascularization, retina)

Definition: is the natural formation of new blood vessels in the form of functional microvascular network, capable of perfusion of red blood cells, that form as collateral circulation in response to local poor perfusion or ischemia

Literature review:

Investigative ophthalmology & visual science - 10.1167/iovs.65.1.22

Scientific reports - 10.1038/s41598-023-49964-8

Journal of opharmaceutical analysis - 10.1016/j.jpha.2023.05.002

1. Severe proliferative diabetic retinopathy

ICD-10-CM code: none

Definition: based on clinical impression,
1) Severe new vessels and severe fibrous proliferation
2) Severe new vessels and red vitreous hemorrhage
3) moderate new vessels, severe fibrous proliferations, and red vitreous hemorrhage

Literature review:

                        Ophthalmic surgery, lasers and imaging retina –

https://doi.org/10.3928/1542-8877-20030701-01

Ophthalmology - 10.1016/s0161-6420(85)34002-2

Archives of ophthalmology - doi:10.1001/archopht.1985.01050110038020

1. Vitreous hemorrhage

ICD-10-CM code: H43.1 (hemorrhage, vitreous [humour] [intraocular])

Definition: Any blood in the vitreous cavity; presence of extravasated blood within a space lined by posterior lens capsule anteriorly, internal limiting membrane posteriorly, and non-pigmented epithelium of ciliary body laterally

Literature review:

                        Survey of Ophthalmology - https://doi.org/10.1016/S0039-6257(97)84041-6

                        Ophthalmology - https://doi.org/10.1016/S0161-6420(87)33528-6

                        Canadian journal of ophthalmology - https://doi.org/10.1016/j.jcjo.2017.09.027

1. Arteriolar abnormalities

ICD-10-CM code: none

Definition: have been described in persons with and without hypertension and associated with clinical and subclinical manifestations of atherosclerosis and a broad group of risk factors for vascular disease; described as focal and generalized narrowing and arteriovenous nicking

Literature review:

Retina - 10.1097/IAE.0000000000003959

Arteriosclerosis, thrombosis, and vascular biology -https://doi.org/10.1161/01.ATV.20.6.1644

Clinical & experimental ophthalmology - https://doi.org/10.1111/j.1442-9071.2008.01825.x

1. Capillary nonperfusion

ICD-10-CM code: none

Definition: occurs when retina does not have the efficient tissue perfusion seen using fundus color or fundus fluorescein angiography

Literature review:

                        Bioimpacts - 10.15171/bi.2015.27

                        Ophthalmology - doi: 10.1016/j.ophtha.2019.06.022.

                        Scientific reports - 10.1038/s41598-020-71622-6.

1. Mild diabetic macular edema

ICD-10-CM code: none

Definition: some retinal thickening or hard exudates in the posterior pole, distant from the center of the macula

Literature review:

                        Ophthalmic and physiological optics - 10.1111/opo.13261

Ophthalmic and physiological optics - 10.1111/opo.13261

                        World journal of diabetes - 10.4239/wjd.v4.i6.290

1. Moderate diabetic macular edema

ICD-10-CM code: none

Definition: retinal thickening or hard exudates near the center of the macula but not involving the center

Literature review:

Ophthalmic and physiological optics - 10.1111/opo.13261

Ophthalmic and physiological optics - 10.1111/opo.13261

                        World journal of diabetes - 10.4239/wjd.v4.i6.290

1. Perifoveal capillary nonperfusion

ICD-10-CM code: none

Definition: is the nonperfusion of the retina circumscribing the parafovea and fovea; perifovea is a belt that covers a 10 degree radius around the fovea and is 1.5 mm wide

Literature review:

                        International ophthalmology - doi.org/10.1007/s10792-023-02882-0

                        Annals of eye science – 10.21037/aes.2017.06.08

                        European journal of ophthalmology - https://doi.org/10.5301/ejo.5000948          

1. Severe diabetic macular edema

ICD-10-CM code: none

Definition: retinal thickening or hard exudates involving the center of the macula

Literature review:

                        Ophthalmology - https://doi.org/10.1016/S0161-6420(03)00475-5

Ophthalmic and physiological optics - 10.1111/opo.13261

                        World journal of diabetes - 10.4239/wjd.v4.i6.290

1. Intraretinal hemorrhages

ICD-10-CM code: none

Definition: hemorrhage of the retina located in various layers from the internal limiting membrane to the outer nuclear layer which can cause hypofluorescent blockage

Literature review:

                        Investigative ophthalmology & visual science - 10.1167/iovs.64.15.39

Journal of vitreoretinal diseases - 10.1177/24741264231163395

Romanian journal of ophthalmology - 10.22336/rjo.2023.51

1. Macular ischemia

ICD-10-CM code: none

Definition: is a common complication of diabetic retinopathy that is associated with damage in the vessels that supply blood to the retina and the enlargement of the foveal avascular zone

Literature review:

                        Ophthalmology and therapy - 10.1007/s40123-022-00546-3

                        Ophthalmologica, International journal of ophthalmology - 10.1159/000515406                           Cureus - 10.7759/cureus.3064

1. Soft exudates

ICD-10-CM code: none

Definition: is a yellow-white lesion in the superficial retina that usually occupies an area less than one fourth of that of the optic nerve

Literature review:

Computers in biology and medicine - 10.1016/j.compbiomed.2023.107854

                        Journal of digital imaging - 10.1007/s10278-015-9793-5

British medical journal case reports - https://doi.org/10.1136/bcr-2023-255723

Document

Thank you Elaine Wooler - I totally missed that link at the bottom of the sidebar! thank you