Baseline DR Severity Linked to Mortality Risk Regardless of DME Status

In a large cohort study, greater DR severity increased the risk of death over an average of 5.5 years, as did several non-medical factors such as age, male sex, Medicaid vs. commercial health insurance, lower educational attainment and residence in a less affluent community. Click image to enlarge. A large multi-center analysis of more than half a million adults with diabetes found that baseline diabetic retinopathy (DR) severity predicts all-cause mortality over the next several years—independent of age, sex, comorbidity burden, glycemic control and social determinants of health. The results were published earlier this week in Ophthalmology.To perform the study, researchers collected electronic health record data of 524,687 patients with diabetes, which was linked to mortality data from the National Death Index. Patients were categorized into the following six groups based on the DR severity of the more affected eye at their first visit: no DR, nonproliferative DR (NPDR) without diabetic macular edema (DME), NPDR with DME, proliferative DR (PDR) without DME, PDR with DME or unspecified DR severity. In their analysis, the researchers adjusted for a wide range of sociodemographic and clinical factors that were not considered in previous studies linking DR severity to mortality risk.The mean age of participants was 59.1 ±16 years, 54.0% were female and 58.3% were white. A total of 36,674 deaths (7.0%) occurred during a mean 5.4 ±4.1 years of follow-up. In multivariable analyses, mortality hazards rose with DR severity. The following hazard ratios (HRs) were reported across subgroups: NPDR without DME (HR: 1.34), NPDR with DME (HR: 1.31), PDR without DME (HR: 2.28) and PDR with DME (HR: 1.87). Several non-medical factors were associated with increased risk of death, including age, male sex, Medicaid health insurance (vs. commercial), lower educational attainment and residence in a less affluent community.Interestingly, the researchers pointed out in their paper, “the presence or absence of DME does not appear to have much of an impact on risk of mortality,” suggesting that risk of death among patients with DR is primarily driven by retinopathy stage.Another notable finding was that HbA1c—“a well-established risk factor for the onset and progression of DR as well as for increased all-cause and cause-specific mortality in patients with diabetes”—did not affect the overall association between DR and mortality, though each one-unit increase in HbA1c did increase the risk of death by 1%. This variable had the least influence on patients with PDR, who maintained considerable mortality associations even after HbA1c adjustment. These findings, the researchers note, “highlight the significance of glycemic control in the management of diabetes mellitus and the utility of DR status as a predictor of patients who require intensified systemic care beyond glycemic control.”This study provides validation for the core principles of oculomics—defined as the study of associations between retinal findings and systemic disease. Beyond AI image analysis, routine EHR-coded DR severity functions as an independent biomarker of systemic risk. Because retinal microvascular changes mirror—and may precede—systemic vascular disease, oculomics offers opportunities for earlier, more personalized intervention and better prognostication in diabetes and other chronic conditions, the researchers explained in their paper. They concluded, “Eyecare professionals should be incentivized to communicate DR severity status to other medical professionals, as this may serve as an important opportunity to identify and address patients’ medical comorbidities that may increase their mortality risk.” Click here for the journal source. Lee SS, Marwah S, Gaddam S, et al. Towards an era of oculomics: the relationship between baseline severity of diabetic retinopathy and risk of mortality. Ophthalmology. March 31, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.