Longitudinal Insights from Ultrawide Field Imaging Referrals in Diabetic Patients: A Three-Year Analysis at a Tertiary Center.

PURPOSE: To characterize diabetic retinopathy (DR) severity and predominantly peripheral lesion (PPL) status among patients with diabetes mellitus (DM) imaged using ultrawide-field (UWF) photography at a tertiary center in Egypt following introduction of the first national UWF camera and certified reading center. METHODS: This prospective, cross-sectional study included all patients imaged from Feb2022 to Jan2025. UWF images were graded using the ETDRS severity scale, and PPLs were evaluated on non-steered color images. Demographic and clinical variables, including DM duration, treatment, HbA1c, age, and age of onset, were collected. Temporal trends in DR severity, PPL prevalence, and patient characteristics were assessed using linear regression and generalized estimating equation models. RESULTS: A total of 61,095 eyes from 26,170 patients were imaged; 47.5% had DM. Among 29,828 diabetic eyes, 34.9% had no DR; 17.2%, 10.8%, and 6.5% had mild, moderate, and severe NPDR; and 25.0% had PDR. The proportion of eyes with no DR increased significantly over time, while moderate NPDR and PDR declined (all p < 0.001). Vision-threatening DR decreased from 53.8% to 39.2%, and more-than-mild retinopathy declined from 61.0% to 42.0% (both p < 0.001). Mean HbA1c and diabetes duration decreased, while age and age of onset increased. Mean HbA1c decreased, while age, DM duration, and age of onset increased. PPL prevalence increased during the initial year, followed by stabilization in mild NPDR and decreases in moderate and severe NPDR. CONCLUSION: Implementation of UWF imaging and certified grading was followed by a shift toward imaging patients with earlier DR and reduced fluorescein angiography use. UWF deployment may facilitate earlier DR detection and triage in resource-limited settings.