The retinal depression sign in diabetic retinopathy

Background: The retinal depression sign, an abnormal light reflex due to ischemia-induced focal inner retinal atrophy, was initially described in patients with sickle cell retinopathy. We undertook this study to characterize the finding in diabetic retinopathy. Methods: The fundus photographs of 97 consecutive patients with diabetic retinopathy seen in the Penn State University Ophthalmology Department were reviewed. We recorded age, sex, type of retinopathy, visual acuity and photographic details, including the presence or absence of the retinal depression halo. Results: The retinal depression sign was present in 9 of 22 patients age 45 years or under, versus 1 of 75 patients age 46 or older (P<0.0001, two-tailed Fisher's exact test). The presence or absence of retinal depression sign did not predict the type of retinopathy in a given patient. Eleven (70%) of the affected eyes had visual acuity 20/40. Conclusion: The retinal depression sign is common in younger patients with diabetes and should be distinguished from other macular lesions associated with diabetic retinopathy.