Hafner J, Pollreisz A, Egner B, et al. - As the effect of peripheral retinal lesions (PL) visualized with ultra–wide-field imaging on diabetic retinopathy (DR) remains uncertain, researchers evaluated the presence of PL and their correlation with macular microvasculopathy, metabolic dysfunction, and neurodegeneration in patients with type II diabetes and early retinal disease. Forty-five degree color fundus (Topcon) and 200° ultra–wide-field images (Optos) were evaluated for the presence and severity of DR. Among the 161 eyes (80 left eyes) of 81 patients (34 female), 64 (39.8%) displayed higher levels of DR on ultra–wide-field than on 45° fundus images. Ultra-wide field imaging helps to identify more early DR eyes due to PL detection, which occur independently of macular microvascular impairment biomarkers, metabolic function, and eye neuropathy without central DR signs. Such findings indicate that the retinal periphery assessment can become critical for DR screening if PL has been shown to affect disease outcomes.