Diabetes and its complications are an emerging public health crisis. Since vision changes can be irreversible in diabetic retinopathy (DR), early detection, recognition of prognostics, and treatment are important to prevent vision loss from DR. At the 2018 American Society of Retina Specialists (ASRS) Annual Meeting, Dr Rishi P. Singh was honored to receive the fifth annual ASRS Presidents’ Young Investigator Award. This article summarizes many advancements in diabetic eye disease that we have witnessed recently covering the concepts of DR, disease pathogenesis, new imaging modalities, and improving treatment outcomes.
ZhangXSaaddineJBChouCFet al.Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304(6):649–656. doi:10.1001/jama.2010.1111
3.
BrownleeM. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54(6):1615–1625. doi:10.2337/diabetes.54.6.1615
4.
YauJWRogersSLKawasakiRet al.Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–564. doi:10.2337/dc11-1909
5.
MelanciaDVicenteACunhaJPAbegão PintoLFerreiraJ. Diabetic choroidopathy: a review of the current literature. Graefes Arch Clin Exp Ophthalmol. 2016;254(8):1453–1461. doi:10.1007/s00417-016-3360-8
6.
HuaRLiuLWangXChenL. Imaging evidence of diabetic choroidopathy in vivo: angiographic pathoanatomy and choroidal-enhanced depth imaging. PloS One. 2013;8(12):1–5. doi:10.1371/journal.pone.0083494
7.
AgemySAScripsemaNKShahCMet al.Retinal vascular perfusion density mapping using optical coherence tomography angiography in normals and diabetic retinopathy patients. Retina. 2015;35(11):2353–2363. doi:10.1097/IAE.0000000000000862
8.
MrejenSSpaideRF. Optical coherence tomography: imaging of the choroid and beyond. Surv Ophthalmol. 2013;58(5):387–429. doi:10.1016/j.survophthal.2012.12.001
9.
ContiFFQinVLRodriguesEBet al.Choriocapillaris and retinal vascular plexus density of diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography. Br J Ophthalmol. 2019;103(4):452–456. doi:10.1136/bjophthalmol-2018-311903
10.
ZhuCHZhangSSKongYBiYFWangLZhangQ. Effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes mellitus. Int J Ophthalmol. 2013;6(2):141–145. doi:10.3980/j.issn.2222-3959.2013.02.06
11.
American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36(suppl 1):S11–S66. doi:10.2337/dc13-S011
12.
WentworthJMPlayfairJLaurieCet al.Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. Lancet Diabetes Endocrinol. 2014;2(7):545–552. doi:10.1016/S2213-8587(14)70066-X
13.
The Diabetes Control and Complications Trial Research Group. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes. 1995;44(8):968–983. doi:10.2337/diab.44.8.968
14.
Feldman-BillardSLargerÉMassinP; Standards for Screening and Surveillance of Ocular Complications in People With Diabetes SFD Study Group. Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes. Diabetes Metab. 2017;44(1):4–14. doi:10.1016/j.diabet.2017.10.014
15.
KondoTVicentDSuzumaKet al.Knockout of insulin and IGF-1 receptors on vascular endothelial cells protects against retinal neovascularization. J Clin Invest. 2003;111(12):1835–1842. doi:10.1172/JCI200317455
16.
PoulakiVJoussenAMMitsiadesNMitsiadesCSIliakiEFAdamisAP. Insulin-like growth factor-I plays a pathogenetic role in diabetic retinopathy. Am J Pathol. 2004;165(2):457–469. doi:10.1016/S0002-9440(10)63311-1
17.
BrownleeM. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414(6865):813–820. doi:10.1038/414813a
18.
TreinsCGiorgetti-PeraldiSMurdacaJSemenzaGLVan ObberghenE. Insulin stimulates hypoxia-inducible factor 1 through a phosphatidylinositol 3-kinase/target of rapamycin-dependent signaling pathway. J Biol Chem. 2002;277(31):27975–27981. doi:10.1074/jbc.M204152200
19.
ThangarajahHYaoDChangEIet al.The molecular basis for impaired hypoxia-induced VEGF expression in diabetic tissues. Proc Natl Acad Sci U S A. 2009;106(32):13505–13510. doi:10.1073/pnas.93.23.12969
20.
ADVANCE Collaborative Group; PatelAMacMahonSet al.Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–2572. doi:10.1056/NEJMoa0802987
21.
JohnsonBLBlackhurstDWLathamBBet al.Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–556; discussion 556-558. doi:10.1016/j.jamcollsurg.2012.12.019
22.
KashyapSRBhattDLSchauerPR; STAMPEDE Investigators. Bariatric surgery vs. advanced practice medical management in the treatment of type 2 diabetes mellitus: rationale and design of the Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently Trial (STAMPEDE). Diabetes Obes Metab. 2010;12(5):452–454. doi:10.1111/j.1463-1326.2009.01172.x
23.
SchauerPRBhattDLKirwanJPet al.Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–651. doi:10.1056/NEJMoa1600869
24.
SinghRPGansRKashyapSRet al.Effect of bariatric surgery versus intensive medical management on diabetic ophthalmic outcomes. Diabetes Care. 2015;38(3):e32–e33. doi:10.2337/dc14-2035
25.
Early Treatment Diabetic Retinopathy Study design and baseline characteristics. ETDRS report number 7. Ophthalmology. 1990;98(5 suppl):741–756. doi:10.1016/S0161-6420(13)38009-9
26.
MitchellPBandelloFSchmidt-ErfurthUet al.The RESTORE study: ranibizumab monotherapy or combined with laser versus laser monotherapy for diabetic macular edema. Ophthalmology. 2011;118(4):615–625. doi:10.1016/j.ophtha.2011.01.031
27.
BrownDMNguyenQDMarcusDMet al.Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013;120(10):2013–2022. doi:10.1016/j.ophtha.2013.02.034
28.
Warid Al-LaftahFAElshafieMAlhashimiMPaiAFarouqM. Pretreatment clinical variables associated with the response to intravitreal bevacizumab (Avastin) injection in patients with persistent diabetic macular edema. Saudi J Ophthalmol. 2010;24(4):133–138. doi:10.1016/j.sjopt.2010.05.001
29.
GrossJGGlassmanARLiuDet al.Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol. 2018;136(10):1138–1148. doi:10.1001/jamaophthalmol.2018.3255
30.
BresslerSBQinHBeckRWet al.Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol. 2012;130(9):1153–1161. doi:10.1001/archophthalmol.2012.1107
31.
MatsudaSTamTSinghRPet al.The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema. J Diabetes Complications. 2014;28(2):166–170. doi:10.1016/j.jdiacomp.2013.11.009
32.
BansalASKhuranaRNWielandMRWangPWVan EverenSATuomiL. Influence of glycosylated hemoglobin on the efficacy of ranibizumab for diabetic macular edema: a post hoc analysis of the RIDE/RISE trials. Ophthalmology. 2015;122(8):1573–1579. doi:10.1016/j.ophtha.2015.04.029
33.
SinghRPHabbuKEhlersJPLansangMCHillLStoilovI. The impact of systemic factors on clinical response to ranibizumab for diabetic macular edema. Ophthalmology. 2016;123(7):1581–1587. doi:10.1016/j.ophtha.2016.03.038
34.
DhootDSBakerKSarojNet al.Baseline factors affecting changes in diabetic retinopathy severity scale score after intravitreal aflibercept or laser for diabetic macular edema: post hoc analyses from VISTA and VIVID. Ophthalmology. 2018;125(1):51–56. doi:10.1016/j.ophtha.2017.06.029
35.
GulkilikGKocaboraSTaskapiliMEnginG. Cystoid macular edema after phacoemulsification: risk factors and effect on visual acuity. Can J Ophthalmol. 2006;41(6):699–703. doi:10.3129/i06-062
36.
KimSJEquiRBresslerNM. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007;114(5):881–889. doi:10.1016/j.ophtha.2006.08.053
37.
ChuCJJohnstonRLBuscombeCet al.Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology. 2016;123(2):316–323. doi:10.1016/j.ophtha.2015.10.001
38.
SchoenbergerSDKimSJ. Nonsteroidal anti-inflammatory drugs for retinal disease. Int J Inflam. 2013;2013:281981. doi:10.1155/2013/281981
KimSJFlachAJJampolLM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol. 2010;55(2):108–133. doi:10.1016/j.survophthal.2009.07.005
41.
SinghRAlpernLJaffeGJet al.Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clin Ophthalmol. 2012;6:1259–1269. doi:10.2147/OPTH.S31902
42.
PollackAStaurenghiGSagerDMukeshBReiserHSinghRP. Prospective randomised clinical trial to evaluate the safety and efficacy of nepafenac 0.1% treatment for the prevention of macular oedema associated with cataract surgery in patients with diabetic retinopathy. Br J Ophthalmol. 2017;101(4):423–427. doi:10.1136/bjophthalmol-2016-308617
43.
SinghRPLehmannRMartelJet al.Nepafenac 0.3% after cataract surgery in patients with diabetic retinopathy: results of 2 randomized phase 3 studies. Ophthalmology. 2017;124(6):776–785. doi:10.1016/j.ophtha.2017.01.036
44.
Diabetic Retinopathy Clinical Research Network, WellsJAGlassmanARet al.Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193–1203. doi:10.1056/NEJMoa1414264.Aflibercept
45.
AwhC. LADDER trial of the port delivery system for ranibizumab: preliminary study results. Paper presented at: 36th Annual Meeting of the American Society of Retina Specialists; July 20–25, 2018; Vancouver, British Columbia, Canada.
46.
ClinicalTrials.gov. Novartis Investigative. Identifier: NCT03481634 Study of Efficacy and Safety of Brolucizumab vs. Aflibercept in Patients With Visual Impairment Due to Diabetic Macular Edema (KESTREL). https://clinicaltrials.gov/ct2/show/NCT03481634?id=NCT0348163. Published March 29, 2018. Updated March 1, 2019. Accessed June 25, 2019.
47.
ClinicalTrials.gov. Jaeb Center for Health Research. Identifier: NCT03866473 A Pilot Study Evaluating Photobiomodulation Therapy for Diabetic Macular Edema (AE). https://clinicaltrials.gov/ct2/show/NCT03866473/. Published March 7, 2019. Updated May 23, 2019. Accessed June 25, 2019.
