Chapter III. Diabetic Retinopathy
| Rev Diabet Stud,
2015,
12(1-2):159-195 |
DOI 10.1900/RDS.2015.12.159 |
Biomarkers in Diabetic Retinopathy
Alicia J. Jenkins1,2,3, Mugdha V. Joglekar1, Anandwardhan A. Hardikar1, Anthony C. Keech1, David N. O'Neal1,3, Andrzej S. Januszewski1,3
1NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Sydney, Australia
2Centre for Experimental Medicine, Queens University, Belfast, Nothern Ireland
3University of Melbourne, Department of Medicine, St. Vincent´s Hospital, Fitzroy, Melbourne, Australia
Address correspondence to: Alicia J. Jenkins, Professor, Diabetes and Vascular Medicine, Sydney Medical School Foundation Fellow, NHMRC Clinical Trials Centre, University of Sydney, 92-94 Parramatta Rd., Camperdown, 2050, Sydney, NSW, Australia, e-mail: alicia.jenkins@ctc.usyd.edu.au
Abstract
There is a global diabetes epidemic correlating with an increase in obesity. This coincidence may lead to a rise in the prevalence of type 2 diabetes. There is also an as yet unexplained increase in the incidence of type 1 diabetes, which is not related to adiposity. Whilst improved diabetes care has substantially improved diabetes outcomes, the disease remains a common cause of working age adult-onset blindness. Diabetic retinopathy is the most frequently occurring complication of diabetes; it is greatly feared by many diabetes patients. There are multiple risk factors and markers for the onset and progression of diabetic retinopathy, yet residual risk remains. Screening for diabetic retinopathy is recommended to facilitate early detection and treatment. Common biomarkers of diabetic retinopathy and its risk in clinical practice today relate to the visualization of the retinal vasculature and measures of glycemia, lipids, blood pressure, body weight, smoking, and pregnancy status. Greater knowledge of novel biomarkers and mediators of diabetic retinopathy, such as those related to inflammation and angiogenesis, has contributed to the development of additional therapeutics, in particular for late-stage retinopathy, including intra-ocular corticosteroids and intravitreal vascular endothelial growth factor inhibitors ('anti-VEGFs') agents. Unfortunately, in spite of a range of treatments (including laser photocoagulation, intraocular steroids, and anti-VEGF agents, and more recently oral fenofibrate, a PPAR-alpha agonist lipid-lowering drug), many patients with diabetic retinopathy do not respond well to current therapeutics. Therefore, more effective treatments for diabetic retinopathy are necessary. New analytical techniques, in particular those related to molecular markers, are accelerating progress in diabetic retinopathy research. Given the increasing incidence and prevalence of diabetes, and the limited capacity of healthcare systems to screen and treat diabetic retinopathy, there is need to reliably identify and triage people with diabetes. Biomarkers may facilitate a better understanding of diabetic retinopathy, and contribute to the development of novel treatments and new clinical strategies to prevent vision loss in people with diabetes. This article reviews key aspects related to biomarker research, and focuses on some specific biomarkers relevant to diabetic retinopathy.
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| Rev Diabet Stud,
2015,
12(1-2):196-210 |
DOI 10.1900/RDS.2015.12.196 |
New Therapeutic Approaches in Diabetic Retinopathy
Kamyar Vaziri, Stephen G. Schwartz, Nidhi Relhan, Krishna S. Kishor, Harry W. Flynn Jr
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136, USA
Address correspondence to: Stephen G. Schwartz, MD, MBA, Bascom Palmer Eye Institute, 3880 Tamiami Trail North, Naples, FL 34103, e-mail: sschwartz2@med.miami.edu
Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus. It affects a substantial proportion of US adults over age 40. The condition is a leading cause of visual loss. Much attention has been given to expanding the role of current treatments along with investigating various novel therapies and drug delivery methods. In the treatment of diabetic macular edema (DME), intravitreal pharmacotherapies, especially anti-vascular endothelial growth factor (anti-VEGF) agents, have gained popularity. Currently, anti-VEGF agents are often used as first-line agents in center-involved DME, with recent data suggesting that among these agents, aflibercept leads to better visual outcomes in patients with worse baseline visual acuities. While photocoagulation remains the standard treatment for proliferative diabetic retinopathy (PDR), recent FDA approvals of ranibizumab and aflibercept in the management of diabetic retinopathy associated with DME may suggest a potential for pharmacologic treatments of PDR as well. Novel therapies, including small interfering RNAs, chemokines, kallikrein-kinin inhibitors, and various anti-angiogenic agents, are currently being evaluated for the management of diabetic retinopathy and DME. In addition to these strategies, novel drug delivery methods such as sustained-release implants and refillable reservoir implants are either under active evaluation or have recently gained FDA approval. This review provides an update on the novel developments in the treatment of diabetic retinopathy.
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