Current and future management of diabetic retinopathy: a personalized evidence-based approach

Fante, Ryan J.; Gardner, Thomas W.; Sundstrom, Jeffrey M.

doi:10.2217/dmt.13.50

Cited by 11 publications

(4 citation statements)

References 80 publications

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“…Factors such as diabetes duration, sex, and genetic susceptibility obviously cannot be altered. However, metabolic control, blood pressure, renal function, lipid levels, and nonhealing ulcers are modifiable and should be addressed in a comprehensive manner coordinated with patients, their physicians, and ophthalmologists (82). This intensive care is vital because DR severity can improve in 18% of patients with type 1 diabetes whose A1C declines by 1 percentage point (83).…”

Section: Management Of Dmementioning

confidence: 99%

PREVENTION AND MANAGEMENT OF Diabetes-Related Eye Disease

Gardner¹,

Wyckoff²,

Shah³

et al. 2019

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Novartis, Regeneron, Regenxbio, and Roche; and is a speaker for Regeneron. B.A.C. has been a speaker for Novo Nordisk and served on an advisory board for Regeneron. No other potential conflicts of interest relevant to this compendium were reported. About the Cover Proliferative diabetic retinopathy showing neovascularization and scar tissue, a condition that needs immediate surgery. Credit: Visuals Unlimited, Inc. / Chris Barry / Getty Images22 | References horizontal diplopia and a lateral out-turning of the affected eye. Seventh-nerve palsies from diabetes cause weakness of the entire half of the facial muscles without double vision. Diabetes-related third-, sixth-, and seventh-nerve palsies usually resolve spontaneously in 6-12 weeks.

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Section: Management Of Dmementioning

confidence: 99%

PREVENTION AND MANAGEMENT OF Diabetes-Related Eye Disease

Gardner¹,

Wyckoff²,

Shah³

et al. 2019

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“…Future work may use the power of vitreous proteomics to reveal molecular targets for therapy, 65 and yield personalized treatment based on the complexity of systemic and local pathophysiologic mechanisms in individual patients. 66 …”

Section: Therapy Of Diabetic Retinopathymentioning

confidence: 99%

Future opportunities in diabetic retinopathy research

Gardner

Chew

2016

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of review The risk of vision loss from diabetic retinopathy has fallen dramatically over the past 3 decades with improvements in diabetes and blood pressure treatments, and with advances in laser surgery and intraocular drug delivery. Nevertheless, diabetes remains to be a major cause of blindness. This paper summarizes the state of the art in diabetic retinopathy research and provides a perspective on opportunities for future investigations. Recent findings New insights into the pathophysiology of diabetes and diabetic retinopathy will improve metabolic control. Structure—function analyses are revealing new details of diabetic retinopathy. Intraocular drug therapy provides improved visual outcomes. Together these steps will yield better means to detect and quantify vision loss, and to develop patient-specific treatments to preserve vision for persons with diabetes. Summary Retinopathy is one of the most successfully treated complications of diabetes and will continue to be an important area of research for patients and their families.

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“…Diabetic retinopathy remains a leading cause of blindness ( 1 , 2 ). The Diabetes Control and Complications Trial demonstrated that achieving blood glucose levels near normal reduces an individual’s probability of developing retinopathy ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, many individuals find it difficult to attain tight glycemic control, with recent reports of only 21% of youth aged 13-20 years and 43% of children aged 6-13 years reaching A1C targets (8). Beyond glycemic control, most therapies target the late proliferative stage of the disease, at a time when vision is threatened (1). Thus, adjunctive therapy that targets the early pathogenesis of diabetic retinopathy is desperately needed to prevent the onset or slow the progression of diabetic retinopathy and, ultimately, vision loss.…”

mentioning

confidence: 99%

Montelukast Prevents Early Diabetic Retinopathy in Mice

Bapputty

Talahalli

Zarini³

et al. 2019

Diabetes

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Chronic inflammation and oxidative stress are critical components in the pathogenic cascade of early diabetic retinopathy, characterized by neuronal and vascular degeneration. We investigated pharmacologic inhibition of the proinflammatory leukotriene cascade for therapeutic benefit in early diabetic retinopathy. Using the streptozotocin-induced diabetes mouse model, we administered montelukast, a leukotriene receptor antagonist, and diabetes-related retinal pathology was assessed. Early biochemical and cellular function measures were evaluated at 3 months’ diabetes duration and included vascular permeability, superoxide production, leukotriene generation, leukocyte-induced microvascular endothelial cell death, and retinal function by electroretinography. Histopathology assessments at 9 months’ diabetes duration included capillary degeneration and retinal ganglion cell loss. Leukotriene receptor antagonism resulted in a significant reduction of early, diabetes-induced retinal capillary leakage, superoxide generation, leukocyte adherence, and leukotriene generation. After 9 months of diabetes, the retinal microvasculature from untreated diabetic mice demonstrated a nearly threefold increase in capillary degeneration compared with nondiabetic mice. Montelukast inhibited the diabetes-induced capillary and neuronal degeneration, whether administered as a prevention strategy, immediately after induction of diabetes, or as an intervention strategy starting at 4.5 months after confirmation of diabetes. Pharmacologic blockade of the leukotriene pathway holds potential as a novel therapy to prevent or slow the development of diabetic retinopathy.

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Current and future management of diabetic retinopathy: a personalized evidence-based approach

Cited by 11 publications

References 80 publications

PREVENTION AND MANAGEMENT OF Diabetes-Related Eye Disease

PREVENTION AND MANAGEMENT OF Diabetes-Related Eye Disease

Future opportunities in diabetic retinopathy research

Montelukast Prevents Early Diabetic Retinopathy in Mice

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