With all the technological and medical advances for the treatment of diabetic eye diseases, retinal specialists still have an ongoing therapy issue because patients require continual and constant monitoring and maintenance, said Rishi P. Singh, MD.
“Unfortunately for our patients, vision gains are limited and in a minority of patients,” said Dr. Singh, of the Cole Eye Institute, Cleveland.
Dr. Singh concentrated on the outstanding questions in diabetic eye disease researchers attempted to answer last year.
For instance, what can imaging tell clinicians about the cause of vascular diseases, in particular, diabetic retinopathy (DR)?
“Is DR truly just a retinal disease or is it a disease of the entire eye?” Dr. Singh asked. “What affect do baseline factors have on the progression of the disease and treatment outcomes? How can we best prevent complications in these patients who now need cataract surgery?”
Lessons learned from imaging
Clinicians often think of diabetic eye disease as limited to the retina, but Dr. Singh and colleagues have found that is not necessarily the case.
In one study on choroidopathy using optical coherence tomography (OCT) angiography, eyes with nonproliferative DR and proliferative DR (PDR) showed significantly decreased choriocapillaris capillary perfusion density (CPD), whereas those without DR did not show a significant change. Compared with controls, only those eyes with PDR showed significantly decreased retinal CPD and significantly increased foveal avascular zone area.
“Proliferative patients manifest decreased in CPD, especially in the parafoveal region,” he said. “It’s important to think about the patient as a whole, and realize that diabetes is a retinal disorder, but may also be a choroidal disorder as well. The vessels below the retina may also contribute to the ischemia and changes that we see in diabetic eye disease.”
Dr. Singh is a consultant for Allergan, Carl Zeiss Meditec, Genentech, Optos, Regeneron, and Shire. He conducts sponsored research from Alcon Laboratories/Novartis, Apellis, Genentech/Roche, and Regeneron.
1. Conti FF, Qin VL, Rodrigues EB, et al. Choriocapillaris and retinal vascular plexus density in diabetic eyes using split-spectrum amplitude decorrelation spectral-domain optical coherence tomography angiography. 2018 May 23. pii: bjophthalmol-2018-311903. doi: 10.1136/bjophthalmol-2018-311903. [Epub ahead of print]
2. DCCT 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;44:968-83.
3. Schauer PR, Bhatt DL, Kirwan JP et al. for the STAMPEDE Investigators. Bariatric Surgery versus Intensive Medical Therapy for Diabetes—5-Year Outcomes. N Engl J Med. 2017;376(7):641-51. Doi: 10.1056/NEJMoa1600869
4. Matsuda S, Tam T, Singh RP, et al. The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema. J Diabetes Complications. 2014;28(2):166-70. doi: 10.1016/j.jdiacomp.2013.11.009
5. Singh RP, Habbu K, Ehlers JP, Lansang MC, Hill L, Stoilov I. The impact of systemic factors on clinical response to ranibizumab for diabetic macular edema. Ophthalmology. 2016;123(7):1581-7. doi: 10.1016/j.ophtha.2016.03.038