Diabetic Eye Disease Awareness: Encourage those with diabetes to take proactive steps to protect their vision
Overview of New Drugs and Research in Diabetic Eye Disease
Author: Dr. Cheryl L . Rowe-Rendleman
CEO and Managing Consultant
Omar Consulting Group, LLC
Diabetes is a group of diseases characterized by high blood sugar. This usually means that a person is unable to make enough (Type 1) or properly use (Type 2) the insulin that naturally occurs in their body. There are 37.5 million diabetics in the United States or roughly 11% of the population1. The Internatinal Diabetes Federation estimates that there are about 537 million people with diabetes worldwide2. This number is expected to rise to 643 million by 20302. Many people are pre-diabetic and don’t know that they are at risk for diabetes1,2. Diabetes is a disease that can cause numerous central and peripheral complications.
Diabetic Retinopathy Signs Seen in 80% of Patients with Diabetes
Diabetic retinopathy is a complication of diabetes. Over time, chronic high blood sugar can damage the retina. The damage may be mild or quite severe. In mild cases an ophthalmologist or optometrist may discover some of the earliest clinical signs of diabetic retinopathy: a microaneurysm or small outpouchings from tiny retinal capillaries and/or dot intraretinal hemorrhages in the back of the eye3. These signs are present in nearly all persons who have had type 1 diabetes for 20 years or more3. Although slightly fewer people with type 2 diabetes3 have these findings it is important that all people with diabetes see an eye doctor to help them manage their vision should their diabetic eye disease worsen.
In severe diabetic retinopathy the areas of tiny intraretinal hemorrhages give way to regional failure of the retinal microvascular circulation, which results in a lack of oxygen (ischemia). During this stage of disease, vision usually worsens. Proliferative diabetic retinopathy involves the formation of new blood vessels in response to the lack of oxygen3. However, these new blood vessels are not healthy and become leaky. The tissues of the retina could also begin to swell (edema) with fluid that is leaking from the retinal circulation3. When the swelling and/or leaky blood vessels form near the central retina where vision is most acute, medical intervention is usually required.
Prediction of Risks and Treatments
It is very difficult for physicians to predict when vision will worsen. It is estimated by some that 90% of vision loss in diabetic retinopathy can be prevented by early diagnosis and treatment. Over the past years there have been a number of clinical studies focused on discovering the most effective treatment for early diabetic retinopathy. Some of the treatments involve laser, drugs, and/or surgery4. At the national registry of clinical trials (clinicaltrials.gov) there were 258 interventional studies for diabetic retinopathy that were flagged as completed or active to evaluate drugs, biologics, and instruments to help treat and diagnose diabetic retinopathy. Only 59 of the studies have reported results5. These results suggest that conventional interventional studies may be missing the mark as far as diabetic retinopathy is concerned.
Breakthrough in Diagnostics
Perhaps one of the most promising breakthroughs has been artificial intelligence (AI) guided diagnostic screening for diabetic retinopathy. The FDA approved an AI tool from AEYE Health (Jerusalem, Israel) in November 20226. According to its manufacturers this tool provides screening diagnostics for diabetic retinopathy and damaged retinas. The test is covered by most insurances. There is a need in this country for tools like these to help with the proactive detection of disease and assist with early treatment of diabetic retinopathy.
Sources
1. Centers for Disease Prevention and Control. By the Numbers: Diabetes in America | Diabetes | CDC. accessed December 14, 2022.
2. International Diabetes Federation. Global diabetes data report 2000. https://diabetesatlas.org Accessed on December 14, 2022.
3. Frank D. Diabetic Retinopathy, New England Journal of Medicine 2004;350:48-58. Kattar A, Concheiro A, Alvarez-Lorenzo C. Diabetic eye: associated diseases, drugs in clinic, and role of self-assembled carriers in topical treatment. Expert Opin Drug Deliv. 2021 Nov;18(11):1589-1607.
4. American Academy of Ophthalmology. Workshop Course on Diabeticr Retinopathy. Diabetes 2022. Course Director Keye Wong. Accessed September 2022.
5. U.S. National Library of Medicine. Accessed at https://clinicaltrials.gov/, on December 14, 2022.
6. AEYE Health. Accessed AI For Diabetic Retinopathy Screening Gets U.S. FDA Approval (forbes.com) on December 5, 2022.