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Journal of Diabetes Investigation Aug 2021Despite progress in the treatment of diabetic macular edema and diabetic retinopathy, the rate of lower fundus examination due to limitations of medical resources delays... (Review)
Review
Despite progress in the treatment of diabetic macular edema and diabetic retinopathy, the rate of lower fundus examination due to limitations of medical resources delays the diagnosis and treatment of diabetic retinopathy. Therefore, implementation of automated diabetic retinopathy screening program and the identification of more specific and sensitive biomarkers are important for facilitating the earlier detection of diabetic macular edema and diabetic retinopathy to decrease the prevalence of poor vision and blindness.
Topics: Biomarkers; Diabetes Mellitus; Diabetic Retinopathy; Humans; Mass Screening; Prevalence; Risk Factors
PubMed: 33316144
DOI: 10.1111/jdi.13480 -
Frontiers in Endocrinology 2022Diabetic retinopathy (DR) is the major ocular complication of diabetes mellitus, and is a problem with significant global health impact. Major advances in diagnostics,... (Review)
Review
Diabetic retinopathy (DR) is the major ocular complication of diabetes mellitus, and is a problem with significant global health impact. Major advances in diagnostics, technology and treatment have already revolutionized how we manage DR in the early part of the 21 century. For example, the accessibility of imaging with optical coherence tomography, and the development of anti-vascular endothelial growth factor (VEGF) treatment are just some of the landmark developments that have shaped the DR landscape over the last few decades. Yet, there are still more exciting advances being made. Looking forward to 2030, many of these ongoing developments are likely to further transform the field. First, epidemiologic projections show that the global burden of DR is not only increasing, but also shifting from high-income countries towards middle- and low-income areas. Second, better understanding of disease pathophysiology is placing greater emphasis on retinal neural dysfunction and non-vascular aspects of diabetic retinal disease. Third, a wealth of information is becoming available from newer imaging modalities such as widefield imaging systems and optical coherence tomography angiography. Fourth, artificial intelligence for screening, diagnosis and prognostication of DR will become increasingly accessible and important. Fifth, new pharmacologic agents targeting other non-VEGF-driven pathways, and novel therapeutic strategies such as gene therapy are being developed for DR. Finally, the classification system for diabetic retinal disease will need to be continually updated to keep pace with new developments. In this article, we discuss these major trends in DR that we expect to see in 2030 and beyond.
Topics: Humans; Diabetic Retinopathy; Artificial Intelligence; Eye; Tomography, Optical Coherence; Diabetes Mellitus
PubMed: 36699020
DOI: 10.3389/fendo.2022.1077669 -
International Journal of Molecular... Jun 2018Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM). It has long been recognized as a microvascular disease. The diagnosis of DR relies... (Review)
Review
Diabetic retinopathy (DR) is the most common complication of diabetes mellitus (DM). It has long been recognized as a microvascular disease. The diagnosis of DR relies on the detection of microvascular lesions. The treatment of DR remains challenging. The advent of anti-vascular endothelial growth factor (VEGF) therapy demonstrated remarkable clinical benefits in DR patients; however, the majority of patients failed to achieve clinically-significant visual improvement. Therefore, there is an urgent need for the development of new treatments. Laboratory and clinical evidence showed that in addition to microvascular changes, inflammation and retinal neurodegeneration may contribute to diabetic retinal damage in the early stages of DR. Further investigation of the underlying molecular mechanisms may provide targets for the development of new early interventions. Here, we present a review of the current understanding and new insights into pathophysiology in DR, as well as clinical treatments for DR patients. Recent laboratory findings and related clinical trials are also reviewed.
Topics: Angiogenesis Inhibitors; Animals; Anti-Inflammatory Agents; Antioxidants; Diabetic Retinopathy; Humans; Laser Therapy; Retina
PubMed: 29925789
DOI: 10.3390/ijms19061816 -
Clinical Medicine (London, England) Mar 2022Diabetic retinopathy is a microangiopathy resulting from the chronic effects of diabetes mellitus. Healthcare professionals often work in isolation to deliver highly... (Review)
Review
Diabetic retinopathy is a microangiopathy resulting from the chronic effects of diabetes mellitus. Healthcare professionals often work in isolation to deliver highly specialised care efficiently and effectively for people living with diabetes. It is not uncommon for people with diabetes to be making frequent visits to community and hospital clinics to see a variety of specialists and healthcare professionals, with seemingly little opportunity for coordination of this complex health management programme between the wider team. In a field that is so diverse and rapidly changing, healthcare professionals of all specialties need to be aware of developments across all aspects of diabetes management. In this article, we discuss the epidemiology and natural history of diabetic retinopathy and describe an approach to its assessment and diagnosis. We provide an overview of the principles of diabetic retinopathy management and outline possible future treatments for diabetic retinopathy.
Topics: Diabetes Mellitus; Diabetic Retinopathy; Health Personnel; Humans; Mass Screening
PubMed: 35304370
DOI: 10.7861/clinmed.2021-0792 -
Deutsches Arzteblatt International Feb 2010Diabetic retinopathy is a microangiopathy of the retina from which nearly all persons with diabetes eventually suffer. Two of its complications threaten the patient's... (Review)
Review
BACKGROUND
Diabetic retinopathy is a microangiopathy of the retina from which nearly all persons with diabetes eventually suffer. Two of its complications threaten the patient's vision: diabetic macular edema and proliferative diabetic retinopathy.
METHODS
Selective literature review, based on national and international guidelines and a literature search from 1981 onward.
RESULTS
Diabetic retinopathy is subdivided into non-proliferative and proliferative retinopathy. Macular edema can arise at any stage of the disease and threatens visual acuity. The main risk factors for the development and progression of diabetic retinopathy are long duration of diabetes and poor control of blood sugar and arterial blood pressure. Laser photocoagulation is an evidence-based treatment for proliferative retinopathy and macular edema. Vitreous surgery is indicated in cases of worsening vision due to a non-clearing vitreous hemorrhage or tractional retinal detachment. The current options for medical treatment involve the intravitreous injection of glucocorticosteroids or of a VEGF antagonist; both of these options are "off label" at present.
CONCLUSION
Diabetic retinopathy is the leading cause of blindness among persons of working age in the industrialized world. Regular ophthalmological examinations, timely laser therapy depending on the stage of the disease, and close interdisciplinary cooperation are essential to prevent loss of vision.
Topics: Diabetic Retinopathy; Humans; Prevalence
PubMed: 20186318
DOI: 10.3238/arztebl.2010.0075 -
Endocrinology and Metabolism Clinics of... Sep 2021Microvascular complications of diabetes present a significant challenge due to their diverse presentations, significant morbidity, and as strong predictors of... (Review)
Review
Microvascular complications of diabetes present a significant challenge due to their diverse presentations, significant morbidity, and as strong predictors of cardiovascular disease. Prevention and management strategies should focus on lifestyle modification, education and awareness, systematic screening for early complications, and intensive management of modifiable risk factors. This review discusses the microvascular complications of diabetes, including diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy, and provides best practice clinical care recommendations to guide health care professionals to better manage people with these conditions.
Topics: Cardiovascular Diseases; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Neuropathies; Diabetic Retinopathy; Humans; Risk Factors
PubMed: 34399955
DOI: 10.1016/j.ecl.2021.05.005 -
Indian Journal of Ophthalmology Jan 2023Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and... (Review)
Review
Vitreous hemorrhage is associated with a myriad of conditions such as proliferative diabetic retinopathy, proliferative retinopathy following vascular occlusion and vasculitis, trauma, retinal breaks, and posterior vitreous detachment without retinal break. Multiple pathological mechanisms are associated with development of vitreous hemorrhage such as disruption of abnormal vessels, normal vessels, and extension of blood from an adjacent source. The diagnosis of vitreous hemorrhage requires a thorough history taking and clinical examination including investigations such as ultra-sonography, which help decide the appropriate time for intervention. The prognosis of vitreous hemorrhage depends on the underlying cause. Treatment options include observation, laser photo-coagulation, cryotherapy, intravitreal injections of anti-vascular endothelial growth factor, and surgery. Pars plana vitrectomy remains the cornerstone of management. Complications of vitreous hemorrhage include glaucoma (ghost cell glaucoma, hemosiderotic glaucoma), proliferative vitreoretinopathy, and hemosiderosis bulbi.
Topics: Humans; Vitreous Hemorrhage; Vitrectomy; Vitreous Detachment; Vitreoretinopathy, Proliferative; Diabetic Retinopathy; Glaucoma; Retinal Perforations
PubMed: 36588205
DOI: 10.4103/ijo.IJO_928_22 -
Nutricion Hospitalaria Mar 2013This paper describes the importance of diabetic retinopathy in the loss of visual function. We exposed the most important risk factors, such as diabetes duration, poor...
This paper describes the importance of diabetic retinopathy in the loss of visual function. We exposed the most important risk factors, such as diabetes duration, poor metabolic control, pregnancy, puberty, hypertension, poor control of blood lipids, renal disease, and sleep apnea syndrome. We describe the pathogenesis of the disease, small retinal vessel microangiopathies which produce extravasation, edema and ischemia phenomena. We put special emphasis on the vascular endothelial growth factor (VEGF) and its pathogenic importance. They are also described the main clinical symptoms as microaneurysms, intraretinal hemorrhages, hard and soft exudates, intraretinal microvascular abnormalities (IRMA), venous disorders, formation of new vessels and diabetic macular edema (the latter being the most common cause of vision loss). Finally we describe the latest diagnostic techniques and eye treatment, with special emphasis on obesity surgery importance as more important preventive factor to eliminate the predisposing and precipitating disease symptoms.
Topics: Diabetic Retinopathy; Humans
PubMed: 23834047
DOI: 10.3305/nh.2013.28.sup2.6714 -
Indian Journal of Ophthalmology Nov 2021Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative... (Review)
Review
Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative literature review conducted in Medline and Google Scholar pertaining to diabetes with coexistent asymmetry of retinopathy included 45 original articles, 21 case reports and series, and 18 review articles from 1965 to 2020. Asymmetric DR is defined as proliferative DR (PDR) in one eye and nonproliferative, preproliferative, background, or no DR in the other eye lasting for at least 2 years. It is observed in 5%-10% of patients with PDR. Associated factors can be divided into (i) vascular: carotid obstructive disease, ocular ischemic syndrome, and retinal vascular diseases; (ii) Inflammatory: uveitis, endophthalmitis, and Fuchs' heterochromic cyclitis; (iii) degenerative: posterior vitreous detachment, high myopia and anisometropia, uveal coloboma, retinal detachment, retinitis pigmentosa, and chorioretinal atrophy and scarring; (iv) cataract surgery and vitrectomy; and (v) miscellaneous: elevated intraocular pressure, glaucoma, amblyopia, retinal detachment, and optic atrophy. The gamut of diagnostic modalities for asymmetric DR includes thorough ocular examination, slit-lamp biomicroscopy, fundus photography, fundus fluorescein angiography, optical coherence tomography, and newer modalities such as ultra-widefield fluorescein angiography and optical coherence tomography angiography, along with a complete systemic evaluation and carotid Doppler studies. The differential diagnosis includes other causes of retinal neovascularization that may present in an asymmetric manner, such as sickle cell retinopathy, retinal vein occlusions, and featureless retina. This review discusses in detail the aforementioned considerations and draws a comprehensive picture of asymmetric DR in order to sensitize ophthalmologists to this important condition.
Topics: Diabetes Mellitus; Diabetic Retinopathy; Fluorescein Angiography; Humans; Retina; Retinal Diseases; Tomography, Optical Coherence
PubMed: 34708738
DOI: 10.4103/ijo.IJO_1525_21 -
Anales Del Sistema Sanitario de Navarra 2008Diabetes mellitus is a metabolic pathology whose evolution affects different organs, amongst them the eye. Diabetic microangiopathy affects the retina in an early and... (Review)
Review
Diabetes mellitus is a metabolic pathology whose evolution affects different organs, amongst them the eye. Diabetic microangiopathy affects the retina in an early and specific way. The appearance of retinopathy is directly related to the time of evolution of the disease and metabolic control. Diabetic microangiopathy in the retina shows specific alterations such as micro-aneurysms, soft or hard exudates, intra-retinal micro-haemorrhages, beaded veins and intraretinal microvascular anomalies. These alterations in the retinal microcirculation cause two physiopathological phenomena: capillary closure with the resulting ischaemia or extravasation of intravascular content to the stroma causing edema. In this chapter we set out the classification and treatments of diabetic retinopathy, excluding macular edema, according to the different multicentric studies present in the current bibliography.
Topics: Diabetic Retinopathy; Humans; Laser Therapy; Vitrectomy
PubMed: 19169292
DOI: No ID Found