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    Keeping up with the latest diabetic eye disease research

    ARVO’s Diabetic Retinopathy meeting brought a wealth of new information

     

    Clinically, poor VA response to anti-VEGF injections for fovea-involved DME was underscored in a talk by Jennifer K. Sun, MD, from Harvard, who showed that disorganization of retinal internal layers within the central 1 mm (what her team calls “DRIL”) on spectral domain OCT (sdOCT) predicted precisely which patients are unlikely to have a good response to anti-VEGF therapy.5 DRIL is typified by loss of distinct boundaries among the ganglion cell, inner plexiform, inner nuclear, outer plexiform, and outer nuclear layers.

    Speaking of imaging advancements, Steve Burns, PhD, from Indiana University’s School of Optometry presented mind-blowing images of early diabetes-induced retinal capillary and blood flow changes using adaptive optics, changes which may precede clinical diagnosis of diabetes.6

    On the prevention front, Emily Chew, MD, PhD, from the National Eye Institute (NEI) reviewed data from the ACCORD-Eye and FIELD studies, both of which showed that use of the triglyceride-lowering agent, fenofibrate significantly lowers the risk of worsening diabetic retinopathy and the need for photocoagulation. She argued that this agent should be considered in addition to tight metabolic control for patients with type 2 diabetes and early DR, a sentiment echoed by former NEI Chair Robert N. Frank, MD, PhD, in his review of controlled clinical trials for diabetic retinopathy. Dr. Frank also suggested an AREDS2-type trial to determine the effects of a multi-component nutritional supplement on the development and progression of DR.

    Related: Why communication is the key to diabetes success

    Michael Brownlee, MD, PhD, from the Albert Einstein College of Medicine presented evidence that duration of hyperglycemia may be more predictive of retinopathy risk than mean blood glucose (as reflected by HbA1c). Specifically, he displayed animal data showing that a mere six-hour exposure to blood glucose >180 mg/dl results in a two-week, massive overproduction of free radical molecules (reactive oxygen species [ROS]) that cause vascular diabetes complications, despite immediate normalization of blood glucose after that six-hour exposure.7 Dr. Brownlee showed data from the Diabetes Control and Complications Trial (DCCT) that HbA1c accounts for a mere six to 11 percent of total individual risk for DR and its progression, and that HbA1c may not reflect these short-term spikes which appear to “massively increase risk."

    Other notable presentations included data showing that green and blue-green wavelengths emitted by an LED sleep mask (through closed eyelids) may mitigate retinal hypoxia in diabetes by down-regulating rod photoreceptor metabolism during sleep (rods account for 90+ percent of retinal oxygen consumption) and a small series of patients with DME who benefited from this therapy. Disturbingly, data from the Chicago HealthLNK Repository of nearly 2 million patients from Chicago area academic medical centers, federally-qualified health centers, and community hospitals showed that Medicaid and uninsured patients with diabetes were significantly less likely to be diagnosed with DR/DME and treated for these conditions than were patients with Medicare or private health insurance; this despite evidence that these patients are no less likely to be affected by eye disease.

    Oh yeah—the poster I presented showed evidence that a novel, multi-component nutritional supplement significantly improved visual function in patients with diabetes and early DR.8 The same formula also prevented mtDNA damage, ROS over-production and capillary apoptosis characteristic of DR in an animal model.9 Check out the results of our human trial at http://www.ncbi.nlm.nih.gov/pubmed/26089210. More on this next time.

     

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