Diabetic retinopathy: New concepts of screening, monitoring, and interventions.

The science of diabetes care has progressed to provide a better understanding of the oxidative and inflammatory lesions and pathophysiology of the neurovascular unit within the retina (and brain) that occur early in diabetes, even prediabetes. Screening for retinal structural abnormalities, has traditionally been performed by fundus examination or color fundus photography; however, these imaging techniques detect the disease only when there are sufficient lesions, predominantly hemorrhagic, that are recognized to occur late in the disease process after significant neuronal apoptosis and atrophy, as well as microvascular occlusion with alterations in vision. Thus, interventions have been primarily oriented toward the later-detected stages, and clinical trials, while demonstrating a slowing of the disease progression, demonstrate minimal visual improvement and modest reduction in the continued loss over prolonged periods.

Slowed Progression of Age-Related Geographic Atrophy Following Subthreshold Laser.

Purpose: To determine the effect of panmacular low-intensity/high-density subthreshold diode micropulse laser (SDM) on age-related geographic atrophy (ARGA) progression.

Methods: The retinal images of all eyes with ARGA in a previously reported database, consisting of all eyes with dry age-related macular degeneration (AMD) active in a vitreoretinal practice electronic medical record (EMR), were identified and analyzed to determine the velocity of radial linear ARGA progression during observation and after panmacular SDM.

Results: Sixty-seven eyes of 49 patients with ARGA, mean age of 86 years were identified as having follow-up both before and after initiation of SDM treatment.

Diabetic Retinopathy-An Underdiagnosed and Undertreated Inflammatory, Neuro-Vascular Complication of Diabetes.

Diabetes mellitus is a world-wide epidemic and diabetic retinopathy, a devastating, vision-threatening condition, is one of the most common diabetes-specific complications. Diabetic retinopathy is now recognized to be an inflammatory, neuro-vascular complication with neuronal injury/dysfunction preceding clinical microvascular damage. Importantly, the same pathophysiologic mechanisms that damage the pancreatic β-cell (e.

Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD.

Purpose: To determine the incidence of new choroidal neovascularization (CNV) in eyes with dry age-related macular degeneration (AMD) following subthreshold diode micropulse laser (SDM).

Method: In an observational retrospective cohort study, the records of all patients active in the electronic medical records database were reviewed to identify eyes with dry AMD treated with SDM. Identified eyes were classified by simplified AREDS categories, and analyzed for the primary endpoint of new CNV after treatment.

Safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in eyes with good visual acuity.

Purpose: To determine the safety of transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema.

Methods: The records of all patients treated with transfoveal subthreshold diode micropulse laser for fovea-involving diabetic macular edema in two retina clinics were reviewed. The eligibility included fovea-involving diabetic macular edema by spectral domain optical coherence tomography and pretreatment visual acuity of 20/40 or better.

Anti-VEGF effects of intravitreal erythropoietin in early diabetic retinopathy.

In the present study, a single intravitreal erythropoietin (EPO) to diabetic rats produced therapeutic effects on blood-retinal barrier (BRB) function and neuronal survival at different time courses of retinopathy. In parallel, the hypoxia-inducible factor 1 alpha (HIF-1 alpha) pathway has been quantitatively studied, including VEGF-A, endogenous EPO, EPO receptor (EpoR), prolyl hydroxylases (PHD1-3) and von Hippel-Lindau tumor suppressor (VHL). The mRNA levels of HIF-1 alpha, VEGF-A, endogenous EPO, PHD1-3 and VHL are all up-regulated in the diabetic retina, and suppressed by exogenous EPO.

Screening athletes with Down syndrome for ocular disease.

Background: Persons with Down syndrome are well known to have a high prevalence of vision and eye health problems, many of which are undetected or untreated primarily because of infrequent ocular examinations. Public screening programs, directed toward the pediatric population, have become more popular and commonly use letter or symbol charts. This study compares 2 vision screening methods, the Lea Symbol chart and a newly developed interactive computer program, the Vimetrics Central Vision Analyzer (CVA), in their ability to identify ocular disease in the Down syndrome population.

Effects of intravitreal erythropoietin therapy for patients with chronic and progressive diabetic macular edema.

Background And Objective: To determine the effects of intravitreal injections of erythropoietin in eyes with severe, chronic diabetic macular edema, 5 eyes of 5 patients underwent injections of rHuEPO alpha (EPO).

Patients And Methods: All eyes had progressive vision loss and persistent or worsening edema with prior multi-modal treatment. EPO (5U/50 microL) was injected intravitreally every 6 weeks for three doses and followed for an additional 6 weeks with complete ocular examinations, fluorescein angiography, optical coherence tomography (OCT), and central field acuity perimetry.

ERK- and Akt-dependent neuroprotection by erythropoietin (EPO) against glyoxal-AGEs via modulation of Bcl-xL, Bax, and BAD.

Purpose: To characterize the neuroprotective mechanisms of erythropoietin (EPO) against the stress of glyoxal-advanced glycation end products (AGEs) in retinal neuronal cells.

Methods: Rat retinal organ culture, primary retinal neuron culture, and retinal cell line (R28 cell) culture under glyoxal-AGEs insult were used as in vitro models. Exogenous EPO was applied to these models.

Entoptic phenomenon following pars plana vitrectomy caused by retained preretinal gel.

A patient who underwent pars plana vitrectomy for vitreous floaters is described. At the time of surgery, the posterior hyaloid was avulsed and stripped from the posterior retinal surface. Postoperatively, the patient described filamentous and "sea-fan" entoptic phenomena scattered throughout the periaxial vision that were in focus, attached, and "waving" with movement that was counter to the direction of gaze pursuit and demonstrated after movement.

Pharmacokinetic and toxicity study of intravitreal erythropoietin in rabbits.

Aim: To study the pharmacokinetics and toxicity of intravitreal erythropoietin (EPO) for potential clinical use.

Methods: For toxicity study, 4 groups (60 rabbits) with intravitreal injection (IVit) of EPO were studied (10 U, 100 U, or 1,000 U) per eye for single injection and 0.6 U/eye (the designed therapeutic level in rabbits) for monthly injections (6X).

Intravitreal injection of erythropoietin protects both retinal vascular and neuronal cells in early diabetes.

Purpose: To explore and evaluate the protective effect of erythropoietin (EPO) on retinal cells of chemically induced diabetic rats after EPO was injected intravitreally at the onset of diabetes.

Methods: Diabetes was induced in Sprague-Dawley rats by intraperitoneal injection of streptozotocin (STZ). At the onset of diabetes, a single intravitreal injection of EPO (0.

Diabetic retinopathy: the unmet needs for screening and a review of potential solutions.

Diabetic retinopathy remains the leading cause of severe vision loss and blindness in the developed world, in spite of recognized ocular treatments that are successful at reducing the rate of vision impairment. Retinal photography appears a promising method to perform screening in such a setting utilizing new 45 degrees + retinal cameras that do not require pupil dilation and can be operated by a trained, nonophthalmic technician. Certain developments may make the photography more successful including the conversion to electronic chip camera sensors that allow each picture as it is taken to be immediately projected onto a monitor for evaluation and assessment.

Diabetic retinopathy: treating systemic conditions aggressively can save sight.

To control diabetic retinopathy, we need not only to detect it promptly, but also to manage common systemic comorbid conditions such as hypertension, hyperlipidemia, anemia, obstructive sleep apnea, and smoking--all of which tend to accelerate its course and increase its severity.

The internist's role in managing diabetic retinopathy: screening for early detection.

Although laser treatment keeps vision damaged by diabetic retinopathy from becoming worse, it only rarely improves vision. If primary care physicians wait until the patient complains of blurred vision, it is too late--there is already permanent retinal injury, and the lost vision almost never can be restored. Unfortunately, only half of patients with diabetes undergo an appropriate examination every year.