Medical treatment of diabetic retinopathy

Donaldson, Mark; Dodson, P M

doi:10.1038/sj.eye.6700586

Cited by 13 publications

(11 citation statements)

References 85 publications

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“…The possibility of an effect of statins has been investigated over the last 10 years with early encouraging results in small studies of macular oedema and exudates. 24 Larger studies of statins for example CARDS, 25 which included 2838 patients over a median follow-up of 3.9 years, showed that atorvostatin 10 mg daily resulted in a trend to reduction of laser therapy compared with placebo, but no influence on diabetic retinopathy progression. Thus, the influence of statins on diabetic retinopathy continues to be debated and better evidence on the effects of larger doses of statins are required but, if there is an effect of statins, it is likely to be small.…”

Section: Statins and Fibratesmentioning

confidence: 99%

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Wright

Dodson

2011

Eye

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The approach of all ophthalmologists, diabetologists and general practitioners seeing patients with diabetic retinopathy should be that good control of blood glucose, blood pressure and plasma lipids are all essential components of modern medical management. The more recent data on the use of fenofibrate in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye studies is reviewed. In FIELD, fenofibrate (200 mg/day) reduced the requirements for laser therapy and prevented disease progression in patients with preexisting diabetic retinopathy. In ACCORD Eye, fenofibrate (160 mg daily) with simvastatin resulted in a 40% reduction in the odds of retinopathy progressing over 4 years, compared with simvastatin alone. This occurred with an increase in HDL-cholesterol and a decrease in the serum triglyceride level in the fenofibrate group, as compared with the placebo group, and was independent of glycaemic control. We believe fenofibrate is effective in preventing progression of established diabetic retinopathy in type 2 diabetes and should be considered for patients with pre-proliferative diabetic retinopathy and/or diabetic maculopathy, particularly in those with macular oedema requiring laser.

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Section: Statins and Fibratesmentioning

confidence: 99%

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Wright

Dodson

2011

Eye

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“…However, further investigation is underway with two large prospective randomised controlled trials, ASPEN and the CARDS study, due to report later in 2004. 7,17,18 The CARDS study will support more widespread statin prescription in type II diabetic patients, and if the conclusions from this study are correct we may in turn see a delay or reduction in the episodes of preretinal or vitreous haemorrhage in diabetic patients.…”

Section: Discussionmentioning

confidence: 73%

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Banerjee

Denniston

Gibson

et al. 2004

Eye

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Aims To review the role of cardiovascular disease and therapy in the onset and recurrence of preretinal/vitreous haemorrhage in diabetic patients. Methods Retrospective case note analysis of diabetic patients with vitreous haemorrhage from the Diabetic Eye Clinic at Birmingham Heartlands Hospital. Results In total, 54 patients (mean age 57.1, 37 males, 20 type I vs 34 type II diabetic patients) were included. The mean (SD) duration of diagnosed diabetes at first vitreous haemorrhage was significantly longer, 21.9 (7.6) years for type I and 14.8 (9.3) years for type II diabetic patients (Po0.01, unpaired t-test, two-tailed).Aspirin administration was not associated with a significantly later onset of vitreous haemorrhage. Four episodes were associated with ACE-inhibitor cough. There was a trend towards HMGCoA reductase inhibitor (statin) use being associated with a delayed onset of vitreous haemorrhage: 21.4 years until vitreous haemorrhage (treatment group) vs 16.2 years (nontreatment group) (P ¼ 0.09, two-tailed, unpaired t-test, not statistically significant).During follow-up 56 recurrences occurred, making a total of 110 episodes of vitreous haemorrhage in 79 eyes of 54 patients. The mean (range) follow-up post haemorrhage was 1067 (77-3842) days, with an average of 1.02 recurrences. Age, gender, diabetes type (I or II) or control, presence of hypertension or hypercholesterolaemia, and macrovascular complications were not associated with a significant effect on the 1-year recurrence rate.Aspirin (and other antiplatelet or anticoagulant agents) and ACE-inhibitors appeared to neither increase nor decrease the 1-year recurrence rate. However, statin use was significantly associated with a reduction in recurrence (Fisher exact Po0.05; two-tailed) with an odds ratio (95% CI) of 0.25 (0.1-0.95). Conclusion In this retrospective analysis, the onset of preretinal/vitreous haemorrhage was not found to be accelerated by gender, hypertension, hypercholesterolaemia, evidence of macrovascular disease, or HbA1c. Neither aspirin nor ACE-inhibitor administration accelerated the onset or recurrence of first vitreous haemorrhage. Statins may have a protective role, both delaying and reducing the recurrence of haemorrhage.

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“…9 In addition, there is limited evidence that statins may reduce retinal exudation in patients with diabetic maculopathy, an effect to be confirmed in ongoing large randomised clinical trials. 15,16 This study has demonstrated that there is still much input required to achieve optimal metabolic and BP control to delay progression and need for laser treatment of DR. In view of the above findings, we feel that ophthalmologists responsible for the care of patients with DR should ensure that the patients receive both adequate medical therapies to optimise glycaemic and BP control, as well as laser photocoagulation.…”

Section: Discussionmentioning

confidence: 98%

Is measurement of blood pressure worthwhile in the diabetic eye clinic?

Al-Husainy

Farmer

Gibson

et al. 2004

Eye

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Purpose The UK Prospective Diabetic Study has confirmed the importance of blood pressure (BP) as a major risk factor for diabetic retinopathy (DR). We wanted to investigate whether measuring the BP in the diabetic eye clinic could identify new hypertensive patients and monitor control in existing ones. Patients and methods We compared BP in patients attending the diabetic eye clinic with home blood pressure measurement (HBPM) and ambulatory BP measurement (ABPM). In all, 106 patients attending a diabetic eye clinic were selected at random from clinic attendees. BP measurement (on an Omron 705 CP) was performed in the eye clinic and also compared to HBPM three times per day with an Omron 705 CP machine, and was compared to diabetic clinic measurements. In addition, 11 randomly chosen patients had 24 h ABPM to validate the above techniques. Results In all, 106 patients (70 male and 36 female) were recruited for the study, of which 71 were known to be hypertensive on antihypertensive medication. Of the total, 75 patients (70.8%) had BP4140/85 in the eye clinic, of which 51 (68%) were known to be hypertensive on treatment and this was confirmed in 46 (90%) on HBPM. A total of, 24 patients (22.6%) were newly diagnosed as hypertensive in the eye clinic, which was confirmed by HBPM in 22 patients (92%). The mean BP of the measurements performed in the eye clinic was significantly higher than that carried out in the diabetic clinic (Po0.01). Tropicamide 1% and phenylephrine 2.5% eye drop instillation had no effect on BP. In 11 randomly chosen patients, 24 h ABPM validated both diabetic eye clinic and home BP measurements. Conclusion Attendance at the diabetic eye clinic is an important chance to detect both new patients with systemic hypertension and those with inadequate BP control.Ophthalmologists should be encouraged to measure BP in their diabetic patients attending diabetic eye clinics, as it is an important risk factor for DR. On the basis of our findings, good BP control is a goal yet to be achieved in diabetic patients with retinopathy.

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Medical treatment of diabetic retinopathy

Abstract: Eye (2003) 17, 550-562.

Cited by 13 publications

References 85 publications

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Medical management of diabetic retinopathy: fenofibrate and ACCORD Eye studies

Does cardiovascular therapy affect the onset and recurrence of preretinal and vitreous haemorrhage in diabetic eye disease?

Is measurement of blood pressure worthwhile in the diabetic eye clinic?

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