Systemic medical management of diabetic retinopathy

Gopal, Lingam; Wong, Tien Yin

doi:10.4103/0974-9233.120010

Cited by 18 publications

(12 citation statements)

References 66 publications

(59 reference statements)

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“…This review will discuss the effects of controlling chronic hyperglycemia, as well as other systemic therapies, on the development and progression of diabetic retinopathy. This topic has also been discussed by Lingam and Wong 1 in a recent review in this journal, and I have discussed certain aspects of it in a recently published editorial. 2 …”

Section: Introductionmentioning

confidence: 88%

Diabetic retinopathy and systemic factors

Frank

2015

Middle East Afr J Ophthalmol

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Diabetic retinopathy, an oculardisease, is governed by systemic as well as local ocular factors. These include primarily chronic levels of blood glucose. Individuals with chronically elevated blood glucose levels have substantially more, and more severe, retinopathy than those with lower blood glucose levels. The relationship of blood glucose to retinopathy is continuous, with no threshold although individuals with hemoglobin A1c levels (a measure of chronic glycemia) <6.5%, generally develop little or no retinopathy. Blood pressure levels have been claimed to influence retinopathy development and progression, but multiple controlled clinical trials of antihypertensive agents in diabetic subjects have produced only weak evidence of benefit from blood pressure lowering on the incidence and progression of diabetic retinopathy. Elevated blood lipids seem to play a role in the progression of retinopathy, and two trials of fenofibrate, a lipid-lowering agent that has not proved effective in preventing cardiovascular disease, have shown benefit in preventing retinopathy progression. The mechanism of this effect may not, however, be directly related to the reduction in blood lipids. Finally, there is strong, but only circumstantial, evidence for a genetic or epigenetic influence on the pathogenesis of diabetic retinopathy. Despite the power of large-scale epidemiologic studies and modern molecular biological and computational techniques, the gene or genes, which predispose or protect against the development and progression of diabetic retinopathy remain elusive.

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Section: Introductionmentioning

confidence: 88%

Diabetic retinopathy and systemic factors

Frank

2015

Middle East Afr J Ophthalmol

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“…Therefore, safer and more effective pharmacological treatments are required for DR treatment, in particular at an early stage. In this aspect, new treatments via oral administration have emerged, which are new pharmacological treatments for DR [ 18 ]. Oral therapies include the beneficial features of safety, good patient compliance, ease of ingestion, and pain avoidance [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

PPARα Agonist Oral Therapy in Diabetic Retinopathy

2020

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Diabetic retinopathy (DR) is an eye condition that develops after chronically poorly-managed diabetes, and is presently the main cause for blindness on a global scale. Current treatments for DR such as laser photocoagulation, topical injection of corticosteroids, intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents and vitreoretinal surgery are only applicable at the late stages of DR and there are possibilities of significant adverse effects. Moreover, the forms of treatment available for DR are highly invasive to the eyes. Safer and more effective pharmacological treatments are required for DR treatment, in particular at an early stage. In this review, we cover recently investigated promising oral pharmacotherapies, the methods of which are safer, easier to use, patient-friendly and pain-free, in clinical studies. We especially focus on peroxisome proliferator-activator receptor alpha (PPARα) agonists in which experimental evidence suggests PPARα activation may be closely related to the attenuation of vascular damages, including lipid-induced toxicity, inflammation, an excess of free radical generation, endothelial dysfunction and angiogenesis. Furthermore, oral administration of selective peroxisome proliferator-activated receptor alpha modulator (SPPARMα) agonists may induce hepatic fibroblast growth factor 21 expression, indirectly resulting in retinal protection in animal studies. Our review will enable more comprehensive approaches for understanding protective roles of PPARα for the prevention of DR development.

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“…D iabetic retinopathy is the most common cause of blindness in individuals greater than 50 years of age, affecting one in three persons with diabetes. 1 It is a chronic vascular complication characterized by low-grade inflammation, serum leakage through microvasculature, loss of capillaries, increased vascular permeability, and eventually neovascularization. 2,3 The last decade has seen scientific and medical progress on early diagnosis and prevention to combat this condition.…”

mentioning

confidence: 99%