Controlling hemoglobin A1c levels and reducing blood pressure have a significant impact on modifying diabetic retinopathy (DR) progression, stated Dr. Allen S. Ho, MD, at Retina 2015. Diabetic retinopathy is a leading cause of blindness among working adults worldwide, and diabetic macular edema (DME), is a complication of diabetic retinopathy.
  

The average A1c level among patients with diabetic retinopathy is 9, and each 1% increase in A1c level above 7 increases the chance of the incidence of progression to proliferative diabetic retinopathy by 50% and increases the chance of development of diabetic macular edema by 40%, stated Dr. Ho. “Conversely, if you reduce your A1c by 1% when it’s elevated, you reduce your chance of diabetic macular edema by 40% for each elevated increment of 1%.”
  

This relationship holds true whether the patient has type 1 or type 2 diabetes, whether macular edema is proliferative or non-proliferative, or whether disease is mild, moderate or severe.
  

Blood pressure control and lipid management, too, can impact diabetic retinopathy progression. The American Diabetes Association recommends a target blood pressure of 130/80 mm Hg or less, and each 10 mm Hg reduction in systolic pressure when blood pressure is elevated reduces microvascular complications of diabetic retinopathy by 10%, regardless of severity of hypertension.
  

“We can modify progression of diabetic retinopathy by getting back to basics with glycemic control, blood pressure control and lipid management,” commented Dr. Ho.
  

Source: Healio

Diabetes is the leading cause of blindness among adults aged 20-74. Patients with type 1 or type 2 diabetes are at risk for developing diabetic retinopathy, a debilitating eye disease, which can lead to the more severe condition of diabetic macular edema (DME). The International Diabetes Federation estimates that DME affects 11% of all people living with diabetes worldwide. DME exacts a severe and growing socioeconomic burden on individuals, health systems, and governments, but recent progress in the field may help to alleviate this burden.
  

The development of VEGF-targeted drugs has produced a true paradigm shift in the treatment of DME. Anti-VEGF therapy blocks the expression of “vascular endothelial growth factor” (VEGF) – a key element in the development of DME. Four anti-VEGF agents have been shown to be effective, and two have already been approved in the United States and the European Union. These therapies can help affected patients prevent further vision impairment and, in some cases, even reverse vision loss.
  

Recognizing the clinically transformative nature of these remarkable therapies, the Angiogenesis Foundation convened a Canadian National Multi-stakeholder Expert Summit for Diabetic Macular Edema in Toronto, Ontario on January 16th – 17th. The summit brought together high-level regional representatives including retinal specialists, ophthalmologists, optometrists, diabetologists, diabetes organization leaders, advocates, researchers, and patients.
  

Experts participated in a series of discussions that reviewed the impact of new drugs in the treatment of DME, the challenges to optimized care, and the necessary steps forward to improve patient outcomes. Dialogue particularly highlighted the need for greater preventative and screening measures while continuing to advance treatment options and safety for those afflicted. Despite complex policy differences between the regions in Canada, thought leaders involved in the Summit were optimistic that changes could be made initially through national education and advocacy campaigns. An action plan, as well as other conclusions from the Summit, will be reported in a white paper published by the Foundation in the coming months.
  

The Canadian National Multi-stakeholder Summit is the second DME Expert Summit convened by the Angiogenesis Foundation, yet the first in North America. The previous assembly was held in Paris, France in June 2014, and brought together experts from 12 countries. Key findings and proposed solutions from the Paris summit are available in the white paper report.
  

Visit ScienceofDME.org to learn more about the development and treatment of DME, and connect on Facebook and Twitter to stay updated on the field.
  

The US Food and Drug Administration (FDA) has granted Lucentis (ranibizumab), a vascular endothelial growth factor (VEGF) inhibitor, its Breakthrough Therapy (BT) designation for the treatment of diabetic retinopathy.
  

Diabetic retinopathy is a vision-threatening complication of type 1 and type 2 diabetes. It is the most common diabetic eye disease and a leading cause of vision loss in working adults, affecting over 93 million people worldwide. Diabetic macular edema is a form of diabetic retinopathy.
  

The FDA based the BT designation on results of the RISE and RIDE phase 3 trials. In these trials, meaningful improvements in disease were observed in a clinically significant proportion of diabetic retinopathy patients treated with ranibizumab at 2 years compared with patients treated with sham (control group). Benefits of ranibizumab were maintained during year 3 of treatment, and the safety in the RISE and RIDE phase 3 trials was consistent with previous studies.
  

The BT designation is intended to expedite the development and review of drugs for serious or life-threatening conditions. Drugs qualifying for this designation must show credible evidence of a substantial improvement on a clinically significant endpoint over available therapies, or placebo if there is no available therapy. The designation includes all of the FDA’s fast-track program features, as well as more intensive guidance and discussion. The BT designation is distinct from both accelerated approval and priority review, which can also be granted to the same drug if relevant criteria are met.
  

Lucentis is currently indicated for diabetic macular edema, wet age-related macular degeneration, and macular edema following retinal vein occlusion. If approved, Lucentis will be the first ocular medication approved for the treatment of diabetic retinopathy.
  

Source: ASRS