Eye Disease  |  Kidney Disease  |  Nerve Damage  |  Cardiovascular Disease

OPPORTUNITIES IN DIABETIC EYE DISEASE
Progress in the clinical treatment of diabetic retinopathy (eye disease) has been remarkable in recent years. However, investigators are still actively seeking a full understanding of how retinopathy begins and progresses and how it can be reversed before blindness occurs.

Diabetic retinopathy seems to have a genetic component. That is, a patient's risk of developing eye disease is greater if they have a close relative who has already been diagnosed with diabetic retinopathy. Discovering the genes that predispose a person to this complication could lead researchers to new molecular targets for drug development to combat it.

Diabetic eye disease may result in part from damage to nerves located in the eye. Understanding nerve damage in the eye, and how it relates to leaky blood vessels, will help investigators develop a more complete picture of diabetic retinopathy initiation and progression.

Researchers have discovered a phenomenon known as "hyperglycemic memory" through which patients who are exposed to chronically high glucose levels are at higher risk for complications, including eye disease, years later even if they reduce their glucose back to a more normal range. Uncovering the cause of this phenomenon and finding ways to reverse it before complications set in is the subject of a vigorous research effort.

It is likely that a combination of drugs will need to be developed to treat retinopathy at different stages of the disease.

Recent studies suggest that deficiencies in insulin signaling seen in type 1 diabetes may play a role in triggering retinopathy. More research is needed to turn these findings into new therapeutic targets and treatments for diabetic retinopathy.

A major limitation to preventing blindness in diabetic patients is lack of access to routine eye care and screening because there are not enough ophthalmologists available to see all diabetes patients. Developing and validating a "telemedicine" approach to retinopathy screening — which allows specialists to interpret eye examination results from a remote location — would greatly improve physicians' ability to identify patients who are at risk for eye disease and treat them at the earliest possible stage.

BENEFITS OF THIS RESEARCH
Diabetic retinopathy, and the blindness that eventually results, exacts enormous personal, financial, and societal costs. Economists estimated in 2000 that laser therapy saves up to $1.6 Billion per year in the U.S. by preventing or treating diabetic retinopathy in both type 1 and type 2 diabetes patients. FDA-approved drugs and others in development for the treatment of age-related acute macular degeneration are showing promising effects in diabetic macular edema and retinopathy. As the aging population represents a significant proportion of diabetic patients, drugs that can efficiently target eye disease will have applications in both the diabetic and aging populations.