Diabetic Retinopathy: An Insight into Clinical Features, Therapeutic Approaches, and Implications

Published: May 7, 2021

Authors

  • Rupinder Kaur
  • Rithik, Kirti
  • Suman Baishnab
  • Shareen Singh
Keywords
Diabetes, Diabetic Retinopathy (DR), Vascular Endothelial Growth Factor (VEGF), Nutraceuticals, Carotenoids

Abstract

Background: Diabetes mellitus is a metabolic disorder that affects the heart, brain, eye, and other organs. Diabetic microvascular complications includes retinopathy, nephropathy, and neuropathy. Diabetic retinopathy is a multifactorial disease that develops as a consequence of microvascular
complications, which causes damage to the retina by damaging the ocular fundus which further leads to visual loss.

Purpose: Pharmacological and non-pharmacological treatment works to prevent, delay or reduce vision loss. Non-pharmacological treatment include nutraceuticals (they have anti-inflammatory and antioxidant property) and pharmacological treatment includes anti-VEGF agents, corticosteroids, and specific moieties. Treatment with nutraceuticals in the early stages of diabetic retinopathy could be a viable option for intervening before the disease progresses.

Conclusion: This review briefly elucidates the emerging condition of diabetic retinopathy from epidemiological, pathophysiological, and therapeutic aspects including the emerging uses of nutraceuticals in diabetic retinopathy. If we control glucose and blood pressure levels in diabetic patients, it may halt the progression and development of diabetic retinopathy.

References

Ahmadinejad, F., Geir Møller, S., Hashemzadeh-Chaleshtori, M., Bidkhori, G., & Jami, M. S. (2017). Molecular Mechanisms behind Free Radical Scavengers Function against Oxidative Stress. Antioxidants (Basel, Switzerland)6(3), 51. https://doi.org/10.3390/antiox6030051

Aiello, L. P., Edwards, A. R., Beck, R. W., Bressler, N. M., Davis, M. D., Ferris, F., Glassman, A. R., Ip, M. S., Miller, K. M., & Diabetic Retinopathy Clinical Research Network (2010). Factors associated with improvement and worsening of visual acuity 2 years after focal/grid photocoagulation for diabetic macular edema. Ophthalmology117(5), 946–953. https://doi.org/10.1016/j.ophtha.2009.10.002

Alberti, K. G., & Zimmet, P. Z. (1998). Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic Medicine: A Journal of the British Diabetic Association15(7), 539–553. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S

Amato, R., Rossino, M. G., Cammalleri, M., Locri, F., Pucci, L., Dal Monte, M., & Casini, G. (2018). Lisosan G Protects the Retina from Neurovascular Damage in Experimental Diabetic Retinopathy. Nutrients10(12), 1932. https://doi.org/10.3390/nu10121932.

American Diabetes Association (2013). Diagnosis and classification of diabetes mellitus. Diabetes Care36 Suppl 1(Suppl 1), S67–S74. https://doi.org/10.2337/dc13-S067

Andreasson, R., Ekelund, C., Landin-Olsson, M., & Nilsson, C. (2018). HbA1c levels in children with type 1 diabetes and correlation to diabetic retinopathy. Journal of Pediatric Endocrinology & Metabolism: JPEM31(4), 369–374. https://doi.org/10.1515/jpem-2017-0417

Bandello, F., Battaglia Parodi, M., Lanzetta, P., Loewenstein, A., Massin, P., Menchini, F., & Veritti, D. (2010). Diabetic macular edema. Developments in Ophthalmology47, 73–110. https://doi.org/10.1159/00032007573-110

Boyer, D. S., Yoon, Y. H., Belfort, R., Jr, Bandello, F., Maturi, R. K., Augustin, A. J., Li, X. Y., Cui, H., Hashad, Y., Whitcup, S. M., & Ozurdex MEAD Study Group (2014). Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology121(10), 1904–1914. https://doi.org/10.1016/j.ophtha.2014.04.024

Brown, M. M., Brown, G. C., Sharma, S., Landy, J., & Bakal, J. (2002). Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration. Archives of Ophthalmology (Chicago, Ill. : 1960)120(4), 481–484. https://doi.org/10.1001/archopht.120.4.481

Campochiaro, P. A., Brown, D. M., Pearson, A., Chen, S., Boyer, D., Ruiz-Moreno, J., Garretson, B., Gupta, A., Hariprasad, S. M., Bailey, C., Reichel, E., Soubrane, G., Kapik, B., Billman, K., Kane, F. E., Green, K., & FAME Study Group (2012). Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema. Ophthalmology119(10), 2125–2132. https://doi.org/10.1016/j.ophtha.2012.04.030

Cao, H., Ou, J., Chen, L., Zhang, Y., Szkudelski, T., Delmas, D., Daglia, M., & Xiao, J. (2019). Dietary polyphenols and type 2 diabetes: Human Study and Clinical Trial. Critical Reviews in Food Science and Nutrition59(20), 3371–3379.https://doi.org/10.1080/10408398.2018.1492900

Chawla, A., Chawla, R., & Jaggi, S. (2016). Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Indian Journal of Endocrinology and Metabolism20(4), 546–551. https://doi.org/10.4103/2230-8210.183480

Cheung, N., Mitchell, P., & Wong, T. Y. (2010). Diabetic retinopathy. Lancet (London, England)376(9735), 124–136. https://doi.org/10.1016/S0140-6736(09)62124-3

Cohen, S. R., & Gardner, T. W. (2016). Diabetic Retinopathy and Diabetic Macular Edema. Developments in Ophthalmology55, 137–146. https://doi.org/10.1159/000438970

Borodina, T., Kostyushev, D., Zamyatnin, A. A., & Parodi, A. (2021). Nanomedicine for Treating Diabetic Retinopathy Vascular Degeneration. International Journal of Translational Medicine1(3), 306-322

Deswal, J., Narang, S., Gupta, N., Jinagal, J., & Sindhu, M. (2020). To study the impact of diabetic retinopathy on quality of life in Indian diabetic patients. Indian Journal of Ophthalmology68(5), 848–853. https://doi.org/10.4103/ijo.IJO_1553_19

Dong, C., Liu, P., Wang, H., Dong, M., Li, G., & Li, Y. (2019). Ginsenoside Rb1 attenuates diabetic retinopathy in streptozotocin-induced diabetic rats1. Acta Cirurgica Brasileira34(2), e201900201. https://doi.org/10.1590/s0102-8650201900201

Effects of aspirin treatment on diabetic retinopathy. ETDRS report number 8. Early Treatment Diabetic Retinopathy Study Research Group. (1991). Ophthalmology98(5 Suppl), 757–765

Fathalipour, M., Fathalipour, H., Safa, O., Nowrouzi-Sohrabi, P., Mirkhani, H., & Hassanipour, S. (2020). The Therapeutic Role of Carotenoids in Diabetic Retinopathy: A Systematic Review. Diabetes, Metabolics Syndrome and Obesity Targets and Therapy13, 2347–2358. https://doi.org/10.2147/DMSO.S255783.

Gao, Y., Ji, Y., Luo, Y., Sun, J., Sun, G., & Sun, X. (2020). Ginsenoside Rg1 prevents early diabetic retinopathy via reducing retinal ganglion cell layer and inner nuclear layer cell apoptosis in db/db mice. Annals of Translational Medicine8(5), 232. https://doi.org/10.21037/atm.2019.12.155

Hendrick, A. M., Gibson, M. V., & Kulshreshtha, A. (2015). Diabetic Retinopathy. Primary Care42(3), 451–464. https://doi.org/10.1016/j.pop.2015.05.005

Heng, L. Z., Comyn, O., Peto, T., Tadros, C., Ng, E., Sivaprasad, S., & Hykin, P. G. (2013). Diabetic retinopathy: pathogenesis, clinical grading, management and future developments. Diabetic Medicine: A Journal of the British Diabetic Association30(6), 640–650. https://doi.org/10.1111/dme.12089

https://www.clinicaltrials.gov

Kaštelan, S., Tomić, M., Gverović Antunica, A., Salopek Rabatić, J., & Ljubić, S. (2013). Inflammation and pharmacological treatment in diabetic retinopathy. Mediators of inflammation2013, 213130. https://doi.org/10.1155/2013/213130

Kim, S. J., Flach, A. J., & Jampol, L. M. (2010). Nonsteroidal anti-inflammatory drugs in ophthalmology. Survey of Opthalmology55(2), 108–133. https://doi.org/10.1016/j.survophthal.2009.07.005

Klein, B. E., Moss, S. E., & Klein, R. (1990). Effect of pregnancy on progression of diabetic retinopathy. Diabetes Care13(1), 34–40. https://doi.org/10.2337/diacare.13.1.34

Kwan, C. C., & Fawzi, A. A. (2019). Imaging and Biomarkers in Diabetic Macular Edema and Diabetic Retinopathy. Current diabetes reports19(10), 95. https://doi.org/10.1007/s11892-019-1226-2

Lightman, S., & Towler, H. M. (2003). Diabetic retinopathy. Clinical Cornerstone5(2), 12–21. https://doi.org/10.1016/s1098-3597(03)90015-9

Morrison, J. L., Hodgson, L. A., Lim, L. L., & Al-Qureshi, S. (2016). Diabetic retinopathy in pregnancy: a review. Clinical &Experimental Ophthalmology44(4), 321–334. https://doi.org/10.1111/ceo.12760

Nabavi, S. F., Barber, A. J., Spagnuolo, C., Russo, G. L., Daglia, M., Nabavi, S. M., & Sobarzo-Sánchez, E. (2016). Nrf2 as molecular target for polyphenols: A novel therapeutic strategy in diabetic retinopathy. Critical Reviews in Clinical Laboratory Sciences53(5), 293–312. https://doi.org/10.3109/10408363.2015.1129530

Nimse, S. B., & Pal, D. (2015). Free radicals, natural antioxidants, and their reaction mechanisms. RSC Advances5(35), 27986-28006

Pereira, D. M., Shah, A., D’Souza, M., Simon, P., George, T., D’Souza, N., Suresh, S., & Baliga, M. S. (2017). Quality of Life in People with Diabetic Retinopathy: Indian Study. Journal of Clinical and Diagnostic Research: JCDR11(4), NC01–NC06. https://doi.org/10.7860/JCDR/2017/24496.9686

Porta, M., & Bandello, F. (2002). Diabetic retinopathyA clinical update. Diabetologia45(12), 1617–1634. https://doi.org/10.1007/s00125-002-0990-7

Rossino, M. G., & Casini, G. (2019). Nutraceuticals for the Treatment of Diabetic Retinopathy. Nutrients11(4), 771. https://doi.org/10.3390/nu11040771

Sahoo, S., Barua, A., Myint, K. T., Haq, A., Abas, A. B., & Nair, N. S. (2015). Topical non-steroidal anti-inflammatory agents for diabetic cystoid macular oedema. The Cochrane Database of Systematic Reviews, (2), CD010009. https://doi.org/10.1002/14651858.CD010009.pub2

Sak, D., Erdenen, F., Müderrisoglu, C., Altunoglu, E., Sozer, V., Gungel, H., Guler, P. A., Sak, T., & Uzun, H. (2019). The Relationship between Plasma Taurine Levels and Diabetic Complications in Patients with Type 2 Diabetes Mellitus. Biomolecules9(3), 96. https://doi.org/10.3390/biom9030096

Garg, S., & Davis, R. M. (2009). Diabetic retinopathy screening update. Clinical Diabetes27(4), 140-145. https://doi.org/10.2337/diaclin.27.4.140

Semeraro, F., Russo, A., Gambicorti, E., Duse, S., Morescalchi, F., Vezzoli, S., & Costagliola, C. (2015). Efficacy and vitreous levels of topical NSAIDs. Expert Opinion on Drug Delivery12(11), 1767–1782. https://doi.org/10.1517/17425247.2015.1068756

Sun, H. H., Chai, X. L., Li, H. L., Tian, J. Y., Jiang, K. X., Song, X. Z., Wang, X. R., Fang, Y. S., Ji, Q., Liu, H., Hao, G. M., Wang, W., & Han, J. (2021). Fufang Xueshuantong alleviates diabetic retinopathy by activating the PPAR signalling pathway and complement and coagulation cascades. Journal of Ethnopharmacology265, 113324. https://doi.org/10.1016/j.jep.2020.113324

Tan, C. S., Chew, M. C., Lim, L. W., & Sadda, S. R. (2016). Advances in retinal imaging for diabetic retinopathy and diabetic macular edema. Indian Journal of Ophthalmology64(1), 76–83. https://doi.org/10.4103/0301-4738.178145

UK Prospective Diabetes Study Group (1998). Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ (Clinical research ed.)317(7160), 703–713

Unnikrishnan, R., Anjana, R. M., & Mohan, V. (2016). Diabetes mellitus and its complications in India. Nature reviews. Endocrinology12(6), 357–370. https://doi.org/10.1038/nrendo.2016.53

Diabetic Retinopathy Clinical Research Network, Wells, J. A., Glassman, A. R., Ayala, A. R., Jampol, L. M., Aiello, L. P., Antoszyk, A. N., Arnold-Bush, B., Baker, C. W., Bressler, N. M., Browning, D. J., Elman, M. J., Ferris, F. L., Friedman, S. M., Melia, M., Pieramici, D. J., Sun, J. K., & Beck, R. W. (2015). Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. The New England Journal of Medicine372(13), 1193–1203. https://doi.org/10.1056/NEJMoa1414264

Wells, J. A., Glassman, A. R., Ayala, A. R., Jampol, L. M., Bressler, N. M., Bressler, S. B., Brucker, A. J., Ferris, F. L., Hampton, G. R., Jhaveri, C., Melia, M., Beck, R. W., & Diabetic Retinopathy Clinical Research Network (2016). Aflibercept, Bevacizumab, or Ranibizumab for Diabetic Macular Edema: Two-Year Results from a Comparative Effectiveness Randomized Clinical Trial. Ophthalmology123(6), 1351–1359. https://doi.org/10.1016/j.ophtha.2016.02.022

Whitehead, M., Wickremasinghe, S., Osborne, A., Van Wijngaarden, P., & Martin, K. R. (2018). Diabetic retinopathy: a complex pathophysiology requiring novel therapeutic strategies. Expert Opinion on Biological Therapy18(12), 1257-1270. https://doi.org/10.1080/14712598.2018.1545836

Woodcock, A., Bradley, C., Plowright, R., ffytche, T., Kennedy-Martin, T., & Hirsch, A. (2004). The influence of diabetic retinopathy on quality of life: interviews to guide the design of a condition-specific, individualised questionnaire: the RetDQoL. Patient Education and Counseling53(3), 365–383. https://doi.org/10.1016/j.pec.2003.10.007

Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group (2002). Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA287(19), 2563–2569. https://doi.org/10.1001/jama.287.19.2563

Yau, J. W., Rogers, S. L., Kawasaki, R., Lamoureux, E. L., Kowalski, J. W., Bek, T., Chen, S. J., Dekker, J. M., Fletcher, A., Grauslund, J., Haffner, S., Hamman, R. F., Ikram, M. K., Kayama, T., Klein, B. E., Klein, R., Krishnaiah, S., Mayurasakorn, K., O’Hare, J. P., Orchard, T. J., … Meta-Analysis for Eye Disease (META-EYE) Study Group (2012). Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care35(3), 556–564. https://doi.org/10.2337/dc11-1909

Zhou, P., Xie, W., Meng, X., Zhai, Y., Dong, X., Zhang, X., Sun, G., & Sun, X. (2019). Notoginsenoside R1 Ameliorates Diabetic Retinopathy through PINK1-Dependent Activation of Mitophagy. Cells8(3), 213. https://doi.org/10.3390/cells8030213

How to Cite

Rupinder Kaur, Rithik, Kirti, Suman Baishnab and Shareen Singh. Diabetic Retinopathy: An Insight into Clinical Features, Therapeutic Approaches, and Implications. J. Pharm. Technol. Res. Manag.. 2021, 09, 17-27
Diabetic Retinopathy: An Insight into Clinical Features, Therapeutic Approaches, and Implications

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