A New Approach to Staging Diabetic Eye Disease: Staging of Diabetic Retinal Neurodegeneration and Diabetic Macular Edema

Overview

Journal Ophthalmol Sci

Specialty Ophthalmology

Date 2024 Jan 29

PMID 38284099

Authors

Roomasa Channa

Risa M Wolf

Rafael Simo

Mitchell Brigell

Patrice Fort

Christine Curcio

Stephanie Lynch

Frank Verbraak

Michael D Abramoff

Affiliations

Soon will be listed here.

Abstract

Topic: The goal of this review was to summarize the current level of evidence on biomarkers to quantify diabetic retinal neurodegeneration (DRN) and diabetic macular edema (DME).

Clinical Relevance: With advances in retinal diagnostics, we have more data on patients with diabetes than ever before. However, the staging system for diabetic retinal disease is still based only on color fundus photographs and we do not have clear guidelines on how to incorporate data from the relatively newer modalities into clinical practice.

Methods: In this review, we use a Delphi process with experts to identify the most promising modalities to identify DRN and DME. These included microperimetry, full-field flash electroretinogram, spectral-domain OCT, adaptive optics, and OCT angiography. We then used a previously published method of determining the evidence level to complete detailed evidence grids for each modality.

Results: Our results showed that among the modalities evaluated, the level of evidence to quantify DRN and DME was highest for OCT (level 1) and lowest for adaptive optics (level 4).

Conclusion: For most of the modalities evaluated, prospective studies are needed to elucidate their role in the management and outcomes of diabetic retinal diseases.

Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Citing Articles

Relationship of OCT-Based Diabetic Retinal Neurodegeneration to the Development and Progression of Diabetic Retinopathy: A Cohort Study.

Tang Z, Yang D, Nguyen T, Zhang S, Fang D, Chan V Invest Ophthalmol Vis Sci. 2025; 66(2):32.

PMID: 39932471 PMC: 11817850. DOI: 10.1167/iovs.66.2.32.

Ultrastructural imaging biomarkers in diabetic macular edema: A major review.

Sen S, Khalid H, Udaya P, Raman R, Rajendram R, ElHousseini Z Indian J Ophthalmol. 2024; 73(Suppl 1):S7-S23.

PMID: 39723865 PMC: 11834929. DOI: 10.4103/IJO.IJO_878_24.

Mitigation of AI adoption bias through an improved autonomous AI system for diabetic retinal disease.

Abramoff M, Lavin P, Jakubowski J, Blodi B, Keeys M, Joyce C NPJ Digit Med. 2024; 7(1):369.

PMID: 39702673 PMC: 11659561. DOI: 10.1038/s41746-024-01389-x.

Diabetes Renders Photoreceptors Susceptible to Retinal Ischemia-Reperfusion Injury.

Antonetti D, Lin C, Shanmugam S, Hager H, Cao M, Liu X Invest Ophthalmol Vis Sci. 2024; 65(13):46.

PMID: 39570639 PMC: 11585066. DOI: 10.1167/iovs.65.13.46.

Data Harmonization, Standardization, and Collaboration for Diabetic Retinal Disease (DRD) Research: Report From the 2024 Mary Tyler Moore Vision Initiative Workshop on Data.

Domalpally A, Fickweiler W, Levine S, Goetz K, VanderBeek B, Lee A Transl Vis Sci Technol. 2024; 13(10):4.

PMID: 39361314 PMC: 11451832. DOI: 10.1167/tvst.13.10.4.

References

Simo R, Stitt A, Gardner T . Neurodegeneration in diabetic retinopathy: does it really matter?. Diabetologia. 2018; 61(9):1902-1912. PMC: 6096638. DOI: 10.1007/s00125-018-4692-1. View

Lee J, Moon B, Cho A, Yoon Y . Optical Coherence Tomography Angiography of DME and Its Association with Anti-VEGF Treatment Response. Ophthalmology. 2016; 123(11):2368-2375. DOI: 10.1016/j.ophtha.2016.07.010. View

Lim H, Shin Y, Lee M, Koo H, Lee W, Kim J . Ganglion Cell - Inner Plexiform Layer Damage in Diabetic Patients: 3-Year Prospective, Longitudinal, Observational Study. Sci Rep. 2020; 10(1):1470. PMC: 6992712. DOI: 10.1038/s41598-020-58465-x. View

Al-Hawasi A, Lagali N . Retinal ganglion cell layer thickness and volume measured by OCT changes with age, sex, and axial length in a healthy population. BMC Ophthalmol. 2022; 22(1):278. PMC: 9233375. DOI: 10.1186/s12886-022-02488-7. View

Kashani A, Green K, Kwon J, Chu Z, Zhang Q, Wang R . Suspended Scattering Particles in Motion: A Novel Feature of OCT Angiography in Exudative Maculopathies. Ophthalmol Retina. 2018; 2(7):694-702. PMC: 6133252. DOI: 10.1016/j.oret.2017.11.004. View

Hamilton R, Graham K . Effect of shorter dark adaptation on ISCEV standard DA 0.01 and DA 3 skin ERGs in healthy adults. Doc Ophthalmol. 2016; 133(1):11-9. DOI: 10.1007/s10633-016-9554-x. View

Tam J, Dhamdhere K, Tiruveedhula P, Manzanera S, Barez S, Bearse Jr M . Disruption of the retinal parafoveal capillary network in type 2 diabetes before the onset of diabetic retinopathy. Invest Ophthalmol Vis Sci. 2011; 52(12):9257-66. PMC: 3302433. DOI: 10.1167/iovs.11-8481. View

Rodriguez Gonzalez-Herrero M, Ruiz M, Roman F, Marin Sanchez J, Domingo J . Supplementation with a highly concentrated docosahexaenoic acid plus xanthophyll carotenoid multivitamin in nonproliferative diabetic retinopathy: prospective controlled study of macular function by fundus microperimetry. Clin Ophthalmol. 2018; 12:1011-1020. PMC: 5983010. DOI: 10.2147/OPTH.S157635. View

Banghart M, Lee K, Bahrainian M, Staggers K, Amos C, Liu Y . Total retinal thickness: a neglected factor in the evaluation of inner retinal thickness. BMJ Open Ophthalmol. 2022; 7(1). PMC: 9528673. DOI: 10.1136/bmjophth-2022-001061. View

10.

Johnson C, Adams A, Lewis R . Evidence for a neural basis of age-related visual field loss in normal observers. Invest Ophthalmol Vis Sci. 1989; 30(9):2056-64. View

11.

Park J, Chen Y, Liu M, Liu K, McAnany J . Structural and Functional Abnormalities in Early-stage Diabetic Retinopathy. Curr Eye Res. 2019; 45(8):975-985. PMC: 7347436. DOI: 10.1080/02713683.2019.1705983. View

12.

Tang F, Ng D, Lam A, Luk F, Wong R, Chan C . Determinants of Quantitative Optical Coherence Tomography Angiography Metrics in Patients with Diabetes. Sci Rep. 2017; 7(1):2575. PMC: 5451475. DOI: 10.1038/s41598-017-02767-0. View

13.

Browning D, Glassman A, Aiello L, Bressler N, Bressler S, Danis R . Optical coherence tomography measurements and analysis methods in optical coherence tomography studies of diabetic macular edema. Ophthalmology. 2008; 115(8):1366-71, 1371.e1. PMC: 2748270. DOI: 10.1016/j.ophtha.2007.12.004. View

14.

Kim K, Kim E, Yu S . Longitudinal Relationship Between Retinal Diabetic Neurodegeneration and Progression of Diabetic Retinopathy in Patients With Type 2 Diabetes. Am J Ophthalmol. 2018; 196:165-172. DOI: 10.1016/j.ajo.2018.08.053. View

15.

Hammoum I, Benlarbi M, Dellaa A, Kahloun R, Messaoud R, Amara S . Retinal dysfunction parallels morphologic alterations and precede clinically detectable vascular alterations in Meriones shawi, a model of type 2 diabetes. Exp Eye Res. 2018; 176:174-187. DOI: 10.1016/j.exer.2018.07.007. View

16.

Wilkinson C, Ferris 3rd F, Klein R, Lee P, Agardh C, Davis M . Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003; 110(9):1677-82. DOI: 10.1016/S0161-6420(03)00475-5. View

17.

Glassman A, Beck R, Browning D, Danis R, Kollman C . Comparison of optical coherence tomography in diabetic macular edema, with and without reading center manual grading from a clinical trials perspective. Invest Ophthalmol Vis Sci. 2008; 50(2):560-6. PMC: 2800257. DOI: 10.1167/iovs.08-1881. View

18.

Browning D, Glassman A, Aiello L, Beck R, Brown D, Fong D . Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2006; 114(3):525-36. PMC: 2585542. DOI: 10.1016/j.ophtha.2006.06.052. View

19.

Greig E, Brigell M, Cao F, Levine E, Peters K, Moult E . Macular and Peripapillary Optical Coherence Tomography Angiography Metrics Predict Progression in Diabetic Retinopathy: A Sub-analysis of TIME-2b Study Data. Am J Ophthalmol. 2020; 219:66-76. DOI: 10.1016/j.ajo.2020.06.009. View

20.

Toscano L, Messias A, Messias K, de Cenco Lopes R, Ribeiro J, Scott I . Proliferative diabetic retinopathy treated with intravitreal ranibizumab and photocoagulation directed at ischemic retinal areas-A randomized study. Doc Ophthalmol. 2021; 143(3):313-322. DOI: 10.1007/s10633-021-09848-6. View