"Classic diabetic retinopathy treatments are not always effective and produce significant side effects, such as a reduction in the field of night vision or contrast sensitivity," indicated Dr. José García-Arumí, IMO retina specialist, today during the retina conference being held in Barcelona that has brought together 300 ophthalmologists from around the world.
By "classic treatments" García-Arumí referred to laser photocoagulation that, despite being "an effective treatment in patients with diabetic macular oedema, cutting the risk of vision loss by half, the destructive nature of the laser and the delayed response in terms of visual benefits have led us to assess other forms of treatment." Among these, the specialist highlighted the intraocular injecting of drugs "such as ranibizumab (Lucentis) or bevacizumab (Avastin) antibodies or triamcinolone or dexamethasone in slow-release systems".
As to another "classic" treatment, surgery, which is currently the only solution for patients with advanced, proliferative diabetic retinopathy, improved results were due to advances in surgical and diagnostic techniques and the early detection of possible complications. The ophthalmologist underlined the important role of optical coherence tomography (OCT), a new technique "that helps in early diagnosis and in controlling evolution after treatment."
Among the surgical advances, García-Arumí highlighted viscodisection, a technique that is used in combination with vitrectomy surgery and consists of introducing a viscous liquid into the retina to separate its proliferative membrane. This procedure, which ceased to be performed years ago, currently offers good results thanks to new cannula and small gauge instruments to perform it, developed by IMO specialist and presented today at the Retina Conference.
Insofar as the future is concerned, the challenges in the treatment of diabetic retinopathy are, according to the ophthalmologist, genetic detection of patients with a risk of proliferation and the use of protective molecules. "We are working on inducing the production of these molecules by the retina cells by using non-viral vectors that change the genetic code of these cells," he indicated. According to García-Arumí, this line of work seeks to "solve the imbalance of the retina protection systems that produce genes by introducing nanoparticles that change the genetic code of these cells, so that they increase protective factors and the balance is re-established." This genetic engineering technique "is already being developed in vitro and in animals," explained IMO specialist.
Diabetic retinopathy is the most common vascular disease of the retina, the vessels of which are damaged by the metabolic decompensation of diabetes. This leads to the spontaneous creation of new, fragile vessels that lose fluid, which could significantly affect vision.
The risk of total vision loss is 25 times higher in diabetics than in the general population. Therefore, diabetes is currently considered the most common cause of blindness among the active population in industrialised countries and accounts for between 20 and 30% of total blindness. The high rate of complications associated with the illness, such as macular oedema, vitreous haemorrhage and retinal detachment, means that diabetics must keep a strict control of their glycaemia, blood pressure and plasmatic lipids, as well as avoiding tobacco. Furthermore, they must also have the retina regularly examined, as diabetic retinopathy generally causes no symptoms until the damage is severe.