Presentations given during session included some providing information with direct clinical application for the management of patients with diabetic eye disease and others with potential future implications.
Treatment personalisation was the subject of two talks during the session. First, Dr José Cunha-Vaz (Portugal) discussed risk markers of progression of severe nonproliferative diabetic retinopathy (NPDR). “Diabetic retinopathy is a frequent complication of diabetes, and it may lead to blindness through its vision-threatening complications, ie, clinically significant macular edema (CSME) and proliferative diabetic retinopathy (PDR). However, the progression of NPDR to vision-threatening stages varies from individual to individual. It is, therefore, crucial to identify progression of the retinopathy in individuals and predict which patients with diabetes are at a high risk for progression to vision loss,” Dr Cunha-Vaz said.
He discussed three major disease pathways that are central to the progression of diabetic retinal disease: neurodegeneration, alteration of the blood-retinal barrier, and vessel hypoperfusion and closure, noted they correspond to different phenotypes and that the different phenotypes have been shown to be associated with different risks for progression and development of vision-threatening complications.
Dr Cunha-Vaz said it is now apparent that DR progression can be characterised by an initial stage of increasing hypoperfusion, which initially involves the superficial capillary plexus with progression to involve the deep capillary plexus and extension from the centre to the periphery, followed by an hyperperfusion response with the development of dilated shunt vessels and finally intraretinal microvascular abnormalities, which identify the more advanced NPDR stages.
The ability to monitor the balance between the initial hypoperfusion stage and the hyperperfusion response using metrics of capillary perfusion and microaneurysm counting obtained with non-invasive technologies (OCT angiography and fundus photography, respectively) open ways to predict risk of progression to vision-threatening complications in a given eye,” Dr Cunha-Vaz said.
A personalised medicine approach to DME management based on identifying DME clinical phenotypes was the topic of a talk by Dr Edoardo Midena (Italy). Dr Midena explained how the integration of OCT imaging with “omics” allowed the identification of different DME phenotypes, avoiding a “one-size-fits-all” treatment strategy that has a failure rate of about 40%. “With the contribution of biologic markers, we identified two DME populations where a personalised treatment may be more successful than the so-called standard of care. This means that integrating information derived by different sources we are able to treat DME according to the most updated standard of care, which is strictly dependent on precise validated biomarkers,” Dr Midena said.
In another talk that has direct application to patient care, Dr David Steel (United Kingdom) discussed the role of anti-VEGF injections for managing diabetic vitreous haemorrhage (VH) by using available evidence and his own experience to answer a series of related questions. Dr Steel concluded that VH is relatively common with PDR. Therefore, patients should be warned that it occurs in a significant proportion of appropriately treated patients. He said that vitrectomy remains the gold standard treatment for persistent, fundal obscuring or vision affecting VH and that anti-VEGF treatment can clear VH and avoid vitrectomy in some very selected patients, but with some risk.
Dr Steel also showed that anti-VEGF treatment given prior to vitrectomy can improve the outcome and reduce the rate of postoperative vitreous cavity haemorrhage (POVCH) and said that anti-VEGF injection can be considered in cases of late recurrent POVCH.
The session also included a talk about new insights in diabetic retinopathy and their clinical potential by Dr Reinier O Schlingemann (Netherlands). In addition, Dr Amani Fawzi (United States) discussed pathophysiologic insights revealed by imaging the retinal pericytes in diabetes.
Registered attendees can watch the session On Demand.
