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Ríos HA, Lövestam-Adrian M, Plainis S, Tsilimbaris M, Joussen AM, Keegan D, Charles M, Cunha-Vaz J, Midena E. Additional measures of macular function beyond visual acuity. Graefes Arch Clin Exp Ophthalmol 2024; 262:1723-1736. [PMID: 37938378 PMCID: PMC11106142 DOI: 10.1007/s00417-023-06272-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
PURPOSE Visual function is a complex process in which external visual stimuli are interpreted. Patients with retinal diseases and prolonged follow-up times may experience changes in their visual function that are not detected by the standard visual acuity measure, as they are a result of other alterations in visual function. With the advancement of different methods to evaluate visual function, additional measurements have become available, and further standardization suggests that some methods may be promising for use in clinical trials or routine clinical practice. The objectives of this article are to review these additional measurements and to provide guidance on their application. METHODS The Vision Academy's membership of international retinal disease experts reviewed the literature and developed consensus recommendations for the application of additional measures of visual function in routine clinical practice or clinical trials. RESULTS Measures such as low-luminance visual acuity, contrast sensitivity, retinal fixation and microperimetry, and reading performance are measures which can complement visual acuity measurements to provide an assessment of overall visual function, including impact on patients' quality of life. Measures such as dark adaptation, color vision testing, binocular vision testing, visual recognition testing, and shape discrimination require further optimization and validation before they can be implemented in everyday clinical practice. CONCLUSION Additional measurements of visual function may help identify patients who could benefit from earlier diagnosis, detection of disease progression, and therapeutic intervention. New and additional functional clinical trial endpoints are required to fully understand the early stages of macular disease, its progression, and the response to treatment.
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Affiliation(s)
- Hernán Andrés Ríos
- Retina y Vítreo, Fundación Oftalmológica Nacional, Universidad del Rosario, Bogotá, Colombia
| | | | - Sotiris Plainis
- Laboratory of Optics and Vision, University of Crete Medical School, Heraklion, Crete, Greece
| | - Miltiadis Tsilimbaris
- Laboratory of Optics and Vision, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - David Keegan
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - José Cunha-Vaz
- AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - Edoardo Midena
- Department of Ophthalmology, University of Padova, Padua, Italy.
- IRCCS Fondazione Bietti, Rome, Italy.
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Pradhana D, Priya NS, Manayath GJ, Kulkarni S, Behera UC, Agarwal T, Agarwal M, Shah S, Giridhar A, Surya J, Ramasamy K, Vignesh TP, Shoba S, Bhende M, Raman R. Natural course of non-center-involving diabetic macular edema progression in patients under initial observation. Indian J Ophthalmol 2024; 72:236-239. [PMID: 38153973 PMCID: PMC10941951 DOI: 10.4103/ijo.ijo_2182_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/23/2023] [Accepted: 07/25/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE We aim to report the natural course of non-center involving diabetic macular edema (NCIDME) progression to center involving diabetic macular edema (CIDME) and associated risk factors. METHODS This is a multicenter retrospective comparative study. Data was collected from electronic medical records from 8 centers in India covering. We included patients with type 2 diabetes above 18 years of age with treatment-naïve NCIDME on OCT and best-corrected visual acuity at baseline of 6/12 or better who were under observation for NCIDME and had 2 years follow-up data. RESULTS Out of 72 patients with NCIDME, 26.38% patients progressed to CI DME by 2 years, and the visit wise proportion was 11.11% at 6 months, 7% at 1st year and 8.3% at 2 years. The change in CST was statistically significant at 2 years in patients who developed CIDME, the mean difference was 137.73 ± 48.56 microns p = 0.045. Duration of diabetes mellitus > 10 years was the only risk factor for conversion to CIDME. CONCLUSION A quarter of eyes with NCIDME developed CIDME and 15% progressed from NPDR to PDR by 2 years, highlighting the disease burden in these patients with NCIDME.
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Affiliation(s)
- Divya Pradhana
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - N Swathi Priya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - George J Manayath
- Department of Vitreo Retina, Aravind Eye Hospital and Post Graduate Institute, Coimbatore, Tamil Nadu, India
| | - Sucheta Kulkarni
- Department of Vitreo Retina, H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Umesh C Behera
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Tushar Agarwal
- Retina Vitreous Service, L. V. Prasad Eye Institute, Mithu Tulsi Chanrai Campus, Bhubaneswar, Odisha, India
| | - Manisha Agarwal
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - Shalin Shah
- Department of Vitreo Retina, Dr. Shroffs Eye Hospital, New Delhi, India
| | - A Giridhar
- Department of Vitreo Retina, Giridhar Eye Institute, Kerala, India
| | - Janani Surya
- Shri Bhagawan Mahavir Vitreoretinal Services, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Kim Ramasamy
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - TP Vignesh
- Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Sivaprasad Shoba
- Department of Vitreo Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Muna Bhende
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Zhang S, Wei X, Bowers M, Jessberger S, Golczak M, Semenkovich CF, Rajagopal R. Increasing Energetic Demands on Photoreceptors in Diabetes Corrects Retinal Lipid Dysmetabolism and Reduces Subsequent Microvascular Damage. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:2144-2155. [PMID: 37741454 PMCID: PMC10777362 DOI: 10.1016/j.ajpath.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/14/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
Mechanisms responsible for the pathogenesis of diabetic retinal disease remain incompletely understood, but they likely involve multiple cellular targets, including photoreceptors. Evidence suggests that dysregulated de novo lipogenesis in photoreceptors is a critical early target of diabetes. Following on this observation, the present study aimed to determine whether two interventions shown to improve diabetic retinopathy in mice-pharmacologic visual cycle inhibition and prolonged dark adaptation-reduce photoreceptor anabolic lipid metabolism. Elevated retinal lipid biosynthetic signaling was observed in two mouse models of diabetes, with both models showing reduced retinal AMP-activated kinase (AMPK) signaling, elevated acetyl CoA carboxylase (ACC) signaling, and increased activity of fatty acid synthase, which promotes lipotoxicity in photoreceptors. Although retinal AMPK-ACC axis signaling was dependent on systemic glucose fluctuations in healthy animals, mice with diabetes lacked such regulation. Visual cycle inhibition and prolonged dark adaptation reversed abnormal retinal AMPK-ACC signaling in mice with diabetes. Although visual cycle inhibition reduced the severity of diabetic retinopathy in control mice, as assessed by retinal capillary atrophy, this intervention was ineffective in fatty acid synthase gain-of-function mice. These results suggest that early diabetic retinopathy is characterized by glucose-driven elevations in retinal lipid biosynthetic activity, and that two interventions known to increase photoreceptor glucose demands alleviate disease by reversing these signals.
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Affiliation(s)
- Sheng Zhang
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Xiaochao Wei
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Megan Bowers
- Faculties of Medicine and Science, Laboratory of Neural Plasticity, Brain Research Institute, University of Zurich, Zurich, Switzerland
| | - Sebastian Jessberger
- Faculties of Medicine and Science, Laboratory of Neural Plasticity, Brain Research Institute, University of Zurich, Zurich, Switzerland
| | - Marcin Golczak
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Clay F Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, St. Louis, Missouri; Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, Missouri
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri.
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Chen Z, Chen B, Hu P, Liu H, Zheng D. A preliminary observation on rod cell photobiomodulation in treating diabetic macular edema. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100051. [PMID: 37846386 PMCID: PMC10577862 DOI: 10.1016/j.aopr.2022.100051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/25/2022] [Accepted: 04/21/2022] [Indexed: 10/18/2023]
Abstract
Purpose To evaluate the safety and effectiveness of photobiomodulation (PBM) in the treatment of diabetic macular edema (DME). Methods It was a single-center, self-controlled prospective study. The clinical records of 12 diabetic retinopathy patients (5 males and 7 females, 20 eyes in total) who were treated with PBM for DME at the Second Affiliated Hospital, Zhejiang University School of Medicine, were analyzed. The mean age was 56 (26-68) years. All the participants received PBM treatment during darkness at night in no less than 5 days per week and no less than 8 h per day. In the baseline check and follow-up checks (1, 2, 6, 10, and 12 months after the start of treatment), the best-corrected visual acuity, the thickness of the retina in the macula, and the changes of the fundus lesions were observed. Wilcoxon signed rank test was used to compare the results before and after treatment. P < 0.05 was considered statistically significant. Results No fundus complication was observed during follow-up checks. In baseline and 12-month follow-up checks, the best-corrected visual acuity was 71.75 ± 12.47 and 79.50 ± 10.85, maximal retinal thickness in macular area was 390.95 ± 77.12 μm and 354.13 ± 55.03 μm, average retinal thickness in macular area was 334.25 ± 36.45 μm and 314.31 ± 33.28 μm, foveal thickness was 287.00 ± 46.79 μm and 265.63 ± 67.14 μm. The best-corrected visual acuity, average retinal thickness in macular area in consecutive follow-up results except that in the 1st month showed significant difference compared with baseline results. There were significant difference between every follow-up result and baseline result of maximal retinal thickness in macular area (P < 0.05). All follow-up results of foveal thickness were not significantly different (P > 0.05) from the baseline result, except that in the 6th month (P = 0.049). Obvious improvement could be observed in retinal fundus fluorescein angiography images. Conclusions PBM is a safe and effective treatment of DME, which deserves further investigation.
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Affiliation(s)
- Zhiqing Chen
- Eye Centre, The Second Affiliated Hospital of the School of Medicine, Zhejiang University, Hangzhou, China
| | - Binbin Chen
- Eye Centre, The Second Affiliated Hospital of the School of Medicine, Zhejiang University, Hangzhou, China
| | - Peike Hu
- Eye Centre, The Second Affiliated Hospital of the School of Medicine, Zhejiang University, Hangzhou, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, University of Coventry, Coventry, UK
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, University of Coventry, Coventry, UK
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Qin YJ, Zhang YL, Zhang YQ, He BT, Wang S, Yu HH, Chan SO, Zhang HY. ELEVATED LEVEL OF URIC ACID, BUT NOT GLUCOSE, IN AQUEOUS HUMOR AS A RISK FACTOR FOR DIABETIC MACULAR EDEMA IN PATIENTS WITH TYPE 2 DIABETES. Retina 2022; 42:1121-1129. [PMID: 35174802 DOI: 10.1097/iae.0000000000003424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine the association of uric acid (UA) and glucose in aqueous humor with diabetic macular edema (DME) in patients with Type 2 diabetes. METHODS Patients with DME or diabetes mellitus without retinopathy were enrolled from August 2016 to December 2020. Nondiabetic patients with age-related cataract or age-related macular degeneration were included as controls. RESULTS A total of 585 eyes from 585 patients were included for this study. Statistical analysis showed that aqueous UA was associated with central retinal thickness (r = 0.39, P < 0.0001), with higher levels of UA in severe DME and lower levels in mild DME, suggesting an ocular source of UA from the diabetic retina. Aqueous UA {odds ratio (OR), 6.88 (95% confidence interval [CI], 2.61-18.12)}, but not aqueous glucose (0.95 [95% CI, 0.73-1.23]) or serum UA (0.90 [95% CI, 0.66-1.23]), was a stronger predictor for DME than the duration of DM (1.26 [95% CI, 1.12-1.42]) or hemoglobin A1c (1.35 [95% CI, 0.99-1.83]). If aqueous UA (<2.46 mg/dL) and aqueous glucose (<6.43 mmol/L) were used as reference, high UA (≥2.46 mg/dL) alone was associated with 5.83-fold increase in risk of DME, but high glucose (≥6.43 mg/dL) alone was not associated with DME. CONCLUSION Increased aqueous UA, but not glucose, is an independent risk factor for DME. These data suggest that an intravitreal UA-lowering therapy could be beneficial for DME.
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Affiliation(s)
- Yong Jie Qin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Lin Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yu Qiao Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Bei Ting He
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Sheng Wang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Hong Hua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sun On Chan
- School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong, China; and
| | - Hong Yang Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Zhou D, Wu Y, Jiang K, Xu F, Hong R, Wang S. Identification of a risk prediction model for clinical prognosis in HER2 positive breast cancer patients. Genomics 2021; 113:4088-4097. [PMID: 34666190 DOI: 10.1016/j.ygeno.2021.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/03/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
Background New biomarkers are needed to identify different clinical outcomes for HER2+ breast cancer (BC). Methods Differential genes of HER2+ BC were screened based on TCGA database. We used WGCNA to identify the genes related to the survival. Genetic Algorithm was used to structure risk prediction model. The prognostic model was validated in GSE data. Results We constructed a risk prediction model of 6 genes to identify prognosis of HER2+ BC, including CLEC9A, PLD4, PIM1, PTK2B, AKNAD1 and C15orf27. Kaplan-Meier curve showed that the model effectively distinguished the survival of HER2+ BC patients. The multivariate Cox regression suggested that the risk model was an independent predictor for HER2+ BC. Analysis related to immune showed that significant differences in immune infiltration between high- and low-risk groups classified by the prognostic model. Conclusions Our study identified a risk prediction model of 6 genes that could distinguish the prognosis of HER2+ BC.
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Affiliation(s)
- Danyang Zhou
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Kuikui Jiang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Fei Xu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Ruoxi Hong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
| | - Shusen Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.
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A Real-World Single-Centre Study of Patients with Diabetic Macular Oedema Who Wore a Home-Use Sleep Mask (Noctura 400) for One Year. J Ophthalmol 2021; 2021:6612126. [PMID: 34258049 PMCID: PMC8249224 DOI: 10.1155/2021/6612126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
A “Real-World” single-centre observational study was carried out to analyse the effects of enhanced patient interaction with the use of the Noctura 400 sleep mask on a group of 26 diabetics displaying diabetic retinopathy (DR) and diabetic macular oedema (DMO), of which 24 completed the study. We hoped to find if patient compliance could be maintained and to determine the anatomical and functional consequences of consistent mask wear. While this study was ongoing, COVID-19 impacted on normal eye clinic practice, allowing an unexpected analysis of the effects of this disruption to the clinical system on mask wear and disease progress. Throughout the whole study, outcomes were positive, with a high level of consistent patient use of the mask, above 74% up to and beyond 1 year. Even during the COVID-19 1st lockdown in England, the patients maintained a 65% nightly light mask compliance. Statistically significant improvements in maculopathy, including cyst reduction (56.4% of eyes with cysts exhibited cyst shrinkage), and visual acuity (VA) improvement (42/48 eyes gained 5 letters or more) were observed and maintained to the end of the study. Anatomical improvement or stability was recorded in all but one study eye. This investigation shows that given that there is appropriate interaction with patients who are self-treating in home environment, a high level of patient compliance can be maintained, even while there are disruptions to the normal hospital clinic setup.
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Whiteside MM, Shorter ES, Margolis MS, Alvi F, Huecker JB, Than TP, Migneco MK, Harthan JS, Morettin CE, Hartwick ATE, Johnson SD, Perera CD, Gordon MO. Success of Masking 5% Povidone-Iodine Treatment: The Reducing Adenoviral Patient Infected Days Study. Optom Vis Sci 2021; 98:469-475. [PMID: 33973917 PMCID: PMC8665724 DOI: 10.1097/opx.0000000000001691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The effectiveness of masking is rarely evaluated or reported in single- or double-masked clinical trials. Knowledge of treatment assignment by participants and clinicians can bias the assessment of treatment efficacy. PURPOSE This study aimed to evaluate the effectiveness of masking in a double-masked trial of 5% povidone-iodine for the treatment of adenoviral conjunctivitis. METHODS The Reducing Adenoviral Patient Infected Days study is a double-masked, randomized trial comparing a one-time, in-office administration of 5% povidone-iodine with artificial tears for the treatment of adenoviral conjunctivitis. Masking was assessed by asking participants and masked clinicians at designated time points if they believed the treatment administered was povidone-iodine or artificial tears, or if they were unsure. Adequacy of masking was quantified using a modified Bang Blinding Index. RESULTS Immediately after treatment, 34% of participants who received povidone-iodine and 69% of those who received artificial tears guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.31 and -0.38, respectively). On day 4, 38% of the povidone-iodine participants and 52% of the artificial tear participants guessed incorrectly or were unsure of their treatment (modified Bang Indices of 0.24 and -0.05, respectively), indicating adequate and ideal masking. On days 1, 4, 7, 14, and 21, masked clinicians guessed incorrectly or were unsure of treatment in 53%, 50%, 40%, 39%, and 42% among povidone-iodine participants compared with 44%, 35%, 38%, 35%, and 39% among artificial tears participants, respectively. The modified Bang Indices for clinician masking in the povidone-iodine group ranged from -0.05 to 0.25 and from 0.13 to 0.29 in the artificial tears group. CONCLUSIONS Masking of participants and clinicians was adequate. Successful masking increases confidence that subjective measurements are not biased. We recommend quantitative assessment and reporting the effectiveness of masking in ophthalmic clinical trials.
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Affiliation(s)
| | - Ellen S Shorter
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Mathew S Margolis
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
| | - Fatima Alvi
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
| | - Julia B Huecker
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
| | - Tammy P Than
- Department of Optometry, Carl Vinson Veterans Medical Center, Dublin, Georgia
| | - Mary K Migneco
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
| | | | | | | | - Spencer D Johnson
- Northeastern State University College of Optometry, Tahlequah, Oklahoma
| | - Chamila D Perera
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
| | - Mae O Gordon
- Department of Ophthalmology and Visual Sciences, Washington University, St. Louis, Missouri
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Jones L, Hui A, Phan CM, Read ML, Azar D, Buch J, Ciolino JB, Naroo SA, Pall B, Romond K, Sankaridurg P, Schnider CM, Terry L, Willcox M. CLEAR - Contact lens technologies of the future. Cont Lens Anterior Eye 2021; 44:398-430. [PMID: 33775384 DOI: 10.1016/j.clae.2021.02.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
Contact lenses in the future will likely have functions other than correction of refractive error. Lenses designed to control the development of myopia are already commercially available. Contact lenses as drug delivery devices and powered through advancements in nanotechnology will open up further opportunities for unique uses of contact lenses. This review examines the use, or potential use, of contact lenses aside from their role to correct refractive error. Contact lenses can be used to detect systemic and ocular surface diseases, treat and manage various ocular conditions and as devices that can correct presbyopia, control the development of myopia or be used for augmented vision. There is also discussion of new developments in contact lens packaging and storage cases. The use of contact lenses as devices to detect systemic disease has mostly focussed on detecting changes to glucose levels in tears for monitoring diabetic control. Glucose can be detected using changes in colour, fluorescence or generation of electric signals by embedded sensors such as boronic acid, concanavalin A or glucose oxidase. Contact lenses that have gained regulatory approval can measure changes in intraocular pressure to monitor glaucoma by measuring small changes in corneal shape. Challenges include integrating sensors into contact lenses and detecting the signals generated. Various techniques are used to optimise uptake and release of the drugs to the ocular surface to treat diseases such as dry eye, glaucoma, infection and allergy. Contact lenses that either mechanically or electronically change their shape are being investigated for the management of presbyopia. Contact lenses that slow the development of myopia are based upon incorporating concentric rings of plus power, peripheral optical zone(s) with add power or non-monotonic variations in power. Various forms of these lenses have shown a reduction in myopia in clinical trials and are available in various markets.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong.
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Chau-Minh Phan
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Michael L Read
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Dimitri Azar
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA; Verily Life Sciences, San Francisco, CA, USA
| | - John Buch
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Brian Pall
- Johnson & Johnson Vision Care, Jacksonville, FL, USA
| | - Kathleen Romond
- Department of Ophthalmology and Visual Sciences, University of Illinois College of Medicine, Chicago, IL, USA
| | - Padmaja Sankaridurg
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia; Brien Holden Vision Institute, Sydney, Australia
| | | | - Louise Terry
- School of Optometry and Vision Sciences, Cardiff University, UK
| | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
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10
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Effects of emixustat hydrochloride in patients with proliferative diabetic retinopathy: a randomized, placebo-controlled phase 2 study. Graefes Arch Clin Exp Ophthalmol 2021; 259:369-378. [PMID: 32852613 PMCID: PMC7843479 DOI: 10.1007/s00417-020-04899-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/29/2020] [Accepted: 08/16/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To evaluate the effects of oral emixustat hydrochloride on pro-angiogenic and inflammatory cytokines in the aqueous humor, as well as other ophthalmic parameters, in subjects with proliferative diabetic retinopathy (PDR). METHODS Twenty-three patients with PDR, with or without diabetic macular edema (DME), were assigned to emixustat or placebo in daily oral doses ranging from 5 to 40 mg over a step-up titration period, for 84 days. The main outcome measures included levels of IL-1β, IL-6, IL-8, TGFβ-1, and VEGF in the aqueous humor. RESULTS Seven of 12 subjects (58%) who were randomized to emixustat and 11 of 12 subjects (92%) who were randomized to placebo completed the study. No statistically significant differences between treatment groups were observed for changes in any of the aqueous humor cytokines tested. However, median VEGF levels were slightly reduced in the emixustat but not the placebo group (- 70.0 pg/mL versus + 42.7 pg/mL, or - 11.8% versus + 6.7%). In a post hoc analysis of all subjects (with or without DME), statistically significant differences between treatment arms in mean changes from baseline in central subfield thickness (CST; emixustat - 11.9 μm, placebo + 36.2 μm; P = 0.076) and total macular volume (TMV; emixustat - 0.13 mm3, placebo + 0.23 mm3; P = 0.026) were observed, both favoring emixustat. Emixustat's safety profile was consistent with prior studies (i.e., the adverse events of delayed dark adaptation and visual impairment were more common in subjects treated with emixustat). CONCLUSION Although this pilot study did not demonstrate statistically significant differences in changes in aqueous humor cytokine levels between the emixustat and placebo groups, VEGF levels were slightly reduced in the emixustat but not in the placebo group. In addition, statistically significant differences favoring the emixustat group were observed in CST and TMV among all subjects. These data warrant further investigation of emixustat's potential therapeutic effects in diabetic retinopathy. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02753400 (April 2016).
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11
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Abstract
Based on clinical findings, diabetic retinopathy (DR) has traditionally been defined as a retinal microvasculopathy. Retinal neuronal dysfunction is now recognized as an early event in the diabetic retina before development of overt DR. While detrimental effects of diabetes on the survival and function of inner retinal cells, such as retinal ganglion cells and amacrine cells, are widely recognized, evidence that photoreceptors in the outer retina undergo early alterations in diabetes has emerged more recently. We review data from preclinical and clinical studies demonstrating a conserved reduction of electrophysiological function in diabetic retinas, as well as evidence for photoreceptor loss. Complementing in vivo studies, we discuss the ex vivo electroretinography technique as a useful method to investigate photoreceptor function in isolated retinas from diabetic animal models. Finally, we consider the possibility that early photoreceptor pathology contributes to the progression of DR, and discuss possible mechanisms of photoreceptor damage in the diabetic retina, such as enhanced production of reactive oxygen species and other inflammatory factors whose detrimental effects may be augmented by phototransduction.
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Abstract
Vision loss, among the most feared complications of diabetes, is primarily caused by diabetic retinopathy, a disease that manifests in well-recognized, characteristic microvascular lesions. The reasons for retinal susceptibility to damage in diabetes are unclear, especially considering that microvascular networks are found in all tissues. However, the unique metabolic demands of retinal neurons could account for their vulnerability in diabetes. Photoreceptors are the first neurons in the visual circuit and are also the most energy-demanding cells of the retina. Here, we review experimental and clinical evidence linking photoreceptors to the development of diabetic retinopathy. We then describe the influence of retinal illumination on photoreceptor metabolism, effects of light modulation on the severity of diabetic retinopathy, and recent clinical trials testing the treatment of diabetic retinopathy with interventions that impact photoreceptor metabolism. Finally, we introduce several possible mechanisms that could link photoreceptor responses to light and the development of retinal vascular disease in diabetes. Collectively, these concepts form the basis for a growing body of investigative efforts aimed at developing novel pharmacologic and nonpharmacologic tools that target photoreceptor physiology to treat a very common cause of blindness across the world.
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13
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Abstract
Blood flow in the retina increases in response to light-evoked neuronal activity, ensuring that retinal neurons receive an adequate supply of oxygen and nutrients as metabolic demands vary. This response, termed "functional hyperemia," is disrupted in diabetic retinopathy. The reduction in functional hyperemia may result in retinal hypoxia and contribute to the development of retinopathy. This review will discuss the neurovascular coupling signaling mechanisms that generate the functional hyperemia response in the retina, the changes to neurovascular coupling that occur in diabetic retinopathy, possible treatments for restoring functional hyperemia and retinal oxygen levels, and changes to functional hyperemia that occur in the diabetic brain.
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14
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Thebeau C, Zhang S, Kolesnikov AV, Kefalov VJ, Semenkovich CF, Rajagopal R. Light deprivation reduces the severity of experimental diabetic retinopathy. Neurobiol Dis 2020; 137:104754. [PMID: 31978605 DOI: 10.1016/j.nbd.2020.104754] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 12/30/2022] Open
Abstract
Illumination of the retina is a major determinant of energy expenditure by its neurons. However, it remains unclear whether light exposure significantly contributes to the pathophysiology of common retinal disease. Driven by the premise that light exposure reduces the metabolic demand of the retina, recent clinical trials failed to demonstrate a benefit for constant illumination in the treatment of diabetic retinopathy. Here, we instead ask whether light deprivation or blockade of visual transduction could modulate the severity of this common cause of blindness. We randomized adult mice with two different models of diabetic retinopathy to 1-3 months of complete dark housing. Unexpectedly, we find that diabetic mice exposed to short or prolonged light deprivation have reduced diabetes-induced retinal pathology, using measures of visual function, compared to control animals in standard lighting conditions. To corroborate these results, we performed assays of retinal vascular health in diabetic Gnat1-/- and Rpe65-/- mice, which lack phototransduction. Both mutants displayed less diabetes-associated retinal vascular disease compared to respective wild-type controls. Collectively, these results suggest that light-induced visual transduction promotes the development of diabetic retinopathy and implicate photoreceptors as an early source of visual pathology in diabetes.
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Affiliation(s)
- Christina Thebeau
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Sheng Zhang
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Alexander V Kolesnikov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Vladimir J Kefalov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Clay F Semenkovich
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine, Saint Louis, MO 63110, USA; Department of Cell Biology and Physiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, MO 63110, USA.
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15
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Dumpala S, Zele AJ, Feigl B. Outer Retinal Structure and Function Deficits Contribute to Circadian Disruption in Patients With Type 2 Diabetes. Invest Ophthalmol Vis Sci 2019; 60:1870-1878. [PMID: 31042793 DOI: 10.1167/iovs.18-26297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Light transmitted by retinal photoreceptors provides the input for circadian photoentrainment. In diabetes, there is a high prevalence of circadian and sleep disruption but the underlying causes are not well understood. Patients with diabetes can exhibit dysfunctional photoreceptors but their role in circadian health is not known. Here we quantify photoreceptor function and contributions to circadian health and sleep in patients with diabetes without diabetic retinopathy and healthy controls. Methods Rod, cone, and melanopsin function was derived using chromatic pupillometry in 47 participants including 23 patients with type 2 diabetes and 24 age-matched healthy controls after an ophthalmic examination including retinal thickness assessment using optical coherence tomography. Circadian health was determined using dim light melatonin onset (DLMO) and sleep questionnaires; light exposure was measured using actigraphy. Results Compared with the control group, the patients with diabetes had a significantly earlier DLMO (1 hour) (P = 0.008), higher subjective sleep scores (P < 0.05), a reduction in pupil constriction amplitude for red stimuli (P = 0.039) and for the early postillumination pupil response (PIPR) for blue (P = 0.024) stimuli. There were no between-group differences in the light exposure pattern, activity levels, and intrinsic melanopsin-mediated PIPR amplitude (P > 0.05). A significant correlation was evident between outer retinal thickness and DLMO (r = -0.65, P = 0.03) and the pupil constriction amplitude (r = 0.63, P = 0.03); patients with thinner retina had earlier DLMO and lower pupil amplitudes. Conclusions We infer that the observed changes in circadian function in patients with no diabetic retinopathy are due to structural and functional outer retinal rod photoreceptor deficits at early stage of diabetic eye disease.
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Affiliation(s)
- Sunila Dumpala
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Australia
| | - Andrew J Zele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Optometry and Vision Sciences, Queensland University of Technology, Brisbane, Australia
| | - Beatrix Feigl
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,School of Biomedical Sciences, Queensland University of Technology, Brisbane, Australia.,Queensland Eye Institute, Brisbane, Australia
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16
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Abstract
PURPOSE OF REVIEW To introduce recent advances in the understanding of diabetic retinopathy and to summarize current and emerging strategies to treat this common and complex cause of vision loss. RECENT FINDINGS Advances in retinal imaging and functional analysis indicate that retinal vascular and neural pathologies exist long before the development of clinically visible retinopathy. Such diagnostics could facilitate risk stratification and selective early intervention in high-risk patients. Antagonists of the vascular endothelial growth factor pathway effectively reduce vision loss in diabetes and promote regression of disease severity. Promising new strategies to treat diabetic retinopathy involve novel systemic diabetes therapy and ocular therapies that antagonize angiogenic growth factor signaling, improve blood-retina barrier function and neurovascular coupling, modulate neuroretinal metabolism, or provide neuroprotection. Long considered a pure microvasculopathy, diabetic retinopathy in fact affects the neural and vascular retina as well as neurovascular communication. Emerging therapies include those that target neuroretinal dysfunction in addition to those modulating vascular biology.
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Affiliation(s)
- Avinash Honasoge
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA
| | - Eric Nudleman
- Shiley Eye Institute, University of California, San Diego, La Jolla, CA, USA
| | - Morton Smith
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, 660 S. Euclid Ave. 8096, St. Louis, MO, 63108, USA.
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17
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Fu Z, Chen CT, Cagnone G, Heckel E, Sun Y, Cakir B, Tomita Y, Huang S, Li Q, Britton W, Cho SS, Kern TS, Hellström A, Joyal JS, Smith LE. Dyslipidemia in retinal metabolic disorders. EMBO Mol Med 2019; 11:e10473. [PMID: 31486227 PMCID: PMC6783651 DOI: 10.15252/emmm.201910473] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/10/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022] Open
Abstract
The light‐sensitive photoreceptors in the retina are extremely metabolically demanding and have the highest density of mitochondria of any cell in the body. Both physiological and pathological retinal vascular growth and regression are controlled by photoreceptor energy demands. It is critical to understand the energy demands of photoreceptors and fuel sources supplying them to understand neurovascular diseases. Retinas are very rich in lipids, which are continuously recycled as lipid‐rich photoreceptor outer segments are shed and reformed and dietary intake of lipids modulates retinal lipid composition. Lipids (as well as glucose) are fuel substrates for photoreceptor mitochondria. Dyslipidemia contributes to the development and progression of retinal dysfunction in many eye diseases. Here, we review photoreceptor energy demands with a focus on lipid metabolism in retinal neurovascular disorders.
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Affiliation(s)
- Zhongjie Fu
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.,Manton Center for Orphan Disease, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Chuck T Chen
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Gael Cagnone
- Department of Pediatrics, Pharmacology and Ophthalmology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Therapeutics, University of Montreal, Montreal, QC, Canada
| | - Emilie Heckel
- Department of Pediatrics, Pharmacology and Ophthalmology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Therapeutics, University of Montreal, Montreal, QC, Canada
| | - Ye Sun
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Bertan Cakir
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Yohei Tomita
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Shuo Huang
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Qian Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - William Britton
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Steve S Cho
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Timothy S Kern
- Center for Translational Vision Research, Gavin Herbert Eye Institute, Irvine, CA, USA
| | - Ann Hellström
- Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Jean-Sébastien Joyal
- Department of Pediatrics, Pharmacology and Ophthalmology, CHU Sainte-Justine Research Center, Université de Montréal, Montreal, QC, Canada.,Department of Pharmacology and Therapeutics, University of Montreal, Montreal, QC, Canada
| | - Lois Eh Smith
- Department of Ophthalmology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
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Liu H, Tang J, Du Y, Saadane A, Samuels I, Veenstra A, Kiser JZ, Palczewski K, Kern TS. Transducin1, Phototransduction and the Development of Early Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2019; 60:1538-1546. [PMID: 30994864 PMCID: PMC6736377 DOI: 10.1167/iovs.18-26433] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/14/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose Recent evidence suggests that retinal photoreceptor cells have an important role in the pathogenesis of retinal microvascular lesions in diabetes. We investigated the role of rod cell phototransduction on the pathogenesis of early diabetic retinopathy (DR) using Gnat1-/- mice (which causes permanent inhibition of phototransduction in rod cells without degeneration). Methods Retinal thickness, oxidative stress, expression of inflammatory proteins, electroretinograms (ERG) and optokinetic responses, and capillary permeability and degeneration were evaluated at up to 8 months of diabetes. Results The diabetes-induced degeneration of retinal capillaries was significantly inhibited in the Gnat1-/- diabetics. The effect of the Gnat1 deletion on the diabetes-induced increase in permeability showed a nonuniform accumulation of albumin in the neural retina; the defect was inhibited in diabetic Gnat1-/- mice in the inner plexiform layer (IPL), but neither in the outer plexiform (OPL) nor inner nuclear (INL) layers. In Gnat1-deficient animals, the diabetes-induced increase in expression of inflammatory associated proteins (iNOS and ICAM-1, and phosphorylation of IĸB) in the retina, and the leukocyte mediated killing of retinal endothelial cells were inhibited, however the diabetes-mediated induction of oxidative stress was not inhibited. Conclusions In conclusion, deletion of transducin1 (and the resulting inhibition of phototransduction in rod cells) inhibits the development of retinal vascular pathology in early DR.
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Affiliation(s)
- Haitao Liu
- Department of Biology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Jie Tang
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Yunpeng Du
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Aicha Saadane
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Ivy Samuels
- Veterans Administration Medical Center Research Service 151, Cleveland, Ohio, United States
- Department of Ophthalmic Research, Cleveland Clinic, Cleveland, Ohio, United States
| | - Alex Veenstra
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Jianying Z. Kiser
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
| | - Krzysztof Palczewski
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, United States
| | - Timothy S. Kern
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, United States
- Veterans Administration Medical Center Research Service 151, Cleveland, Ohio, United States
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California, United States
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Ophthalmology research in the UK's National Health Service: the structure and performance of the NIHR's Ophthalmology research portfolio. Eye (Lond) 2018; 33:610-618. [PMID: 30459469 DOI: 10.1038/s41433-018-0251-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/30/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report on the composition and performance of the portfolio of Ophthalmology research studies in the United Kingdom's National Institute for Health Research (NIHR) Clinical Research Network (UK CRN). METHODS Ophthalmology studies open to recruitment between 1 April 2010 and 31 March 2018 were classified by: sub-specialty, participant age, gender of Chief Investigator, involvement of genetic investigations, commercial/ non-commercial, interventional/observational design. Frequency distributions for each covariate and temporal variation in recruitment to time and target were analysed. RESULTS Over 8 years, 137,377 participants were recruited (average of 15,457 participants/year; range: 5485-32,573) with growth by year in proportion of commercial studies and hospital participation in England (76% in 2017/18). Fourteen percent of studies had a genetic component and most studies (82%) included only adults. The majority of studies (41%) enrolled patients with retinal diseases, followed by glaucoma (17%), anterior segment and cataract (13%), and ocular inflammation (6%). Overall, 68% of non-commercial studies and 55% of commercial studies recruited within the anticipated time set by the study and also recruited to or exceeded the target number of participants. CONCLUSIONS High levels of clinical research activity, growth and improved performance have been observed in Ophthalmology in UK over the past 8 years. Some sub-specialties that carry substantial morbidity and a very high burden on NHS services are underrepresented and deserve more patient-centred research. Yet the NIHR and its CRN Ophthalmology National Specialty Group has enabled key steps in achieving the goal of embedding research into every day clinical care.
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Okada M, Chhablani J. Out of darkness comes light-is there a role for light masks in treatment of diabetic macular oedema? ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:S73. [PMID: 30613648 DOI: 10.21037/atm.2018.10.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mali Okada
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Jay Chhablani
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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21
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Wong TY. Are light masks useful for early diabetic macular oedema? Lancet Diabetes Endocrinol 2018. [PMID: 29519745 DOI: 10.1016/s2213-8587(18)30068-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 168751 Singapore; Duke-NUS Medical School, National University of Singapore, Singapore.
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