1
|
Shanmugam PM, Shah P, Ramanjulu R, Mishra D. Impact of systemic parameters before commencing anti-vascular endothelial growth factor therapy for diabetic macular edema - Pan-Indian survey of retina specialists. Indian J Ophthalmol 2021; 69:3273-3278. [PMID: 34708786 PMCID: PMC8725122 DOI: 10.4103/ijo.ijo_1178_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) injection therapy has emerged as the mainstay of treatment in the management of diabetic macular edema (DME) today. Various systemic risk factors have to be considered before initiating anti-VEGF therapy. The aim of our study was to form a consensus on various systemic factors to consider before starting anti-VEGF therapy for DME. Methods: A questionnaire was created and sent across to various retina specialists across India. A Google™ form with various questions pertaining to what systemic parameters would one consider before giving anti-VEGF therapy for DME was sent to each of them by email/WhatsApp™/direct telephonic interview. Results: Of the 650 retina specialists contacted, 322 responded to the questionnaire. There was no difference in responses between private and institutional practitioners. The majority would consider RBS (85%), HbA1c (61%), blood pressure (63%), and renal function (57%) as a routine before administering the anti-VEGF injection, while the majority would not consider hemoglobin (63%) or lipid profile (55%) of the patient as a routine practice prior to administering the injection. Conclusion: In our study, most VR specialists prefer to consider RBS, HbA1c, BP, and renal profile (creatinine) routinely prior to anti-VEGF injection. We suggest that it is important to consider blood pressure control, glycemic control, HbA1c, Hb, lipid profile, and renal profile (UACR, eGFR, and creatinine) prior to anti-VEGF therapy in all diabetic patients and to discuss the need for statins in patients with dyslipidemias with the physician.
Collapse
Affiliation(s)
- P Mahesh Shanmugam
- Department of Vitreoretinal and Ocular Oncology Services, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Payal Shah
- Department of Vitreoretinal and Ocular Oncology Services, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Rajesh Ramanjulu
- Department of Vitreoretinal and Ocular Oncology Services, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Divyansh Mishra
- Department of Vitreoretinal and Ocular Oncology Services, Sankara Eye Hospital, Bangalore, Karnataka, India
| |
Collapse
|
2
|
Nutrition for diabetic retinopathy: plummeting the inevitable threat of diabetic vision loss. Eur J Nutr 2017; 56:2013-2027. [PMID: 28258307 DOI: 10.1007/s00394-017-1406-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 02/10/2017] [Indexed: 12/14/2022]
Abstract
Diabetic retinopathy (DR) is among the leading causes of preventable blindness. Hyperglycemia, hypertension, hyperlipidemia and anemia majorly predispose its pathogenesis. The current treatment modalities of DR include laser photocoagulation therapy, intravitreal corticosteroids, intravitreal anti-vascular endothelial growth factor (VEGF) agents and vitreo-retinal surgery which are costly, highly invasive, unproven for prolonged use and opted in advanced stages of DR. By then retina already encounters a vast damage. Nutrients by their natural physiological, biochemical and molecular action can preserve retinal structure and functions by interfering with the various pathological steps prompting DR incidence, thereby altering the risk of developing this ocular morbidity. Nutrients can also play a central role in DR patients resistant towards the conventional medical treatments. However due to the byzantine interplay existing between nutrients and DR, the worth of nutrition in curbing this vision-threatening ocular morbidity remains silent. This review highlights how nutrients can halt DR development. A nutritional therapy, if adopted in the initial stages, can provide superior-efficacy over the current treatment modalities and can be a complementary, inexpensive, readily available, anodyne option to the clinically unmet requirement for preventing DR. Assessment of nutritional status is presently considered relevant in various clinical conditions except DR. Body Mass Index (BMI) conferred inconclusive results in DR subjects. Subjective Global Assessment (SGA) of nutritional status has recently furnished relevant association with DR status. By integrating nutritional strategies, the risk of developing DR can be reduced substantially. This review summarizes the subsisting knowledge on nutrition, potentially beneficial for preventing DR and sustaining good vision among diabetic subjects.
Collapse
|
3
|
Traveset A, Rubinat E, Ortega E, Alcubierre N, Vazquez B, Hernández M, Jurjo C, Espinet R, Ezpeleta JA, Mauricio D. Lower Hemoglobin Concentration Is Associated with Retinal Ischemia and the Severity of Diabetic Retinopathy in Type 2 Diabetes. J Diabetes Res 2016; 2016:3674946. [PMID: 27200379 PMCID: PMC4855016 DOI: 10.1155/2016/3674946] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 03/31/2016] [Indexed: 12/25/2022] Open
Abstract
Aims. To assess the association of blood oxygen-transport capacity variables with the prevalence of diabetic retinopathy (DR), retinal ischemia, and macular oedema in patients with type 2 diabetes mellitus (T2DM). Methods. Cross-sectional, case-control study (N = 312) with T2DM: 153 individuals with DR and 159 individuals with no DR. Participants were classified according to the severity of DR and the presence of retinal ischemia or macular oedema. Hematological variables were collected by standardized methods. Three logistic models were adjusted to ascertain the association between hematologic variables with the severity of DR and the presence of retinal ischemia or macular oedema. Results. Individuals with severe DR showed significantly lower hemoglobin, hematocrit, and erythrocyte levels compared with those with mild disease and in individuals with retinal ischemia and macular oedema compared with those without these disorders. Hemoglobin was the only factor that showed a significant inverse association with the severity of DR [beta-coefficient = -0.52, P value = 0.003] and retinal ischemia [beta-coefficient = -0.49, P value = 0.001]. Lower erythrocyte level showed a marginally significant association with macular oedema [beta-coefficient = -0.86, P value = 0.055]. Conclusions. In patients with DR, low blood oxygen-transport capacity was associated with more severe DR and the presence of retinal ischemia. Low hemoglobin levels may have a key role in the development and progression of DR.
Collapse
Affiliation(s)
- Alicia Traveset
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- *Alicia Traveset: and
| | - Esther Rubinat
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
- Institut de Recerca Biomedica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Emilio Ortega
- Department of Endocrinology and Nutrition, Institut d'Investigacions Biomediques August Pi Suñer, CIBER de Obesidad y Nutrición, Hospital Clinic, 08036 Barcelona, Spain
| | - Nuria Alcubierre
- Institut de Recerca Biomedica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Beatriz Vazquez
- Department of Optometry, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Carmen Jurjo
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Ramon Espinet
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Juan Antonio Ezpeleta
- Department of Ophthalmology, University Hospital Arnau de Vilanova, 25198 Lleida, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Health Sciences Research Institute and University Hospital Germans Trias i Pujol, 08916 Badalona, Spain
- *Didac Mauricio:
| |
Collapse
|
4
|
Gupta A, Raman R, Kulothungan V, Sharma T. Association of systemic and ocular risk factors with neurosensory retinal detachment in diabetic macular edema: a case-control study. BMC Ophthalmol 2014; 14:47. [PMID: 24716846 PMCID: PMC3984633 DOI: 10.1186/1471-2415-14-47] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/04/2014] [Indexed: 11/22/2022] Open
Abstract
Background Diabetic macular edema (DME) with neurosensory retinal detachment (NSD) remains an important cause of visual loss in patients with diabetes. The aim of the study was to elucidate the association of systemic and ocular risk factors with NSD in DME. Methods In a retrospective case–control study, we reviewed clinical records of all the subjects with DME seen between January 2010 and December 2010. Cases and controls were selected based on optical coherence tomography and stereoscopic biomicroscopy review. NSD was defined as subfoveal fluid accumulation under detached retina with or without overlying foveal thickening. The association between the presence of NSD, blood pressure, lipid status and various other biochemical parameters was evaluated. Results Group I (cases) included 37 eyes of 33 patients having DME with NSD and Group II (controls) included 30 eyes of 21 patients having DME without NSD. Patients ranged in age (mean ± SD) from 50 to 62 years (56.6 +/-6.78) for cases and from 51 to 65 years (58.4+/-7.84) for controls. The duration of diabetes ranged from 4 to 15 year (mean 9.45+/-6.08) among cases and 4 to 14 years (9.7+/-5.12) among controls. Significant risk factors for NSD were high values of systolic and diastolic blood pressure (p = 0.039 and 0.043 respectively). Conclusion High systolic and diastolic blood pressures are independent and significant risk factors for NSD in DME.
Collapse
Affiliation(s)
| | | | | | - Tarun Sharma
- Shri Bhagwan Mahavir Department of Vitreoretinal Services, Sankara Nethralaya, 18, College Road, Chennai 600 006, Tamil Nadu, India.
| |
Collapse
|
5
|
He BB, Wei L, Gu YJ, Han JF, Li M, Liu YX, Bao YQ, Jia WP. Factors associated with diabetic retinopathy in chinese patients with type 2 diabetes mellitus. Int J Endocrinol 2012; 2012:157940. [PMID: 22844279 PMCID: PMC3400337 DOI: 10.1155/2012/157940] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 05/07/2012] [Indexed: 12/11/2022] Open
Abstract
Objective. To investigate the risk factors of DR in Chinese T2DM patients. Methods. 2009 patients with T2DM were included in this cross-sectional study. All patients underwent eye examination, and the DR stage was defined by an ophthalmologist. Correlation analysis was performed to evaluate the relation between DR and clinical variables. Logistic regression models were used to assess risk for those factors associated with DR. Results. A total of 597 T2DM patients (29.7%) had DR, of which 548 (27.3%) were nonproliferative diabetic retinopathy and 49 (2.4%) were proliferative diabetic retinopathy. Positive correlations were found between DR and duration of diabetes, systolic blood pressure (SBP), diastolic blood pressure, glycated hemoglobin, glycated albumin, 24 hurinary albumin excretion, peripheral atherosclerosis (PA), diabetes nephropathy (DN), diabetic peripheral neuropathy, and anemia. Negative correlations were found between DR and C-peptide and glomerular filtration rate. Logistic regression analysis revealed that duration of diabetes, SBP, DN, anemia, PA, and C-peptide were each independent risk factors of DR. Conclusion. The duration of diabetes, SBP, DN, anemia, and PA are positively associated with DR in Chinese T2DM patients, while C-peptide is negatively associated with DR. Monitoring and evaluation of these related factors will likely contribute to the prevention and treatment of DR.
Collapse
Affiliation(s)
- Bin-Bin He
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Li Wei
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
- *Li Wei:
| | - Yun-Juan Gu
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jun-Feng Han
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Ming Li
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yu-Xiang Liu
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Yu-Qian Bao
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Wei-Ping Jia
- Shanghai Municipal Key Laboratory on Diabetes, Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, and Shanghai Municipal Clinical Center on Diabetes, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| |
Collapse
|
6
|
Ajoy Mohan VK, Nithyanandam S, Idiculla J. Microalbuminuria and low hemoglobin as risk factors for the occurrence and increasing severity of diabetic retinopathy. Indian J Ophthalmol 2011; 59:207-10. [PMID: 21586841 PMCID: PMC3120240 DOI: 10.4103/0301-4738.81029] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To assess the influence of urinary microalbuminuria and hemoglobin concentration on the occurrence and severity of diabetic retinopathy (DR), clinically significant macular edema (CSME) and hard exudate formation. MATERIALS AND METHODS In this prospective cross-sectional study carried out over a period of 2 years, type 2 diabetic patients seeking ocular evaluation for DR were assessed for presence and severity of DR, presence of hard exudates and CSME. Retinal findings were correlated to severity of microalbuminuria, hemoglobin concentration and other systemic risk factors using linear regression analysis. RESULTS Three hundred and six patients were included in the study. DR of any grade was seen in 132 (43%) patients, hard exudate formation in 93/306 (30.4%) patients, CSME in 50/306 (16.3%) patients and proliferative DR in 26/306 (8.5%) patients. Duration of diabetes (P < 0.001), microalbuminuria (P < 0.001) and low hemoglobin (P = 0.001) were found to be highly significant risk factors for the development and increasing severity of DR as well as for CSME and hard exudate formation. CONCLUSION Microalbuminuria and low hemoglobin are strong predictors for DR, CSME and hard exudate formation in type 2 diabetics even after correcting for duration of diabetes and other systemic risk factors. Although not directly involved in the pathogenesis, microalbuminuria can help in identifying patients at risk for more severe diabetic eye disease. Microalbuminuria warrants intensive monitoring of both retinal and renal status. The hemoglobin levels should be monitored regularly in diabetic patients to detect and treat anemia, thereby reducing one risk factor for DR.
Collapse
Affiliation(s)
- V K Ajoy Mohan
- Department of Ophthalmology, St John's Medical College Hospital, Bangalore - 560 034, India
| | | | | |
Collapse
|
7
|
Singh R, Ramasamy K, Abraham C, Gupta V, Gupta A. Diabetic retinopathy: an update. Indian J Ophthalmol 2008; 56:178-88. [PMID: 18417817 PMCID: PMC2636123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Accepted: 11/24/2007] [Indexed: 10/25/2022] Open
Abstract
Diabetes mellitus is a major cause of avoidable blindness in both the developing and the developed countries. Significant technological advances have taken place to improve the diagnostic accuracy of diabetic retinopathy. In the last three decades, the treatment strategies have been revised to include, besides laser photocoagulation, early surgical interventions and pharmacotherapies.
Collapse
Affiliation(s)
- Ramandeep Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | |
Collapse
|