10 June 2024

Diabetes Awareness Week: Spotlight on diabetic retinopathy

Header image with an illustration of an eye and the statistic that 1 in 3 people with diabetes have some form of diabetic retinopathy

 

Many of us know someone living with diabetes. It is a major public health concern, with 4.3 million people diagnosed in the UK alone [1]. Type 1 diabetes is an autoimmune condition in which the pancreas cannot produce insulin at all [2]. Type 2 diabetes (which represents 90% of diabetes cases in the UK [1]) develops over time when the pancreas produces insufficient amounts of insulin, or the insulin becomes ineffective at stimulating sugar uptake in cells [2]. Both types result in chronically elevated levels of glucose in the blood; over time, this leads to a variety of complications, including kidney problems, damage to the circulation, and increased risk of heart attack and stroke [1].

For Diabetes Awareness Week, Porterhouse Medical would like to highlight diabetic retinopathy, which is a progressive complication of diabetes affecting the eyes.

Diabetes and vision

Diabetic retinopathy occurs when blood vessels that supply the retina at the back of the eye become damaged [3]. One in three people with diabetes has some form of retinopathy, and 1 in 10 will reach a stage that can threaten their vision [4]. In fact, it is the most common cause of blindness in working-age people and is a growing epidemic, predicted to affect 160 million people worldwide by 2045 [4, 5].

The risk of developing this complication increases with the duration of diabetes, but not all people with diabetes will develop it [6, 7]. Contributing factors include high blood pressure, high cholesterol, smoking, poor control of blood sugar and certain genetic predispositions [6].

Most importantly, diabetic retinopathy can have a negative impact on the mental health and quality of life of people who develop vision loss [8, 9]. Symptoms occurring in more advanced stages (such as flashes of light, altered colour vision, blurriness, and loss of peripheral or central vision) can cause distress and lead to struggles with work, social interactions or basic everyday tasks, increasing the risk of anxiety and depression [8, 9].

Progression and treatment options

  • Signs of diabetic retinopathy may not manifest for 8–10 years [7]. During this period, subtle changes that cannot be detected by diagnostic tests are usually taking place [10].
  • Non-proliferative diabetic retinopathy is an early stage of the complication, in which the retinal blood vessels weaken and leak fluid. It tends to be asymptomatic at this stage [11].
  • Proliferative diabetic retinopathy is the advanced stage, in which new, abnormal blood vessels start growing to replace the damaged ones. They may break, causing bleeding into the eye and vision impairment [11].

Fortunately, early detection and treatment can prevent blindness in 50%–70% of cases [12].

There are no targeted treatment options in the early stages. Recommendations include normal diabetes management, such as controlling blood sugar levels with lifestyle modifications and anti-diabetic medications and undergoing regular diagnostic tests of the eye.

If retinopathy advances and starts to affect or threaten sight, treatment options include [13]:

  • Laser treatment to shrink the new, abnormal blood vessels
  • Injections into the eye to inhibit growth of the abnormal blood vessels
  • An operation to remove blood or scar tissue from the eye

Building better futures

Currently, treatment options for diabetic retinopathy are limited, invasive and only administered at the advanced stages. Some avenues for the future include [14]:

  • Establishing national systemic screening programmes to identify the complication in its early stages. These have been implemented in many high-income countries (for example, the NHS Diabetic Eye Screening Programme in the UK), but most lower- and middle-income countries are lagging behind.
  • Developing treatment options that could target diabetic retinopathy in its early stages.
  • Developing treatment options with longer intervals between doses (currently, eye injections might be required as often as every month) or less intrusive treatments (such as oral medications or eye drops).

Fortunately, at Porterhouse Medical we are already helping our global pharmaceutical partners chart a course to improvement. We are passionate and knowledgeable in the field of ophthalmology, working on a variety of projects to improve treatment options and patient outcomes through healthcare communications and insights.

If you are interested in finding out more about the services offered by Porterhouse Medical and whether our team could help you, please visit https://www.porterhousemedical.com/our-approach/ or contact mark.walker@porterhousemedical.com. We would love to hear from you!

References

  1. The British Diabetic Association. How many people in the UK have diabetes? Available at: https://www.diabetes.org.uk/about-us/about-the-charity/our-strategy/statistics. Accessed June 2024.
  2. The British Diabetic Association. Differences between type 1 and type 2 diabetes. Available at: https://www.diabetes.org.uk/diabetes-the-basics/differences-between-type-1-and-type-2-diabetes. Accessed June 2024.
  3. co.uk. Diabetic retinopathy. Available at: https://www.diabetes.co.uk/diabetes-complications/diabetic-retinopathy.html. Accessed June 2024.
  4. Wong TY and Sabanayagam C. Strategies to tackle the global burden of diabetic retinopathy: From epidemiology to artificial intelligence. Ophthalmologica 2020; 243 (1): 9–20.
  5. Teo ZL, Tham Y-C, Yu M et al. Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis. Ophthalmology 2021; 128 (11): 1580–1591.
  6. Fung TH, Patel B, Wilmot EG et al. Diabetic retinopathy for the non-ophthalmologist. Clin Med (Lond) 2022; 22 (2): 112–116.
  7. Cabrera AP, Mankad RN, Marek L et al. Genotypes and phenotypes: A search for influential genes in diabetic retinopathy. Int J Mol Sci 2020; 21 (8): 2712.
  8. Morello CM. Etiology and natural history of diabetic retinopathy: An overview. Am J Health Syst Pharm 2007; 64 (17 Suppl 12): S3–S7.
  9. DR Barometer. The Diabetic Retinopathy Barometer Report: Global Findings. Available at: https://drbarometer.com/wp-content/uploads/2022/08/drbarometer_global_report-1.pdf. Accessed June 2024.
  10. Wong TY, Cheung CM, Larsen M et al. Diabetic retinopathy. Nat Rev Dis Primers 2016; 2: 16012.
  11. Wang W and Lo ACY. Diabetic retinopathy: Pathophysiology and treatments. Int J Mol Sci 2018; 19 (6): 1816.
  12. Coney JM. Addressing unmet needs in diabetic retinopathy. Am J Manag Care 2019; 25 (16 Suppl): S311–S316.
  13. Bahr TA and Bakri SJ. Update on the management of diabetic retinopathy: Anti-VEGF agents for the prevention of complications and progression of nonproliferative and proliferative retinopathy. Life (Basel) 2023; 13 (5): 1098.
  14. Tan T-E and Wong TY. Diabetic retinopathy: Looking forward to 2030. Front Endocrinol (Lausanne) 2023; 13:

Author: Gabija Barauskaite

Photo of female author and intern at Porterhouse Medical