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Diabetic Retinopathy

Disease Details

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Description: Diabetic retinopathy is a diabetes complication that impacts the eyes, caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).
Type: Diabetic retinopathy is not classified as a hereditary disease. It is primarily a complication of diabetes mellitus, resulting from prolonged high blood sugar levels causing damage to the blood vessels in the retina. While there may be genetic factors that influence an individual's susceptibility to diabetes and its complications, diabetic retinopathy itself is not directly transmitted genetically.
Signs And Symptoms: Nearly all people with diabetes develop some degree of retina damage ("retinopathy") over several decades with the disease. For many, that damage can only be detected by a retinal exam, and has no noticeable effect on vision. Over time, progressive retinal damage may appear on a retinal exam, first with small bulges in retinal blood vessels called microaneurysms. Then larger abnormalities in retinal vessels: cotton wool spots, hemorrhages, lipid deposits called "hard exudates", intraretinal microvascular abnormalities, and abnormal-looking retinal veins. Eventually, many progress to a stage where new blood vessels grow throughout the retina. These new blood vessels often break and bleed. Minor bleeding can cause dark floating spots obstructing vision; major bleeding can completely block vision.Around half of people with diabetic retinopathy develop swelling of the macula, called macular edema, which can begin at any time. If the swelling occurs near the center of the macula, it can cause vision disruptions ranging from mildly blurred vision to severe loss of the center of an affected person's visual field. Left untreated, around 30% of those with such swelling experience vision disruption over the next 3–5 years. Macular edema is the most common cause of vision loss in people with diabetic retinopathy.The repeated processes of blood vessel growth, swelling, and scarring can eventually cause retinal detachment, which manifests as the sudden appearance of dark floating spots, flashes of light, or blurred vision.
Prognosis: The prognosis for diabetic retinopathy depends on several factors, including the stage of the disease and the effectiveness of treatment and management of diabetes. Early detection and proper management of blood sugar levels, blood pressure, and cholesterol can slow or even halt the progression of the disease. If left untreated, diabetic retinopathy can lead to vision loss and complete blindness. Regular eye exams and timely treatment, such as laser therapy or injections, can help preserve vision and improve outcomes for patients.
Onset: The onset of diabetic retinopathy is typically gradual and associated with long-term uncontrolled blood sugar levels in diabetic patients. It often does not present symptoms in the early stages, and the changes may be detected during a routine eye examination. Over time, as the condition progresses, symptoms such as blurred vision, floaters, dark areas in vision, and difficulty perceiving colors may occur.
Prevalence: Diabetic retinopathy is a common complication of diabetes. Globally, it affects approximately one-third of people with diabetes, with variations in prevalence depending on factors such as duration and control of diabetes. Among individuals with diabetes, the prevalence can be higher in those with longer disease duration and poorly managed blood sugar levels.
Epidemiology: Around 35% of people with diabetes have some kind of diabetic retinopathy; around 10% experience some degree of vision loss. Diabetic retinopathy is particularly common in those with type 1 diabetes – affecting 25% of people five years from diagnosis, 60% 10 years from diagnosis, and 80% 15 years from diagnosis. Chances of disease progression are heavily influenced by blood sugar control, but on average 7% of those with diabetes experiencing proliferative diabetic retinopathy and 7% diabetic macular edema. Diabetic retinopathy is the leading cause of vision loss in those 20–74 years old.The global burden of diabetic retinopathy increased dramatically from 1990 to 2015—from 1.4 million to 2.6 million people with visual impairment; from 0.2 million to 0.4 million blinded—due in large part to the increasing burden of type 2 diabetes in low- and middle-income countries.
Intractability: Diabetic retinopathy is not necessarily intractable. Management includes controlling blood sugar levels, blood pressure, and cholesterol. Treatments such as laser therapy, intraocular injections, and vitrectomy can address complications. Early detection and consistent management are crucial for preventing severe vision loss.
Disease Severity: Diabetic retinopathy is categorized into two main stages:

1. **Non-Proliferative Diabetic Retinopathy (NPDR)**:
- **Mild**: Presence of at least one microaneurysm.
- **Moderate**: More extensive microaneurysms, hemorrhages, and some level of macular edema.
- **Severe**: Numerous microaneurysms and hemorrhages, with noticeable blood vessel blockages leading to reduced retinal blood supply.

2. **Proliferative Diabetic Retinopathy (PDR)**:
- Characterized by the growth of new, abnormal blood vessels on the retina or vitreous humor. These can lead to severe vision problems, such as retinal detachment or vitreous hemorrhage.

The condition can range from mild with no symptoms to severe with significant vision impairment. Regular screening and early treatment are crucial to manage and slow the progression of the disease.
Healthcare Professionals: Disease Ontology ID - DOID:8947
Pathophysiology: Diabetic retinopathy is a diabetes complication that affects the eyes. Its pathophysiology involves prolonged hyperglycemia leading to damage in the retinal blood vessels. This damage can result in increased vascular permeability, capillary occlusion, and, ultimately, ischemia. These changes cause microaneurysms, hemorrhages, and formation of new, fragile blood vessels (neovascularization). This neovascularization can lead to further complications such as vitreous hemorrhage, retinal detachment, and vision loss.
Carrier Status: Diabetic retinopathy is not an inherited condition and does not have a carrier status. It is a complication of diabetes that affects the eyes and is caused by damage to the blood vessels of the retina due to prolonged high blood sugar levels.
Mechanism: Diabetic retinopathy is a diabetes complication that affects the eyes. The mechanism involves damage to the blood vessels in the retina due to prolonged high blood sugar levels. These damaged blood vessels can leak fluid or hemorrhage, causing vision impairment. In advanced stages, abnormal blood vessels can grow (neovascularization), leading to serious vision problems and potentially blindness.

On a molecular level:

1. **Hyperglycemia-induced damage**: Chronic high blood glucose levels lead to the formation of advanced glycation end products (AGEs), which alter the structure and function of retinal proteins.
2. **Oxidative stress**: Increased glucose levels cause the overproduction of reactive oxygen species (ROS), leading to oxidative stress and damage to retinal cells.
3. **Protein kinase C (PKC) activation**: High glucose levels activate the PKC pathway, contributing to the increased permeability and leakage of retinal blood vessels.
4. **Inflammation**: Elevated blood sugar induces the expression of various inflammatory cytokines and growth factors, including vascular endothelial growth factor (VEGF), which promotes neovascularization.
5. **Polyol pathway**: Excess glucose is converted to sorbitol via aldose reductase, leading to osmotic stress and cellular damage in the retina.

Together, these molecular mechanisms contribute to the progression of diabetic retinopathy, ultimately impairing vision.
Treatment: Diabetic retinopathy treatment aims to slow or stop the progression of the disease and preserve vision. Treatments include:

1. **Laser Surgery (Photocoagulation):** This helps seal leaking blood vessels and reduce swelling.
2. **Vitrectomy:** Surgical removal of the vitreous gel and blood in the back of the eye if there is significant bleeding or scar tissue.
3. **Anti-VEGF Injections:** Medications like Avastin, Lucentis, or Eylea are injected into the eye to reduce inflammation and vascular leakage.
4. **Corticosteroid Injections:** These help reduce inflammation in the retina.
5. **Control of Blood Sugar, Blood Pressure, and Cholesterol:** Managing these can significantly impact the progression of diabetic retinopathy.

Regular eye exams are crucial for early detection and management of diabetic retinopathy.
Compassionate Use Treatment: Compassionate use treatment, off-label, or experimental treatments for diabetic retinopathy include:

1. **Anti-VEGF Therapies**: While commonly used for diabetic retinopathy, some anti-VEGF (vascular endothelial growth factor) drugs such as bevacizumab (Avastin) are used off-label.

2. **Intravitreal Steroid Injections**: These can reduce inflammation and edema. Dexamethasone intravitreal implant (Ozurdex) and fluocinolone acetonide intravitreal implant (Iluvien) might be used off-label in specific cases.

3. **Gene Therapy**: Experimental treatments are exploring gene therapy approaches to address underlying causes and create long-lasting solutions.

4. **Oral Medications**: Certain oral medications, such as fenofibrate, traditionally used to lower cholesterol, have shown promise in reducing the risk of diabetic retinopathy progression, though this is not their primary use.

5. **Stem Cell Therapy**: Experimental treatments utilizing stem cells are being researched for their potential in regenerating damaged retinal tissue and restoring vision.

6. **Laser Therapies**: While not new, there continue to be advancements and experimental protocols related to the use of laser treatments, like different wavelengths and patterns.

These treatments may not be widely available and should be discussed with a healthcare provider to understand their potential benefits and risks.
Lifestyle Recommendations: For diabetic retinopathy, lifestyle recommendations include:

1. **Blood Sugar Management**: Keep blood sugar levels within target ranges through diet, exercise, and medications.
2. **Regular Eye Exams**: Have a comprehensive dilated eye exam at least once a year to detect early signs of retinopathy.
3. **Blood Pressure Control**: Maintain blood pressure within normal ranges to reduce the risk of blood vessel damage in the retina.
4. **Healthy Diet**: Follow a diet rich in fruits, vegetables, whole grains, and lean proteins. Limit intake of processed foods, sugars, and unhealthy fats.
5. **Regular Exercise**: Engage in at least 150 minutes of moderate aerobic activity per week, such as walking or cycling.
6. **No Smoking**: Avoid smoking, as it can exacerbate blood vessel damage and increase the risk of complications.
7. **Cholesterol Management**: Keep cholesterol levels within recommended ranges to decrease the risk of vascular problems.
8. **Weight Management**: Maintain a healthy weight to improve overall health and reduce the burden on your circulatory system.

Adhering to these lifestyle recommendations can help manage diabetic retinopathy and reduce the risk of progression.
Medication: There are no specific medications to take orally for diabetic retinopathy, but treatments include anti-VEGF injections (e.g., ranibizumab, aflibercept), corticosteroids injections (e.g., triamcinolone), and sometimes laser surgery or vitrectomy. Management of diabetes through blood sugar control is crucial to slow the progression.
Repurposable Drugs: Diabetic retinopathy is a complication of diabetes that affects the eyes. Various drugs originally developed for other conditions have been investigated for their potential to treat diabetic retinopathy. These include:

1. **Angiotensin II Receptor Blockers (ARBs):** Originally used for hypertension, drugs like losartan and candesartan may help reduce inflammation and vascular damage in diabetic retinopathy.

2. **Statins:** Commonly prescribed to lower cholesterol, statins like atorvastatin and simvastatin have anti-inflammatory properties that might benefit patients with diabetic retinopathy.

3. **Fenofibrate:** A lipid-lowering agent, fenofibrate has shown efficacy in reducing the progression of diabetic retinopathy in some clinical trials.

4. **Doxycycline:** An antibiotic with anti-inflammatory properties, doxycycline is being explored for its potential to prevent retinal damage.

5. **NSAIDs:** Nonsteroidal anti-inflammatory drugs like aspirin and celecoxib may help reduce retinal inflammation and improve outcomes in diabetic retinopathy.

These drugs' potential repurposing for diabetic retinopathy is subject to ongoing research and clinical trials to confirm their efficacy and safety in this specific condition.
Metabolites: Diabetic retinopathy is primarily influenced by changes in glucose and lipid metabolism. Key metabolites associated with diabetic retinopathy include:

1. **Glucose:** Chronic hyperglycemia is a pivotal factor in the development and progression of diabetic retinopathy.
2. **Advanced Glycation End Products (AGEs):** Formed through non-enzymatic glycation of proteins and lipids, AGEs contribute to vascular damage.
3. **Oxidative Stress Markers:** Elevated levels of oxidative stress markers like malondialdehyde (MDA) are commonly observed.
4. **Inflammatory Cytokines:** Molecules like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) are involved in inflammatory processes damaging the retinal vessels.

Understanding these metabolites can help in the diagnosis, monitoring, and treatment of diabetic retinopathy.
Nutraceuticals: Nutraceuticals, including certain vitamins and supplements, may play a role in managing diabetic retinopathy. Antioxidants like vitamins C and E, omega-3 fatty acids, and carotenoids such as lutein and zeaxanthin have been studied for their potential to protect retinal cells and reduce inflammation. Additionally, compounds like bilberry extract, alpha-lipoic acid, and resveratrol are also being explored for their protective effects on retinal health.

Regarding nanotechnology, it shows promise in delivering drugs more effectively to the retina, enhancing the treatment of diabetic retinopathy. Nanoparticles can be engineered to target specific cells in the retina, improving drug absorption and minimizing side effects. Research is ongoing to develop nano-formulations that could potentially offer more precise and sustained therapeutic effects for this condition.
Peptides: Diabetic retinopathy is a diabetes complication that affects the eyes, specifically the retina. It is caused by damage to the blood vessels in the retina due to high blood sugar levels.

Peptides: Certain peptides have shown potential in the treatment and management of diabetic retinopathy. They can target various pathways involved in retinal damage, reduce inflammation, and inhibit abnormal blood vessel growth (angiogenesis). For instance, anti-VEGF (vascular endothelial growth factor) peptides are used to prevent the proliferation of abnormal blood vessels in the retina.

Nanotechnology (nan): Nanotechnology provides innovative solutions for diabetic retinopathy by delivering drugs more effectively to the retina. Nanoparticles can encapsulate therapeutic agents, ensuring targeted and sustained release, thus improving treatment efficacy while minimizing side effects. Nanocarriers like liposomes, dendrimers, and polymeric nanoparticles are being explored to deliver anti-inflammatory drugs, antioxidants, and gene therapies directly to retinal cells.