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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Review Article

Diabetic Retinopathy Leading to Blindness- A Review

Author(s): Amandeep Kaur, Ranjeet Kumar* and Amit Sharma

Volume 20, Issue 9, 2024

Published on: 23 January, 2024

Article ID: e240124225997 Pages: 7

DOI: 10.2174/0115733998274599231109034741

Price: $65

Abstract

Diabetic retinopathy (DR) is the most common microvascular complication of diabetes that damages the retina, leading to blindness. People with type 1 diabetes are at greater risk of developing DR than people with type 2 diabetes. Diabetic retinopathy may be divided into two primary categories: Proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR). There are multiple risk factors for the onset and progression of diabetic retinopathy, such as hypertension, obesity, smoking, duration of diabetes, and genetics. Numerous investigations have evaluated the levels of a wide range of inflammatory chemokines within DR patients' serum, vitreous, and aqueous fluids. In diabetic retinopathy, the vitreous fluid exhibited rises in angiogenic factors like platelet-derived growth factor (PDGF) or vascular endothelial growth factor (VEGF) or declines in antiangiogenic factors like pigment epithelium-derived factor (PEDF). For prevention of diabetic retinopathy, more physical activity as well as less sedentary behavior were linked to a reduced likelihood of DR. Supplementing with nutraceuticals containing vitamins (B1, B2, B6, B12, C, D, E, and l-methyl folate) and mineral (zinc) can help decrease or avoid an outbreak of DR. Only laser photocoagulation and Anti-vascular endothelial growth factor (Anti-VEGF) injections are advised as favorable therapies in severe retinopathy. When it comes to treating DR's VEGF levels, inflammation, oxidative stress, apoptosis, and angiogenesis, Traditional Chinese medicine (TCM) has an excellent future.

[1]
Kropp M, Golubnitschaja O, Mazurakova A, et al. Diabetic retinopathy as the leading cause of blindness and early predictor of cascading complications—risks and mitigation. EPMA J 2023; 14(1): 21-42.
[http://dx.doi.org/10.1007/s13167-023-00314-8] [PMID: 36866156]
[2]
Kashim R, Newton P, Ojo O. Diabetic retinopathy screening: A systematic review on patients’ non-attendance. Int J Environ Res Public Health 2018; 15(1): 157.
[http://dx.doi.org/10.3390/ijerph15010157] [PMID: 29351207]
[3]
Scanlon PH, Carter SC, Foy C, Husband R F A, Abbas J, Bachmann MO. Diabetic retinopathy and socioeconomic deprivation in Gloucestershire. J Med Screen 2008; 15(3): 118-21.
[http://dx.doi.org/10.1258/jms.2008.008013] [PMID: 18927093]
[4]
Ansari P, Tabasumma N, Snigdha NN, et al. Diabetic retinopathy: An overview on mechanisms, pathophysiology and pharmacotherapy. Diabetology 2022; 3(1): 159-75.
[http://dx.doi.org/10.3390/diabetology3010011]
[5]
Stewart MW. Treatment of diabetic retinopathy: Recent advances and unresolved challenges. World J Diabetes 2016; 7(16): 333-41.
[http://dx.doi.org/10.4239/wjd.v7.i16.333] [PMID: 27625747]
[6]
Wat N, Wong RLM, Wong IYH. Associations between diabetic retinopathy and systemic risk factors. Hong Kong Med J 2016; 22(6): 589-99.
[http://dx.doi.org/10.12809/hkmj164869] [PMID: 27779095]
[7]
Scanlon P, Aldington S, Stratton I. Epidemiological issues in diabetic retinopathy. Middle East Afr J Ophthalmol 2013; 20(4): 293-300.
[http://dx.doi.org/10.4103/0974-9233.120007] [PMID: 24339678]
[8]
Mueller I, Talks JS. Should we still be performing macular laser for non-centre involving diabetic macular oedema? No Eye 2022; 36(3): 485-6.
[http://dx.doi.org/10.1038/s41433-021-01787-5] [PMID: 34645965]
[9]
Jorge EC, Jorge EN, Botelho M, Farat JG, Virgili G, El Dib R. Monotherapy laser photocoagulation for diabetic macular oedema. Cochrane Database Syst Rev 2018; 10
[http://dx.doi.org/10.1002/14651858.CD010859.pub2]
[10]
Osaadon P, Fagan XJ, Lifshitz T, Levy J. A review of anti-VEGF agents for proliferative diabetic retinopathy. Eye (Lond) 2014; 28(5): 510-20.
[http://dx.doi.org/10.1038/eye.2014.13] [PMID: 24525867]
[11]
Sharma S. Interleukin-6 trans-signaling: A pathway with therapeutic potential for diabetic retinopathy.In: Cochrane Database Syst Rev. Frontiers Media SA 2021; p. 689429.
[12]
Gu Z, Li Y, Wang Z, Kan J, Shu J, Wang Q. Classification of diabetic retinopathy severity in fundus images using the vision transformer and residual attention. Comput Intell Neurosci 2023; Vol. 2023
[13]
Kollias AN, Ulbig MW. Diabetic retinopathy: Early diagnosis and effective treatment. Dtsch Arztebl Int 2010; 107(5): 75-83.
[PMID: 20186318]
[14]
Habashy SM. Identification of diabetic retinopathy stages using fuzzy C-means classifier. Int J Comput Appl 2013; 77(9)
[http://dx.doi.org/10.5120/13420-1096]
[15]
Spaide RF. Retinal vascular cystoid macular edema: Review and new theory. Retina 2016; 36(10): 1823-42.
[http://dx.doi.org/10.1097/IAE.0000000000001158] [PMID: 27328171]
[16]
Suriyasekeran K, Santhanamahalingam S, Duraisamy M. Algorithms for diagnosis of diabetic retinopathy and diabetic macula edema-a review. Adv Exp Med Biol 2020; 1307: 357-73.
[http://dx.doi.org/10.1007/5584_2020_499] [PMID: 32166636]
[17]
Grant MB, Mames RN, Fitzgerald C, et al. The efficacy of octreotide in the therapy of severe nonproliferative and early proliferative diabetic retinopathy: A randomized controlled study. Diabetes Care 2000; 23(4): 504-9.
[http://dx.doi.org/10.2337/diacare.23.4.504] [PMID: 10857943]
[18]
Fong DS, Aiello LP, Ferris FL III, Klein R. Diabetic retinopathy. Diabetes Care 2004; 27(10): 2540-53.
[http://dx.doi.org/10.2337/diacare.27.10.2540] [PMID: 15451934]
[19]
Xie J, Ikram MK, Cotch MF, et al. Association of diabetic macular edema and proliferative diabetic retinopathy with cardiovascular disease: A systematic review and meta-analysis. JAMA Ophthalmol 2017; 135(6): 586-93.
[http://dx.doi.org/10.1001/jamaophthalmol.2017.0988] [PMID: 28472362]
[20]
Ong YT, De Silva DA, Cheung CY, et al. Microvascular structure and network in the retina of patients with ischemic stroke. Stroke 2013; 44(8): 2121-7.
[http://dx.doi.org/10.1161/STROKEAHA.113.001741] [PMID: 23715958]
[21]
Zhou JB, Zhu XR, Zhao W, et al. Retracted: prediction of proliferative diabetic retinopathy to asymptomatic obstructive coronary artery disease in chinese type 2 diabetes individuals: An exploratory study. Metab Syndr Relat Disord 2019; 17(7): 367-73.
[http://dx.doi.org/10.1089/met.2018.0140] [PMID: 31145036]
[22]
Külahçıoğlu Ş, Karagöz IK, Bilen Y, et al. Evaluation of the relationship between diabetic retinopathy and left atrial deformation parameters. Egypt Heart J 2022; 74(1): 30.
[http://dx.doi.org/10.1186/s43044-022-00265-x] [PMID: 35416514]
[23]
Cheung N, Rogers S, Couper DJ, Klein R, Sharrett AR, Wong TY. Is diabetic retinopathy an independent risk factor for ischemic stroke? Stroke 2007; 38(2): 398-401.
[http://dx.doi.org/10.1161/01.STR.0000254547.91276.50] [PMID: 17194880]
[24]
Hu K, Jiang M, Zhou Q, et al. Association of diabetic retinopathy with stroke: A systematic review and meta-analysis. Front Neurol 2021; 12: 626996.
[http://dx.doi.org/10.3389/fneur.2021.626996] [PMID: 33796063]
[25]
Wang Z, Cao D, Zhuang X, et al. Diabetic retinopathy may be a predictor of stroke in patients with diabetes mellitus. J Endocr Soc 2022; 6(8): bvac097.
[http://dx.doi.org/10.1210/jendso/bvac097] [PMID: 35795810]
[26]
Kochar A, Saini DC, Poonia R. Clinical correlation of diabetic retinopathy with nephropathy and neuropathy. Indian J Ophthalmol 2021; 69(11): 3364-8.
[http://dx.doi.org/10.4103/ijo.IJO_1237_21] [PMID: 34708806]
[27]
Li T. Applying a convolutional neural network as a statistical method to evaluate the correlation between diabetic retinopathy and diabetic nephropathy 2023.
[http://dx.doi.org/10.21203/rs.3.rs-2829075/v1]
[28]
Luo WM, Su JY, Xu T, Fang ZZ. Prevalence of diabetic retinopathy and use of common oral hypoglycemic agents increase the risk of diabetic nephropathy—A cross-sectional study in patients with type 2 diabetes. Int J Environ Res Public Health 2023; 20(5): 4623.
[http://dx.doi.org/10.3390/ijerph20054623] [PMID: 36901633]
[29]
Jawa A, Kcomt J, Fonseca VA. Diabetic nephropathy and retinopathy. Med Clin North Am 2004; 88(4): 1001-1036 xi.
[http://dx.doi.org/10.1016/j.mcna.2004.04.012] [PMID: 15308388]
[30]
Harjutsalo V, Kallio M, Forsblom C, Groop P-H. The impact of diabetic nephropathy and severe diabetic retinopathy on chronic limb threatening ischemia risk in individuals with type 1 diabetes: a nationwide, population study. Lancet Reg. Heal 2023; Vol. 28.
[31]
Callaghan BC, Price RS, Chen KS, Feldman EL. The importance of rare subtypes in diagnosis and treatment of peripheral neuropathy: a review. JAMA Neurol 2015; 72(12): 1510-8.
[http://dx.doi.org/10.1001/jamaneurol.2015.2347] [PMID: 26437251]
[32]
Navel V. Dérégulation de l’expression du Récepteur aux Produits Avancés de Glycation (RAGE) dans la pathologie de la Surface oculaire. Université Clermont Auvergne 2023.
[33]
Kamath YS, Karam T, Rao L, Rao K, Shenoy S, Bhandary S. Diabetic retinopathy in patients with diabetic foot syndrome in South India. Indian J Ophthalmol 2018; 66(4): 547-50.
[http://dx.doi.org/10.4103/ijo.IJO_1000_17] [PMID: 29582817]
[34]
Hwang DJ, Lee KM, Park MS, et al. Association between diabetic foot ulcer and diabetic retinopathy. PLoS One 2017; 12(4): e0175270.
[http://dx.doi.org/10.1371/journal.pone.0175270] [PMID: 28388680]
[35]
Alavi A, Sibbald RG, Mayer D, et al. Diabetic foot ulcers. J Am Acad Dermatol 2014; 70(1): 1.e1-1.e18.
[http://dx.doi.org/10.1016/j.jaad.2013.06.055] [PMID: 24355275]
[36]
Sela Y, Grinberg K, Cukierman-Yaffe T, Natovich R. Relationship between cognitive function in individuals with diabetic foot ulcer and mortality. Diabetol Metab Syndr 2022; 14(1): 133.
[http://dx.doi.org/10.1186/s13098-022-00901-1] [PMID: 36123752]
[37]
Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet 2005; 366(9498): 1719-24.
[http://dx.doi.org/10.1016/S0140-6736(05)67698-2] [PMID: 16291066]
[38]
Reiber GE, Vileikyte L, Boyko EJ, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care 1999; 22(1): 157-62.
[PMID: 10333919]
[39]
Bora A, Balasubramanian S, Babenko B, et al. Predicting the risk of developing diabetic retinopathy using deep learning. Lancet Digit Health 2021; 3(1): e10-9.
[http://dx.doi.org/10.1016/S2589-7500(20)30250-8] [PMID: 33735063]
[40]
Liu L, Quang ND, Banu R, et al. Hypertension, blood pressure control and diabetic retinopathy in a large population-based study. PLoS One 2020; 15(3): e0229665.
[http://dx.doi.org/10.1371/journal.pone.0229665] [PMID: 32134944]
[41]
Flaxel CJ, Adelman RA, Bailey ST, et al. Age-related macular degeneration preferred practice pattern®. Ophthalmology 2020; 127(1): 1-P65.
[PMID: 31757502]
[42]
Lin KY, Hsih WH, Lin YB, Wen CY, Chang TJ. Update in the epidemiology, risk factors, screening, and treatment of diabetic retinopathy. J Diabetes Investig 2021; 12(8): 1322-5.
[PMID: 33316144]
[43]
Rajalakshmi R, Amutha A, Ranjani H, et al. Prevalence and risk factors for diabetic retinopathy in Asian Indians with young onset Type 1 and Type 2 Diabetes. J Diabetes Complications 2014; 28(3): 291-7.
[http://dx.doi.org/10.1016/j.jdiacomp.2013.12.008] [PMID: 24512748]
[44]
Varma R, Macias GL, Torres M, Klein R, Peña FY, Azen SP. Biologic risk factors associated with diabetic retinopathy: The Los Angeles Latino Eye Study. Ophthalmology 2007; 114(7): 1332-40.
[http://dx.doi.org/10.1016/j.ophtha.2006.10.023] [PMID: 17306879]
[45]
Ting DSW, Cheung GCM, Wong TY. Diabetic retinopathy: Global prevalence, major risk factors, screening practices and public health challenges: A review. Clin Exp Ophthalmol 2016; 44(4): 260-77.
[http://dx.doi.org/10.1111/ceo.12696] [PMID: 26716602]
[46]
Flaxel CJ, Adelman RA, Bailey ST, et al. Retinal and ophthalmic artery occlusions preferred practice pattern®. Ophthalmology 2020; 127(2): P259-287.
[http://dx.doi.org/10.1016/j.ophtha.2019.09.028] [PMID: 31757501]
[47]
Mamtora S, Sandinha T, Carey PE, Steel DHW. Optimizing medical management in patients with sight-threatening diabetic retinopathy. Ophthalmol Ther 2017; 6(1): 105-14.
[http://dx.doi.org/10.1007/s40123-016-0069-z] [PMID: 27858333]
[48]
Hwang IC, Bae JH, Kim JM. Relationship between body fat and diabetic retinopathy in patients with type 2 diabetes: A nationwide survey in Korea. Eye (Lond) 2019; 33(6): 980-7.
[http://dx.doi.org/10.1038/s41433-019-0352-z] [PMID: 30760896]
[49]
Khalangot M, Tronko M, Kravchenko V, Kulchinska J, Hu G. Body mass index and the risk of total and cardiovascular mortality among patients with type 2 diabetes: A large prospective study in Ukraine. Heart 2009; 95(6): 454-60.
[http://dx.doi.org/10.1136/hrt.2008.150524] [PMID: 18697804]
[50]
Price SA, Gorelik A, Fourlanos S, Colman PG, Wentworth JM. Obesity is associated with retinopathy and macrovascular disease in type 1 diabetes. Obes Res Clin Pract 2014; 8(2): e178-82.
[http://dx.doi.org/10.1016/j.orcp.2013.03.007] [PMID: 24743014]
[51]
Wang YZ, He YG, Mitzel G, Zhang S, Bartlett M. Handheld shape discrimination hyperacuity test on a mobile device for remote monitoring of visual function in maculopathy. Invest Ophthalmol Vis Sci 2013; 54(8): 5497-505.
[http://dx.doi.org/10.1167/iovs.13-12037] [PMID: 23860761]
[52]
Raum P, Lamparter J, Ponto KA, et al. Prevalence and cardiovascular associations of diabetic retinopathy and maculopathy: Results from the Gutenberg Health Study. PLoS One 2015; 10(6): e0127188.
[http://dx.doi.org/10.1371/journal.pone.0127188] [PMID: 26075604]
[53]
Klein R, Klein BK, Davis MD. Is cigarette smoking associated with diabetic retinopathy? Am J Epidemiol 1983; 118(2): 228-38.
[http://dx.doi.org/10.1093/oxfordjournals.aje.a113630] [PMID: 6881128]
[54]
Vestgaard M, Ringholm L, Laugesen CS, Rasmussen KL, Damm P, Mathiesen ER. Pregnancy-induced sight-threatening diabetic retinopathy in women with Type 1 diabetes. Diabet Med 2010; 27(4): 431-5.
[http://dx.doi.org/10.1111/j.1464-5491.2010.02958.x] [PMID: 20536515]
[55]
Olsen BS, Sjølie AK, Hougaard P, et al. The significance of the prepubertal diabetes duration for the development of retinopathy and nephropathy in patients with type 1 diabetes. J Diabetes Complications 2004; 18(3): 160-4.
[http://dx.doi.org/10.1016/S1056-8727(03)00073-4] [PMID: 15145327]
[56]
Stalnikiewicz L, Floriot M, Guerci B, Angioi K. Progression de la rétinopathie diabétique chez les femmes enceintes: étude rétrospective monocentrique d’une série de 77 patientes consécutives. J Fr Ophtalmol 2010; 33(7): 481-6.
[http://dx.doi.org/10.1016/j.jfo.2010.06.005] [PMID: 20674081]
[57]
Klein BEK, Moss SE, Klein R. Is menarche associated with diabetic retinopathy? Diabetes Care 1990; 13(10): 1034-8.
[http://dx.doi.org/10.2337/diacare.13.10.1034] [PMID: 2209299]
[58]
Sunness JS. The pregnant woman’s eye. Surv Ophthalmol 1988; 32(4): 219-38.
[http://dx.doi.org/10.1016/0039-6257(88)90172-5] [PMID: 3279558]
[59]
Bryl A, Mrugacz M, Falkowski M, Zorena K. The effect of hyperlipidemia on the course of diabetic retinopathy—literature review. J Clin Med 2022; 11(10): 2761.
[http://dx.doi.org/10.3390/jcm11102761] [PMID: 35628887]
[60]
Chou Y, Ma J, Su X, Zhong Y. Emerging insights into the relationship between hyperlipidemia and the risk of diabetic retinopathy. Lipids Health Dis 2020; 19(1): 241.
[http://dx.doi.org/10.1186/s12944-020-01415-3] [PMID: 33213461]
[61]
Wong TY, Cheung N, Tay WT, et al. Prevalence and risk factors for diabetic retinopathy: The Singapore Malay Eye Study. Ophthalmology 2008; 115(11): 1869-75.
[http://dx.doi.org/10.1016/j.ophtha.2008.05.014] [PMID: 18584872]
[62]
Kowluru RA, Mishra M, Kowluru A, Kumar B. Hyperlipidemia and the development of diabetic retinopathy: Comparison between type 1 and type 2 animal models. Metabolism 2016; 65(10): 1570-81.
[http://dx.doi.org/10.1016/j.metabol.2016.07.012] [PMID: 27621192]
[63]
Ma J, Li Y, Zhou F, Xu X, Guo G, Qu Y. Meta-analysis of association between the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor-γ2 gene and diabetic retinopathy in Caucasians and Asians. Mol Vis 2012; 18: 2352-60.
[PMID: 22993484]
[64]
Jenkins AJ, Joglekar MV, Hardikar AA, Keech AC, O’Neal DN, Januszewski AS. Biomarkers in diabetic retinopathy. Rev Diabet Stud 2015; 12(1-2): 159-95.
[http://dx.doi.org/10.1900/RDS.2015.12.159] [PMID: 26676667]
[65]
Cunha-Vaz J, Ribeiro L, Lobo C. Phenotypes and biomarkers of diabetic retinopathy. Prog Retin Eye Res 2014; 41: 90-111.
[http://dx.doi.org/10.1016/j.preteyeres.2014.03.003] [PMID: 24680929]
[66]
Vujosevic S, Simó R. Local and systemic inflammatory biomarkers of diabetic retinopathy: An integrative approach. Invest Ophthalmol Vis Sci 2017; 58(6): BIO68-75.
[http://dx.doi.org/10.1167/iovs.17-21769] [PMID: 28510630]
[67]
Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343-50.
[http://dx.doi.org/10.1056/NEJM200105033441801] [PMID: 11333990]
[68]
Bukht MS, Ahmed KR, Hossain S, Masud P, Sultana S, Khanam R. Association between physical activity and diabetic complications among Bangladeshi type 2 diabetic patients. Diabetes Metab Syndr 2019; 13(1): 806-9.
[http://dx.doi.org/10.1016/j.dsx.2018.11.069] [PMID: 30641812]
[69]
Hassabi M. Association between physical activity and severity of diabetic retinopathy in patients with diabetes mellitus. Res Bull Med Sci 2020; 25(1): e8-8.
[70]
Wang YX, Wei WB, Xu L, Jonas JB. Physical activity and eye diseases. The Beijing eye study. Acta Ophthalmol 2019; 97(3): 325-31.
[http://dx.doi.org/10.1111/aos.13962] [PMID: 30338672]
[71]
Shi C, Wang P, Airen S, et al. Nutritional and medical food therapies for diabetic retinopathy. Eye Vis 2020; 7(1): 33.
[http://dx.doi.org/10.1186/s40662-020-00199-y] [PMID: 32582807]
[72]
Mahoney SE, Loprinzi PD. Influence of flavonoid-rich fruit and vegetable intake on diabetic retinopathy and diabetes-related biomarkers. J Diabetes Complications 2014; 28(6): 767-71.
[http://dx.doi.org/10.1016/j.jdiacomp.2014.06.011] [PMID: 25055729]
[73]
Zheng H, Han X, Guo W, et al. Recent developments and challenges of Li-rich Mn-based cathode materials for high-energy lithium-ion batteries. Mater Today Energy 2020; 18: 100518.
[http://dx.doi.org/10.1016/j.mtener.2020.100518]
[74]
Singh RP, Elman MJ, Singh SK, Fung AE, Stoilov I. Advances in the treatment of diabetic retinopathy. J Diabetes Complications 2019; 33(12): 107417.
[http://dx.doi.org/10.1016/j.jdiacomp.2019.107417] [PMID: 31669065]
[75]
Ai X, Yu P, Hou Y, et al. A review of traditional Chinese medicine on treatment of diabetic retinopathy and involved mechanisms. Biomed Pharmacother 2020; 132: 110852.
[http://dx.doi.org/10.1016/j.biopha.2020.110852] [PMID: 33065390]
[76]
Acar Duyan ŞN, Bozkurt B, Unlu A, Yılmaz S, Karaküçük Y. Serum inflammatory cytokines and growth factors in patients with sjögren’s syndrome and diabetes mellitus. Genel Tip Derg 2023; 33(4): 360-6.
[http://dx.doi.org/10.54005/geneltip.1314282]
[77]
Sali F, Aykut V, Kunbaz A, et al. Endothelial loss following postoperative intracameral triamcinolone acetonide and subconjunctival dexamethasone injections. Cutan Ocul Toxicol 2023; 42(4): 237-42.
[http://dx.doi.org/10.1080/15569527.2023.2239897] [PMID: 37486313]
[78]
Lin Z, Deng A, Hou N, Gao L, Zhi X. Advances in targeted retinal photocoagulation in the treatment of diabetic retinopathy. Front Endocrinol 2023; 14: 1108394.
[http://dx.doi.org/10.3389/fendo.2023.1108394] [PMID: 36936172]

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