A global view of diabetic eye disease

In collaboration with Modern Retina, we spotlighted developments in the DME and DR spaces from the 2023 EURETINA congress. Image credit: ©Chris Tefme – stock.adobe.com

The 2023 EURETINA conference hosted in Amsterdam, the Netherlands, from 5 to 8 October, showcased research and data on diabetic macular oedema (DME) and diabetic retinopathy (DR) from not only Europe, but from countries around the world. The meeting brought together many of the best retina specialists working today. In collaboration with Modern Retina, we spotlighted developments in the DME and DR spaces that were particular standouts.

United States

David Almeida, MD, MBA, PhD, DABO, FRCSC, FASRS, from the United States, shared data on the 0.19-mg fluocinolone acetonide (FAc) implant and the USER study, which highlighted the visual and reduced-treatment-burden benefit of treating eyes with good baseline visual acuity, 20/40 or better.

The report provided real-world evidence from the 3-year prospective, phase 4 PALADIN study in which 202 eyes from 159 patients with center-involved DME were treated for up to 36 months with the 0.19-mg FAc implant. The results of this study showed that vision was maintained or improved regardless of baseline visual acuity, and no new safety concerns were identified.¹

United Arab Emirates

In a presentation titled “Real-World Evidence of Faricimab for the Management of DME and nAMD: A Multi-Center Study from the United Arab Emirates,” the authors shared that it spanned seven private centres from the United Arab Emirates and involved a retrospective chart review of 142 patients (185 eyes) with DME or neovascular age-related macular degeneration (nAMD) treated with faricimab between June 2022 and May 2023.

The study results showed that the mean change in visual acuity at week 16 was +7.2 letters in patients with nAMD and +6.4 letters in patients with DME. The mean change in central subfield thickness at week 16 was –113.4 μm in patients with nAMD and –85.6 μm in patients with DME.²

United Kingdom

Alasdair Simpson, MBChB, BSc, presented on “The Impact of Flash Glucose Monitoring on Diabetic Retinopathy in Type 1 Diabetics” at the EURETINA conference. The abstract set the purpose of the study, saying, “We sought to evaluate the impact of the flash glucose monitoring on diabetic retinopathy screening scores.”

To determine this, a retrospective observational cohort study of patients commenced on flash monitoring (FM) in National Health Service Greater Glasgow and Clyde comparing retinopathy scores before and after FM insertion. There were 229 patients (47.5% of whom were female) identified with a mean age of 42, a mean duration of diabetes of 20 years (range, 1-50) and a mean hemoglobin A1c (HbA1c) level of 61 mmol/mol. The results showed that FM in this cohort did not lead to development of proliferative diabetic retinopathy in any patients and therefore appears to be a safe intervention. However, the researcher also noted that those who did have an improvement in HbA1c were more likely to see a worsening of their retinopathy score from R0R0 to R1R0 or worse in the first year.³

Italy

Researchers presented a preliminary report on the use of artificial intelligence (AI) software to diagnose DR in the Italian health care system. Along with reviewing the impact of AI on the diagnostic burden on eye care specialists and time costs for patients, the researchers were also focused on analyzing the performance of the AI tool RetCAD(Thirona BV Nijmegen, the Netherlands), which obtains retinal images with a true-color, confocal, fully automated nonmydriatic fundus imaging system (DRSplus by Centervue Spa, a company of iCare Finland Oy; Vantaa, Finland).

After evaluating the 337 patients included in the study sample, the RetCAD AI system demonstrated an excellent sensitivity in detecting more than mild retinopathy. Also, specificity was very accurate with a low false-positive rate. Overall, this study showed that the AI system can improve DR screening and monitoring in people with diabetes by non–eye care professionals.⁴

The state of DME and DR research

The retina field is full of research that continues to progress the treatment of DME and DR. Through the combined efforts of researchers, we are better able to understand the nuances of this disease, progress current treatments and develop innovative solutions to further preserve and ultimately reverse the damage of diabetic eye diseases. Along with the presentations mentioned here, there are dozens of other efforts working towards a brighter future for patients and providers.

References

1. Almeida D, Gonzalez V, Cutino A, Coughlin B, Kasper J. 0.19 mg Fluocinolone acetonide (FAc) implant leads to superior vision-, anatomical-, and treatment burden-related outcomes in eyes with better baseline visual acuity (≥20/40). Abstract presented at: EURETINA; October 5-8, 2023; Amsterdam, Netherlands. Accessed October 25, 2023. https://euretina.softr.app/amsterdam-abstract?recordId=recS7MXX3Lssfi0km

2. El Khashab A, Safar A, Ayad A, et al. Real-world evidence of faricimab for the management of DME and nAMD: a multi-center study from the United Arab Emirates. Abstract presented at: EURETINA; October 5-8, 2023; Amsterdam, Netherlands. Accessed October 25, 2023. https://euretina.softr.app/amsterdam-abstract?recordId=recian1FT02yDiO1g

3. Simpson A. The impact of flash glucose monitoring on diabetic retinopathy in type 1 diabetics. Abstract presented at: EURETINA; October 5-8, 2023; Amsterdam, Netherlands. Accessed October 25, 2023.https://euretina.softr.app/amsterdam-abstract?recordId=recGterhV3LDjseUZ

4. Piatti A, Giorda CB, Romeo F. Diabetic retinopathy screening with artificial intelligence: preliminary experience in Italian healthcare system. Abstract presented at: EURETINA; October 5-8, 2023; Amsterdam, Netherlands. Accessed October 25, 2023. https://euretina.softr.app/amsterdam-abstract?recordId=recTeGlzMEUo5hl6T