Multifactorial approach for prevention of proliferative diabetic retinopathy

With a number of measures, the risk of damage from proliferative diabetic retinopathy can be expected to be significantly reduced. A good example is tear fluid analysis: this makes it relatively easy to stratify diabetic patients based on potential complications and to predict progressive damage to the retina.

Proliferative diabetic retinopathy (PDR), which manifests after diabetic retinopathy (DR), is a common complication of diabetes mellitus (DM). In fact, PDR is the leading cause of blindness in the working population. Current screening methods that aim to identify the risk of DR often cannot prevent the condition from worsening and patients from suffering irreversible damage.

Kropp et al. investigated various evidence-based DR ‘targets’ that can be used as a new and predictive model. This could implement a personalized, cost-effective and prevention-oriented strategy for both primary and secondary treatment of DR. The research resulted in a number of recommendations, such as population screening for people with suboptimal health. This is strongly recommended to identify and quantify reversible health damage, not only for targeted protection against DR but also to prevent life-threatening complications of DM. The severity of mitochondrial damage and excessive autophagy – both hallmarks of DR pathophysiology – could also be measured. By quantifying the patient’s individual predisposition, very targeted measures can be taken to, for example, tackle oxidative damage to mitochondria. Another tool to diagnose systemic diseases with ocular complications and monitor treatment is tear fluid analysis. Specific parameters such as endothelial activation, inflammation and oxidative stress as a result of DR are reflected in specific biomarker patterns that can be demonstrated in tear fluid. Precisely because tear fluid analysis is a non-invasive method that requires little specific training, it is a very attractive tool in developing a more prevention-oriented approach to DR.

Source:

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;14:21-42.