Targeted Treatments and Optimised Outcomes in Diabetic Eye Disease Tanya Pejnovic

The Diabetes Epidemic Biggest challenge to Australia’s healthcare system 280 people develop diabetes in Australia each day Over 1 million people in Australia have been diagnosed with diabetes Australia’s leading cause of preventable blindness

Diabetic Eye Disease Cataract Refractive changes Nerve palsies Diabetic retinopathy University of Maryland Knowyourdoctor.com

Diabetic Retinopathy Approximately 1 in 3 diabetics develop retinopathy Bleeding in the retina Closure of retinal capillaries Growth of abnormal blood vessels Leakage of fluid from retinal blood vessels

Diabetic Retinopathy

Diabetic Macular Edema bbc.co.uk

Normal Macula

Diabetic Macular Edema

Chronic hyperglycaemia Inflammation Increased VEGF and inflammatory mediators (cytokines) Increased permeability of blood vessels Diabetic macular oedema VISION LOSS Leakage of fluid/proteins

Vascular Endothelial Growth Factor-VEGF Avastin Lucentis Eylea

Vascular Endothelial Growth Factor-VEGF

Vascular Endothelial Growth Factor-VEGF Wide variation in VEGF levels leads to varying response to VEGF inhibition. Pts with higher VEGF concentrations may respond better to VEGF blockade About 40% show minimal or no benefit Those with low VEGF concentration may have DME driven by other inflammatory factors – cytokines

Cytokines Small proteins expressed by cells Aid communication between cells involved in inflammatory response Can be pro- or anti-inflammatory

Discern Measuring cytokine levels before and after anti-VEGF treatment for DME Anti-VEGF treatment influences levels of some pro-inflammatory cytokine levels Elevated concentrations of certain inflammatory cytokines in the eye may be a possible reason for poor response to anti-VEGF monotherapy

Discern Targeted anti-cytokine treatment available for systemic diseases Targeted anti-cytokine treatment may lead to better outcomes in patients with DME

Ladamo Capillary closure increases VEGF levels in the eye Raised VEGF levels promote DME Laser treatment of ischemic areas lowers VEGF expression Comparison of anti-VEGF treatment of DME in eyes treated with laser to those without laser treatment

Ladamo

Ladamo

Ladamo Does laser therapy of peripheral retinal ischaemia reduce the overall number of intravitreal aflibercept injections required to control DME over a 24 month period?

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