1. Targeted Treatments and Optimised Outcomes in Diabetic Eye Disease
Tanya Pejnovic

2. 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

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

4. 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

5. Diabetic Retinopathy

6. Diabetic Macular Edema
bbc.co.uk

7. Normal Macula

8. Diabetic Macular Edema

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

10. Vascular Endothelial Growth Factor-VEGF
Avastin
Lucentis
Eylea

11. Vascular Endothelial Growth Factor-VEGF

12. 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

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

14. 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

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

16. 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

17. Ladamo

18. Ladamo

19. 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?

20. Saving sight. Changing lives