1. State of the art treatments in diabetic eye disease
Dr Sanj Wickremasinghe

4. Diabetes and the eye Cataract Refractive changes Cranial nerve palsies
Diabetic retinopathy

5. 10% will likely develop visual impairment secondary to diabetic retinopathy
Leading cause of blindness in working aged people
DME accounts for 2/3 of cases

6. Chronic hyperglycaemia
Inflammation, ischaemia, retinal hypoxia, endothelial damage
Increased VEGF and inflammatory mediators
Breakdown of blood–retina barrier
Increased permeability and neovascularisation
Diabetic macular oedema
VISION LOSS
Leakage of fluid/proteins

8. OCT

11. Treatment

13. Diabetic Retinopathy Retinal laser treatment can prevent blindness
Retinal laser treatment can not restore sight that is already lost

14. DME MA- too close to foveal centre Diffuse odema
Disrupted foveal architecture
Lipid++

15. Intravitreal anti-VEGF injections
Lucentis®
Avastin®
Eylea®

16. Anti VEGF

18. Difficulties Often younger patients Works well in 50-60% of cases
Reproductive age
Works well in 50-60% of cases
But many injections
40-50% have minimal or no benefit
Risks

19. What else??

21. Studies
DISCERN
Wide variation in VEGF levels = response to VEGF inhibition.
Pts with higher VEGF concentrations may respond better to VEGF blockade
Those with low VEGF concentration may have DME driven by inflammation= poor response

22. Studies
LADAMO

23. New drugs
Gene therapy platforms that release anti- VEGF drug over long periods
Refillable implant device
Longer acting anti-VEGF agents
DROPS/ subcutaneous injections that inhibit VEGF or stabilise blood vessels