Impact of treatment of diabetic macular edema on visual impairment in people with diabetes mellitus in India

Compliance with follow-up in patients with diabetic macular edema: Eye care center vs. diabetes care center

Purpose

The study was conducted to compare the compliance to intravitreal injection treatment and follow-up in patients with center-involving diabetic macular edema (CI-DME) and treatment outcomes between a tertiary eye care facility and a tertiary diabetes care center.

Methods

A retrospective review was conducted on treatment naïve DME patients who had received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in 2019. Participants were people with type 2 diabetes who were under regular care at the eye care center or the diabetes care center in Chennai. The outcome measures were noted at months 1, 2, 3, 6, and 12.

Results

A review of 136 patients treated for CI-DME (72 from the eye care center and 64 from a diabetes care center) was carried out. The severity of diabetic retinopathy (DR) was similar in both centers. There was no statistically significant (P > 0.05) difference in the choice of initial intravitreal drug in the two centers. At 12-month follow-up, only 29.16% came for a follow-up in the eye center vs. 76.56% in a diabetes care center (P = 0.000). The multivariate logistic regression showed increasing age was associated with non-compliance in both the groups (eye care center: odds ratio [OR] 0.91; 95% confidence interval [CI] 0.82-1.21; P = 0.044) and diabetes care center (OR 1.15; 95% CI 1.02-1.29; P = 0.020).

Conclusion

The follow-up rate between eye care and diabetic care center with DME showed a significant disparity. By providing comprehensive diabetes care for all complications under one roof, compliance with follow-up can be improved in people with DME.

Deep learning-based detection of diabetic macular edema using optical coherence tomography and fundus images: A meta-analysis

Diabetic macular edema (DME) is an important cause of visual impairment in the working-age group. Deep learning methods have been developed to detect DME from two-dimensional retinal images and also from optical coherence tomography (OCT) images. The performances of these algorithms vary and often create doubt regarding their clinical utility. In resource-constrained health-care systems, these algorithms may play an important role in determining referral and treatment. The survey provides a diversified overview of macular edema detection methods, including cutting-edge research, with the objective of providing pertinent information to research groups, health-care professionals, and diabetic patients about the applications of deep learning in retinal image detection and classification process. Electronic databases such as PubMed, IEEE Explore, BioMed, and Google Scholar were searched from inception to March 31, 2022, and the reference lists of published papers were also searched. The study followed the preferred reporting items for systematic review and meta-analysis (PRISMA) reporting guidelines. Examination of various deep learning models and their exhibition regarding precision, epochs, their capacity to detect anomalies for less training data, concepts, and challenges that go deep into the applications were analyzed. A total of 53 studies were included that evaluated the performance of deep learning models in a total of 1,414,169°CT volumes, B-scans, patients, and 472,328 fundus images. The overall area under the receiver operating characteristic curve (AUROC) was 0.9727. The overall sensitivity for detecting DME using OCT images was 96% (95% confidence interval [CI]: 0.94-0.98). The overall sensitivity for detecting DME using fundus images was 94% (95% CI: 0.90-0.96).

Diabetic Retinopathy and Diabetic Macular Edema in People With Early-Onset Diabetes

This study examined the clinical profile, treatment profile, and vision outcomes of people ≤40 years of age with diabetes and diabetic macular edema (DME). Within this age-group, the prevalence of center-involving DME was 16%, with 74% of eyes showing cystoid edema, 37% showing spongiform edema, and 41% having neurosensory detachment. Longer diabetes duration (P = 0.001) and greater severity of diabetic retinopathy (P <0.001) were associated with DME prevalence. Thus, regular and more frequent follow-up, as well as early and aggressive treatment of diabetic eye disease, are required in people diagnosed early with diabetes.

Anti-VEGF and Other Novel Therapies for Neovascular Age-Related Macular Degeneration: An Update

Age-related macular degeneration (AMD) is a leading cause of visual impairment and blindness in older adults. The prognosis for the neovascular type of advanced AMD improved with the introduction of biological drugs with antiangiogenic properties, beginning with off-label bevacizumab, which was first used intravitreally in 2006. These drugs target newly formed vessels that grow beneath the center of the retina, causing loss of central vision, and they can help to maintain or improve vision. Repeated intravitreal injections are needed to achieve prolonged inhibition of proangiogenic cytokines, primarily vascular endothelial growth factor (VEGF). Major regulatory agencies have approved several molecules for AMD treatment, including ranibizumab, aflibercept, and brolucizumab. The development of further drugs was mainly targeted at prolonging anti-VEGF inhibition-thus reducing the frequency of injections-and expanding the biological targets of proangiogenic cytokine inhibition. Finally, biosimilars are already being marketed in some countries, allowing the containment of costs of AMD treatment, which are growing steadily in many settings because of the need for long-term treatment. This review summarizes the properties and clinical profiles of anti-VEGF biological drugs that are approved to treat neovascular AMD as well as ongoing research on molecules that may be marketed in the near future.