Diabetes: Current and Future Developments

The incidence of diabetes mellitus is increasing worldwide. Over time, diabetes is associated with the development of diabetic retinopathy, a major cause of vision loss globally. Research has demonstrated factors associated with the onset and progression of the disease. Despite advancements in understanding the importance of optimizing care, the cases of vision loss due to diabetic retinopathy are also increasing. The epidemic of this systemic disease and the retinal manifestations will be discussed in detail in this chapter.

Diabetes is a major public health problem affecting millions of people around the globe. In the United States alone, over 7.5 million have type 2 diabetes and an alarming 78 million adults have prediabetes and remain largely undiagnosed. This epidemic was ushered in by the ongoing epidemic of obesity and is caused in-part by sedentary life style and aging population. In this chapter we discuss the diabetes epidemic highlighting the major risk factor of diabetes, particularly type 2. We also discuss the complications of diabetes including microvascular complications as well as macrovascular disease including coronary heart disease and stroke, the major cause of morbidity and mortality in the diabetic population. Finally, we present the major therapeutic advances in diabetes including modern pharmacologic agents and their potential effects on cardiovascular risk. We also outline the recent technological advances in diabetes management including closed loop systems, artificial pancreas, stem cell therapy among other ongoing research bound to prevent and/or alleviate the effects of this ongoing epidemic.

In this chapter, we review the established classification system of diabetic retinopathy and diabetic macular edema. Reversible and non-reversible causes of vision loss in diabetic patients are discussed with illustrative clinical examples.

This chapter will review some of the infections that can be seen in and around the eye in diabetic patients. Specifically, six cases of infection will be highlighted and discussed.

Eye disease attributed to Diabetes can have devastating effects on all aspects of vision as all parts of the eyes are subject to damage including the optic nerve and cranial nerves. In this chapter, we will discuss the most common neuro-ophthalmic problems seen in diabetic patients.

Diabetic eye disease is a potential vision-threatening condition. The most well-known complication of uncontrolled diabetes is diabetic retinopathy, but diabetes can affect various structures of the globe other than the retina. Anterior segment complications include ocular surface disease, which includes Dry Eye Syndrome and diabetic keratopathy, cataracts, refractive changes, extraocular movement disorders, and neovascular glaucoma. Posterior segment complications include diabetic papillopathy and retinopathy. Diabetic retinopathy causes vision loss in multiple ways including macular edema and ischemia, vitreous hemorrhage, and retinal detachment. Tight glucose control can help to prevent these complications from occurring.

Diabetes affects the eye in many ways. We most commonly think of posterior segment complications as the main problem causing loss of vision in diabetes which is certainly the most common way people suffer ocular damage. However, the anterior segment is not immune to diabetic complications, and the cornea can be affected in a variety of ways. The manifestations of the corneal disease will be discussed in detail in this chapter.

Diabetes Mellitus (DM) affects many parts of the eye. While we traditionally associate vision loss from DM with diabetic retinopathy, it can affect various structures of the eye other than the retina. In this chapter, we will focus on the disease’s effects on the lens, and on the drainage apparatus of the eye. Specifically, we will look at cataract and glaucoma incidence in DM and its etiologic role, and then discuss treatment strategies.

The assessment and monitoring of diabetic retinopathy are aided by multiple imaging techniques, including optical coherence tomography, optical coherence tomography angiography, and fluorescein angiography. We will discuss each modality in this chapter.

An understanding of the classification scheme of nonproliferative and proliferative diabetic retinopathy is essential for the proper management of diabetic eye disease. The level of retinopathy is based on clinical findings seen on fundus examination.

This chapter will review most common therapies currently used for diabetic retinopathy. Specifically, the treatments being used for diabetic macular edema (DME) and proliferative diabetic retinopathy will be discussed.

Diabetic retinopathy is one of the leading causes of vision loss worldwide and its incidence is only projected to increase. Much effort has been dedicated to investigating new therapies and drug delivery approach in treating its complications, diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Although anti-vascular endothelial growth factor (VEGF) has gained popularity in treatment for DR, patients who respond poorly to intravitreal injections have prompted the search for additional pathogenic pathways and thus therapeutic targets that may better control disease activity. These novel therapies, including various anti-angiogenic agents, growth factor inhibitors, integrin inhibitors, sustained delivery platforms, gene therapy, chemokine and other inflammatory inhibitors, and neuroprotective agents, are currently being evaluated for the management of DR. Optimal treatment paradigms in the management of PDR are also under investigation.