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by Melissa Calton
Diabetes is the primary cause of adult blindness, leaving patients to use highly invasive and often ineffective treatments. In addition to searching for more effective therapies, pharmaceutical companies have begun to develop preventative alternatives for diabetic eye disease. These life-changing options could transform the standard of care for diabetes patients and those at risk for diabetic eye disease.
Diabetes mellitus—a group of serious metabolic disorders that require careful daily management in patients—is the seventh leading cause of death in the United States. The Centers for Disease Control and Prevention report an alarming 30.3 million adults in the US are currently living with diabetes, and 1 in 4 affected haven’t even been diagnosed. Because the prevalence of diabetes has nearly tripled in the last 20 years and diabetes is not yet curable, scientists are pressed to find novel methods of treatment for the disease and its many complications.
People with diabetes are at risk of a variety of conditions triggered by high blood glucose levels. When these levels go unmanaged for long periods of time, vascular damage can occur and cause debilitating physical and cognitive health problems.
Of the many complications people with diabetes face, eye disease is one of the most common, affecting about one third of patients. Damaged vessels in the retina, otherwise known as diabetic retinopathy (DR), underlies most of these eye-related conditions. Specifically, diabetic macular edema (DME), a progressive stage of DR, is the leading cause of blindness in working-age adults with diabetes. DME is indicated by retinal thickening and a buildup of fluid in the macula—the center of the retina—which is responsible for sharp, central vision and leaves 28% of patients with impaired vision.
Despite the prevalence of eye disease in the diabetic community, current treatment methods for retinopathy and DME are highly invasive and often ineffective.
A common method of treatment for DME is laser therapy, in which a laser targets damaged eye tissue. Unfortunately, success rates vary, its use is limited to certain conditions, and recovery can take up to six months. What’s more, eye irritation, vision disturbances, and light sensitivity are commonly reported side effects.Anti-VEGF therapy
A second method of treatment for DME, anti-vascular endothelial growth factor therapy (anti-VEGF), aims to reduce new blood vessel growth and swelling in the eye. Anti-VEGF therapy is performed by recurring injections of the anti-VEGF drug into the eye. However, this treatment is highly invasive and also associated with rare but serious side effects, including infection, inflammation, hemorrhage, and retinal detachment. In addition, anti-VEGF injections do not prevent DME and may only be effective in about half of those treated.Corticosteroid implants
Less commonly used than the anti-VEGF biologics, corticosteroids can be administered as intravitreal implants to reduce inflammation. These implants reduce the frequency of eye injections from once every six months to once every three years. Despite this upside, they are still associated with the side effects of intravitreal injections and can also lead to the development of cataracts.
Diabetes has reached epidemic proportions in the US and continues to grow as a global burden. An estimated 33.9% of adults in the US are unaware that they have prediabetes, and over 1.5 million new diagnoses are confirmed annually. Current treatments are inconvenient, expensive, and unsuitable to prevent the onset of DME in the many patients at risk. Until new treatment options or cures for diabetes are discovered, drugs that treat diabetic complications like DME are in urgent need.
Over the recent years, drug developers have realized this need and have started to turn their attention to new potential treatments for diabetic eye diseases with less invasive modes of administration. The goal is to develop a drug with a new method of delivery, such as an oral pill, that both treats and prevents the disease.
In the serine protease plasma kallikrein, a central mediator of DME, researchers have found a promising new target for DME. Laboratory studies have shown that new drug candidates can be effective at treating the hallmarks of the disease and have the potential to be administered as a pill. Clinical studies will have to confirm that these findings hold up in patients, but hope is on the horizon. For the growing number of diabetes patients who currently rely on recurring injections, a pill could be life changing and vison loss could be prevented all together.
Melissa Calton is the Program Manager of Ophthalmology at Verseon.
- DME - diabetic eye disease -