Back to Journals » Eye and Brain » Volume 8

Clinical biomarkers and molecular basis for optimized treatment of diabetic retinopathy: current status and future prospects

Authors Saxena R, Singh D, Saklani R, Gupta SK

Received 3 September 2015

Accepted for publication 25 October 2015

Published 19 February 2016 Volume 2016:8 Pages 1—13

DOI https://doi.org/10.2147/EB.S69185

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Pachiappan Arjunan

Peer reviewer comments 3

Editor who approved publication: Professor Margaret Wong-Riley

Rohit Saxena,1 Digvijay Singh,2 Ravi Saklani,3 Suresh Kumar Gupta,3

1Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 2Division of Ophthalmology, Medanta-The Medicity, Gurgaon, 3Ocular Pharmacology Laboratory, Delhi Institute of Pharmaceutical Sciences and Research, New Delhi, India

Abstract: Diabetic retinopathy is a highly specific microvascular complication of diabetes and a leading cause of blindness worldwide. It is triggered by hyperglycemia which causes increased oxidative stress leading to an adaptive inflammatory assault to the neuroretinal tissue and microvasculature. Prolonged hyperglycemia causes increased polyol pathway flux, increased formation of advanced glycation end-products, abnormal activation of signaling cascades such as activation of protein kinase C (PKC) pathway, increased hexosamine pathway flux, and peripheral nerve damage. All these changes lead to increased oxidative stress and inflammatory assault to the retina resulting in structural and functional changes. In addition, neuroretinal alterations affect diabetes progression. The most effective way to manage diabetic retinopathy is by primary prevention such as hyperglycemia control. While the current mainstay for the management of severe and proliferative diabetic retinopathy is laser photocoagulation, its role is diminishing with the development of newer drugs including corticosteroids, antioxidants, and antiangiogenic and anti-VEGF agents which work as an adjunct to laser therapy or independently. The current pharmacotherapy of diabetic retinopathy is incomplete as a sole treatment option in view of limited efficacy and short-term effect. There is a definite clinical need to develop new pharmacological therapies for diabetic retinopathy, particularly ones which would be effective through the oral route and help recover lost vision. The increasing understanding of the mechanisms of diabetic retinopathy and its biomarkers is likely to help generate better and more effective medications.

Keywords:
mechanism, pharmacotherapy microvascular changes, neurodegeneration, laser, progression

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Readers of this article also read:

Macular thickness and macular volume measurements using spectral domain optical coherence tomography in normal Nepalese eyes

Pokharel A, Shrestha GS, Shrestha JB

Clinical Ophthalmology 2016, 10:511-519

Published Date: 21 March 2016

Strategies for improving the early diagnosis of keratoconus

Shi Y

Clinical Optometry 2016, 8:13-21

Published Date: 24 February 2016

How bees distinguish patterns by green and blue modulation

Horridge A

Eye and Brain 2015, 7:83-107

Published Date: 5 October 2015

Infectious optic neuropathies: a clinical update

Kahloun R, Abroug N, Ksiaa I, Mahmoud A, Zeghidi H, Zaouali S, Khairallah M

Eye and Brain 2015, 7:59-81

Published Date: 28 September 2015

Papilledema: epidemiology, etiology, and clinical management

Rigi M, Almarzouqi SJ, Morgan ML, Lee AG

Eye and Brain 2015, 7:47-57

Published Date: 17 August 2015

Horner syndrome: clinical perspectives

Kanagalingam S, Miller NR

Eye and Brain 2015, 7:35-46

Published Date: 10 April 2015

How bees distinguish colors

Horridge A

Eye and Brain 2015, 7:17-34

Published Date: 11 March 2015

How bees distinguish black from white

Horridge A

Eye and Brain 2014, 6:9-17

Published Date: 31 October 2014