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Challenges and Opportunities in Diabetic Retinopathy

Challenges and Opportunities in Diabetic Retinopathy

Le, P., Olson, D., Zehden, J., Vu, T., Van Buren, E., Lin, F., & Zhang, A. (2023)


Purpose: To determine the relationship between nonproliferative diabetic retinopathy (NPDR), proliferative diabetic retinopathy (PDR), anxiety, and depression.

Materials and Methods: This retrospective case-control study identified patients 18 years or older seen by the University of North Carolina Ophthalmology department between July 2008-July 2018 diagnosed with anxiety, depression, NPDR, and PDR. Odds ratios (OR) were calculated separately for the severity of diabetic retinopathy (DR) and anxiety or depression.

Results: Among the 47,740 study subjects, 27,893 (58%) were female, 3,239 (6.8%) had NPDR and 1,430 (3.0%) had PDR. The incidence of anxiety after DR was 1.5%, and the incidence of depression after DR was 2.4%. NPDR (0.997; 0.896-1.110; p<0.001) conveyed no change in odds, while PDR (0.869; 0.756-0.998; p<0.001) demonstrated a reduction in odds for a subsequent diagnosis of anxiety. Compared to other 18-34 year old patients with less severe or no disease, 18-34 year old patients with NPDR (2.801; 1.450-5.408; p=0.003) and PDR (2.999; 1.499-6.001; p=0.004) exhibited an increased odds for subsequent anxiety. NPDR (1.473; 1.342-1.617; p<0.001) and PDR (1.232; 1.092-1.389; p<0.001) demonstrated an increased odds for subsequent diagnosis of depression. When stratifying by age, 18-34 year old patients again had the highest increase in odds for subsequent diagnosis of depression (NPDR 3.452; 1.774-6.719; p<0.001 and PDR 4.382; 2.232-8.603; p<0.001).

Conclusions: Patients with DR have an increased risk for a new diagnosis of depression, and DR severity has a positive linear relationship with the diagnosis of depression. Age likely plays a prominent role in risk stratification for a new diagnosis of anxiety in patients with DR.

Alabdulmunem, M. (2022)


Purpose: Diabetic retinopathy is a common cause of blindness among diabetics. Studies around the globe establish oxidative stress as one of the major players of diabetes and diabetic retinopathy. Epidemiological reports suggest that consumption of large quantity of fruits and vegetables of high carotenoid content decreases risk of diabetes-based complications including retinopathy. Lycopene is a potent antioxidant and a carotenoid family member having known health benefits. Thus, the present investigation was designed to evaluate the antioxidant property.

Methods: The antioxidant potential of lycopene was determined using D407 retinal pigment epithelial cell lines through lycopene incorporation studies and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide cell cytotoxicity assay.

Results: Lycopene showed good antioxidant effect in-vitro on retinal pigment epithelial cell line and it was devoid of any cellular toxicity in 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.

Conclusion: The results suggest that lycopene can be a potential candidate to halt the progression of diabetic retinopathy due to its effective defense against oxidative stress and non-toxic nature on the retinal pigment epithelial cells.

Sridhar, G., & Lakshmi, G. (2023)


Artificial intelligence (AI) has permeated various branches of clinical medicine, with promising applications in predictive, diagnostic and therapeutic areas. Digital innovations are increasingly useful in the management of non communicable diseases in the form of tracking applications,  data collection systems (EMRs) and wearable sensors. Globally, diabetes mellitus is the most common and serious non communicable disease. There is a mismatch between the people with diabetes and the number of healthcare professionals needed to manage them. Therefore, artificial intelligence has the potential to play a significant role in addressing the unmet need. Majority of AI applications have been developed for the diabetes population. Ethical issues arising from the application can be carried over to its application in other areas of clinical medicine. Among diabetic population, artificial intelligence has been prominently employed in screening for diabetic retinopathy. Continuous glucose monitoring and insulin pumps are other areas of application. Data collection and sharing through AI media can ease the burden of poor doctor-patient ratio, and improve efficacy of treatment. Despite its advantages, and the fact that citizen juries have been found to be favourable towards the use of AI in research and treatment, certain drawbacks continue to exist. With the threat of data theft and breach of privacy, due diligence must be given to ethical and legal aspects to protect the patient. It is acknowledged that AI can facilitate the decision making process but not entirely replace a physician’s role. With able governing laws, systems to protect safety, minimize bias and improve transparency, AI and precision medicine could help control the burden of disease.

Tin, S. T. W., Matoto, V., Na’ati, E., Tomiki, S., Ofahulu, M., Fangalua, A., & Toli, V. (2023)


Background: The small Pacific Island nation like Tonga has faced a crisis for decades due to premature loss of lives and disabilities due to diabetes. However, there is limited peer-reviewed literatures on the rates of diabetes complications and capacity for providing quality diabetes care in Tonga. The lack of adequate information in local context triggers significant challenges to make informed decision, proper planning, and effective implementation to improve diabetes care.

Aim: This study aims to determine the prevalence of diabetes complications and associated risk factors among people with diabetes, and the capacity for managing diabetes as an initial step towards strengthening diabetes care at the primary health care setting in Tonga.

Methods: This cross-sectional study was conducted on a sample of 207 people with diabetes from the primary health care centre in Tonga. People with diabetes were screened by qualified health professional using a standardised protocol, and the capacity of diabetes care was assessed by a standardised assessment form.

Results: Of the 207 people with diabetes aged between 20 and 80 years screened for diabetes related complications, 135 (74%) had family history of diabetes, 57 (28%) female subjects had history of gestational diabetes, and 28 (14%) subjects were current smokers. The prevalence of overweight was 51%, obese was 38% and hypertension was 44%. The percentage of subjects with high cholesterol was 42%. HbA1c was measured and subjects with good, poor, and very poor blood glucose control were 15%, 49% and 36% respectively. The percentage of people with diabetes who had retinopathy was 18% and who were at risk of developing diabetic foot ulcer was 14%. This study also found that people with diabetes did not attend regular follow-up visits at the health care centre and the capacity to provide quality diabetes care services is limited.

Conclusion: This study highlighted the urgent need to improve the quality and accessibility of diabetes care to reduce diabetes complications. The findings also provided a timely reminder to government and development partners to invest additional resources to effectively manage diabetes at the primary health care level. Tonga will require to strengthen a resilient health system to improve screening for early detecting of diabetes complications and enhance management services at the primary health care setting.

De Faria, J. B. L. (2023)


Opium prescriptions date from the Sumerian era about 8,000 years ago, and they were commonly abused among wounded soldiers during the American Civil and Prussian French wars. With the isolation of morphine in 1805 by Setürner, the synthesis of morphine by Tschudi in 1952 and the manufacturing of synthetic derivatives called opioids, a new era of research began. In normal conditions, the endogenous opioid levels are elevated under stress conditions as a part of adaptive response. This mechanism implies in b-endorphin release, not only from the hypothalamus but also by immune circulating cells as lymphocytes.  This system is powerful against pain, ischemic insult and oxidative imbalance protecting the tissues.  The recognition of opioid receptors, particularly the delta subtype in retinal tissue, has broadened the potential for clinical applications. In the eye, opioid receptors were demonstrated to be present in optic nerve head, ganglion cells and pigmented epithelium cells.  As such, studies have revealed that opioid receptors play a role in the pathogenesis of DR preserving the outer blood retinal barrier and also acting as a retinal neuroprotective agent. In this scenario, the modulation of the opioid receptor in the retina might become an attractive therapeutic target in the treatment of this devastating complication. Thus, this review assesses recent and scarce findings on this topic which deserves to be further investigated.