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Novel Ways to Treat Diabetic Edema

Posted by Ilena Di Toro | Posted on July 16, 2019

Having diabetes is never a good thing. A person has to monitor blood glucose, take medication, and watch what he or she eats. Diabetes can also wreak havoc with vision. One condition that a diabetic has to be on the lookout for is diabetic edema.

Diabetic edema is a result of complications of diabetic retinopathy. Treatments for retinopathy include focal laser photocoagulation, which seals leaking retinal blood vessels. Now thanks to research, other treatments are available. One such treatment is intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs. These drugs are designed to stop the growth of blood vessels and slow the progression of the edema. Corticosteroid treatments, which reduce inflammation, can help as well.

Of course, none of these treatments are cures, so what can be done to preserve vision, especially since diabetic edema doesn’t present symptoms until the disease is in the advanced stages and there is vision loss? Believe it or not, it is something as simple as monitoring the patient’s eye to see how the disease is progressing.

It sounds like a small thing to just monitor the eye, but treating diabetic edema can be tricky. If someone is treated too soon, it can lead to unnecessary costs and complications. If someone is treated too late, then there’s the risk of permanent vision loss. Research done by the DRCR Retina Network, a multicenter clinical research network funded by the National Eye Institute (NEI), showed that monitoring a patient’s condition and starting treatment for diabetic edema once vision declines, is the best course of action.

Participants were assigned to one of three groups: 1) One group had the anti-VEGF drug aflibercept (EYLEA®) injected every four weeks. 2) Another group had a laser photocoagulation procedure done. 3) Another group just had its vision observed. After two years, there was little change among participants. The aflibercept group had 16 percent of the people experience visual acuity loss, the laser group had 17 percent of the cohort experience visual acuity loss and 19 percent of those in the observation group had visual acuity loss. So, this is a case where waiting is a good thing.

Still, there comes a time when something needs to be done and another study showed that Artificial Intelligence can be used to detect the severity of diabetic edema. This is particularly good for those who don’t have regular eye exams. The study was done by Roche and Genentech and it showed that deep learning, which is learning from data that is unstructured, can detect both the swelling in the macula and the severity of the swelling.

The way diabetic edema is diagnosed is via optical coherence tomography (OCT). OCT uses two-dimensional color photos, known as color fundus photos. The trouble with color fundus photos is that the fact that the images are two-dimensional, which can make it difficult to detect the severity of diabetic edema. What the technology developed by Roche and Genentech did was to view 18,000 color fundus photos and OCT images. Results showed that Artificial Intelligence was 97 percent accurate in detecting the diabetic edema using just color fundus photos.

This technology can be used triage patients via telemedicine so that doctors can develop a course of action related to when to prescribe treatment and when to wait things out. The knowledge gained from the research mentioned in this blog entry will help to improve outcomes for those with diabetic edema.

Sources:

https://nei.nih.gov/content/watchful-waiting-reasonable-patients-diabetic-macular-edema-and-good-vision

https://nei.nih.gov/health/macular-edema/fact_sheet

https://www.biospace.com/article/roche-study-shows-ai-can-detect-severity-of-diabetic-macular-edema/

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