Advances in the Treatment of Diabetic Retinopathy with Anti-VEGF Therapy
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Abstract
Objective: This narrative review seeks to compare the advances and efficacy of various anti-VEGF therapies in the treatment of diabetic retinopathy, using the PICO format.
Methods: A comprehensive search of medical and scientific literature was conducted to identify studies investigating the efficacy of anti-VEGF therapies in the treatment of diabetic retinopathy. The PICO format guided the research question and review process. Accurate diagnosis, side effects, quality of life, and patient satisfaction were analyzed and compared for each treatment option.
Results: Anti-VEGF therapies were shown to be effective in reducing the progression of diabetic retinopathy, improving visual acuity and decreasing macular edema. Although generally safe, differences in side effect profiles were observed between the different anti-VEGF agents.
Conclusion: The selection of an appropriate Anti-VEGF therapy for diabetic retinopathy should consider accurate diagnosis, side effects, quality of life, and patient satisfaction. Although anti-VEGF therapies are promising, more research is needed to optimize their use and fully understand their benefits and limitations.
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References
I. Kumar S, Kumar G, Velu S, et al. Patient and provider perspectives on barriers to screening for diabetic retinopathy: an exploratory study from southern India. BMJ Open. 2020; 10(12):E037277. doi:10.1136/bmjopen-2020-037277
II. Retinopathy screening in patients with type 1 diabetes diagnosed in young age using a non-mydriatic digital stereoscopic retinal imaging - PubMed. Accessed December 31, 2023. https://pubmed.ncbi.nlm.nih.gov/21985859/
III. Lee VS, Kingsley RM, Lee ET, et al. The diagnosis of diabetic retinopathy. Ophthalmoscopy versus fundus photography. Ophthalmology. 1993; 100(10):1504-1512. doi:10.1016/s0161-6420(93)31449-1
IV. Namvar E, Ahmadieh H, Maleki A, Nowroozzadeh MH. Sensitivity and specificity of optical coherence tomography angiography for diagnosis and classification of diabetic retinopathy; a systematic review and meta-analysis. Eur J Ophthalmol. 2023; 33(6):2068-2078. doi:10.1177/11206721231167458
V. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994; 331(22):1480-1487. doi:10.1056/NEJM199412013312203
VI. Teo ZL, Tham YC, Yu M, et al. Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis. Ophthalmology. 2021; 128(11):1580-1591. doi:10.1016/j.ophtha.2021.04.027
VII. Yau JWY, Rogers SL, Kawasaki R, et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012; 35(3):556-564. doi:10.2337/DC11-1909
VIII. Alemu Mersha G, Alimaw YA, Woredekal AT. Prevalence of diabetic retinopathy among diabetic patients in Northwest Ethiopia-A cross sectional hospital based study. PloS One. 2022; 17(1):E0262664. doi:10.1371/journal.pone.0262664
IX. Zegeye AF, Temachu YZ, Mekonnen CK. Prevalence and factors associated with Diabetes retinopathy among type 2 diabetic patients at Northwest Amhara Comprehensive Specialized Hospitals, Northwest Ethiopia 2021. BMC Ophthalmol. 2023; 23(1):9. doi:10.1186/s12886-022-02746-8
X. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994; 331(22):1480-1487. doi:10.1056/NEJM199412013312203
XI. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994; 331(22):1480-1487. doi:10.1056/NEJM199412013312203
XII. Zeng Y, Dai F, Yang K, Tang Y, Xu M, Zhou Y. Association between a vascular endothelial growth factor gene polymorphism (rs2146323) and diabetic retinopathy: a meta-analysis. BMC Ophthalmol. 2015;15:163. doi:10.1186/s12886-015-0155-3
XIII. Awata T, Inoue K, Kurihara S, et al. A common polymorphism in the 5'-untranslated region of the VEGF gene is associated with diabetic retinopathy in type 2 diabetes. Diabetes. 2002; 51(5):1635-1639. doi:10.2337/diabetes.51.5.1635
XIV. Feghhi M, Nikzamir A, Esteghamati A, Mahmoudi T, Yekaninejad MS. Relationship of vascular endothelial growth factor (VEGF) +405 G/C polymorphism and proliferative retinopathy in patients with type 2 diabetes. Transl Res J Lab Clin Med. 2011; 158(2):85-91.
XV. doi:10.1016/j.trsl.2011.03.002
XVI. Awata T, Inoue K, Kurihara S, et al. A common polymorphism in the 5'-untranslated region of the VEGF gene is associated with diabetic retinopathy in type 2 diabetes. Diabetes. 2002; 51(5):1635-1639. doi:10.2337/diabetes.51.5.1635
XVII. Feghhi M, Nikzamir A, Esteghamati A, Mahmoudi T, Yekaninejad MS. Relationship of vascular endothelial growth factor (VEGF) +405 G/C polymorphism and proliferative retinopathy in patients with type 2 diabetes. Transl Res J Lab Clin Med. 2011; 158(2):85-91.
XVIII. doi:10.1016/j.trsl.2011.03.002
XIX. Zeng Y, Dai F, Yang K, Tang Y, Xu M, Zhou Y. Association between a vascular endothelial growth factor gene polymorphism (rs2146323) and diabetic retinopathy: a meta-analysis. BMC Ophthalmol. 2015;15:163. doi:10.1186/s12886-015-0155-3
XX. Qiu M, Xiong W, Liao H, Li F. VEGF -634G>C polymorphism and diabetic retinopathy risk: a meta-analysis. Gene. 2013; 518(2):310-315. doi:10.1016/j.gene.2013.01.018
XXI. Wirkkala J, Kubin AM, Ohtonen P, Yliselä J, Siik T, Hautala N. Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study. BMC Ophthalmol. 2022; 22(1):258. doi:10.1186/s12886-022-02482-z
XXII. Davidović SP, Nikolić SV, Curić NJ, et al. Changes of serum VEGF concentration after intravitreal injection of Avastin in treatment of diabetic retinopathy. Eur J Ophthalmol. 2012; 22(5):792-798. doi:10.5301/ejo.5000118
XXIII. Sahni J, Patel SS, Dugel PU, et al. Simultaneous Inhibition of Angiopoietin-2 and Vascular Endothelial Growth Factor-A with Faricimab in Diabetic Macular Edema: BOULEVARD Phase 2 Randomized Trial. Ophthalmology. 2019; 126(8):1155-1170. doi:10.1016/j.ophtha.2019.03.023
XXIV. Bressler SB, Liu D, Glassman AR, et al. Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab. JAMA Ophthalmol. 2017; 135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821
XXV. Bressler SB, Liu D, Glassman AR, et al. Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab. JAMA Ophthalmol. 2017; 135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821
XXVI. Parikh R, Ross JS, Sangaralingham LR, Adelman RA, Shah ND, Barkmeier AJ. Trends of Anti-Vascular Endothelial Growth Factor Use in Ophthalmology Among Privately Insured and Medicare Advantage Patients. Ophthalmology. 2017; 124(3):352-358. doi:10.1016/j.ophtha.2016.10.036
XXVII. Bressler SB, Liu D, Glassman AR, et al. Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab. JAMA Ophthalmol. 2017; 135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821
XXVIII. Wang DY, Zhao XY, Zhang WF, Meng LH, Chen YX. Perioperative anti-vascular endothelial growth factor agents treatment in patients undergoing vitrectomy for complicated proliferative diabetic retinopathy: a network meta-analysis. Sci Rep. 2020; 10(1):18880. doi:10.1038/s41598-020-75896-8
XXIX. Bressler SB, Liu D, Glassman AR, et al. Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab. JAMA Ophthalmol. 2017; 135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821
XXX. Wirkkala J, Kubin AM, Ohtonen P, Yliselä J, Siik T, Hautala N. Visual outcomes of observation, macular laser and anti-VEGF in diabetic macular edema in type 1 diabetes: a real-world study. BMC Ophthalmol. 2022; 22(1):258. doi:10.1186/s12886-022-02482-z
XXXI. S Z, A W, S V, et al. Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol. 2023; 141(7). doi:10.1001/jamaophthalmol.2023.2098
XXXII. Zafar S, Walder A, Virani S, et al. Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol. 2023; 141(7):658-666. doi:10.1001/jamaophthalmol.2023.2098
XXXIII. Zafar S, Walder A, Virani S, et al. Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol. 2023; 141(7):658-666. doi:10.1001/jamaophthalmol.2023.2098
XXXIV. VanderBeek BL, Shah N, Parikh PC, Ma L. Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort. PloS One. 2016; 11(2):E0149450. doi:10.1371/journal.pone.0149450
XXXV. VanderBeek BL, Shah N, Parikh PC, Ma L. Trends in the Care of Diabetic Macular Edema: Analysis of a National Cohort. PloS One. 2016; 11(2):E0149450. doi:10.1371/journal.pone.0149450
XXXVI. Wubben TJ, Johnson MW, Anti-VEGF Treatment Interruption Study Group. Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions. Am J Ophthalmol. 2019;204:13-18. doi:10.1016/j.ajo.2019.03.005
XXXVII. Singh RP, Welch L, Longo NL, Frese M. Impact of an immerive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol. 2023; 23(1):285. doi:10.1186/s12886-023-03034-9
XXXVIII. Singh RP, Welch L, Longo NL, Frese M. Impact of an immerive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol. 2023; 23(1):285. doi:10.1186/s12886-023-03034-9
XXXIX. Heier JS, Bressler NM, Avery RL, et al. Comparison of Aflibercept, Bevacizumab, and Ranibizumab for Treatment of Diabetic Macular Edema: Extrapolation of Data to Clinical Practice. JAMA Ophthalmol. 2016; 134(1):95-99. doi:10.1001/jamaophthalmol.2015.4110
XL. Bressler SB, Liu D, Glassman AR, et al. Change in Diabetic Retinopathy Through 2 Years: Secondary Analysis of a Randomized Clinical Trial Comparing Aflibercept, Bevacizumab, and Ranibizumab. JAMA Ophthalmol. 2017; 135(6):558-568. doi:10.1001/jamaophthalmol.2017.0821
XLI. Ho AC, Scott IU, Kim SJ, et al. Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmology. 2012; 119(10):2179-2188. doi:10.1016/j.ophtha.2012.07.058
XLII. Ho AC, Scott IU, Kim SJ, et al. Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmology. 2012; 119(10):2179-2188. doi:10.1016/j.ophtha.2012.07.058
XLIII. Ho AC, Scott IU, Kim SJ, et al. Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmology. 2012; 119(10):2179-2188. doi:10.1016/j.ophtha.2012.07.058
XLIV. Heier JS, Bressler NM, Avery RL, et al. Comparison of Aflibercept, Bevacizumab, and Ranibizumab for Treatment of Diabetic Macular Edema: Extrapolation of Data to Clinical Practice. JAMA Ophthalmol. 2016; 134(1):95-99. doi:10.1001/jamaophthalmol.2015.4110
XLV. Kiss S, Campbell J, Almony A, et al. Management and Outcomes for Neovascular Age-Related Macular Degeneration: Analysis of United States Electronic Health Records. Ophthalmology. 2020; 127(9):1179-1188. doi:10.1016/j.ophtha.2020.02.027
XLVI. Tao Y, Jiang P, Zhao Y, et al. Retrospective study of aflibercept in combination therapy for high-risk proliferative diabetic retinopathy and diabetic maculopathy. Int Ophthalmol. 2021; 41(6):2157-2165. doi:10.1007/s10792-021-01773-6
XLVII. Mitchell P, Wong TY, Diabetic Macular Edema Treatment Guideline Working Group. Management paradigms for diabetic macular edema. Am J Ophthalmol. 2014; 157(3):505-513.e1-8. doi:10.1016/j.ajo.2013.11.012
XLVIII. VanderVeen DK, Melia M, Yang MB, Hutchinson AK, Wilson LB, Lambert SR. Anti-Vascular Endothelial Growth Factor Therapy for Primary Treatment of Type 1 Retinopathy of Prematurity: A Report by the American Academy of Ophthalmology. Ophthalmology. 2017; 124(5):619-633. doi:10.1016/j.ophtha.2016.12.025
XLIX. Mitchell P, Wong TY, Diabetic Macular Edema Treatment Guideline Working Group. Management paradigms for diabetic macular edema. Am J Ophthalmol. 2014; 157(3):505-513.e1-8. doi:10.1016/j.ajo.2013.11.012
L. Y T, P J, Y Z, et al. Retrospective study of aflibercept in combination therapy for high-risk proliferative diabetic retinopathy and diabetic maculopathy. Int Ophthalmol. 2021; 41(6). doi:10.1007/s10792-021-01773-6
LI. Mitchell P, Wong TY, Diabetic Macular Edema Treatment Guideline Working Group. Management paradigms for diabetic macular edema. Am J Ophthalmol. 2014; 157(3):505-513.e1-8. doi:10.1016/j.ajo.2013.11.012
LII. Kiss S, Campbell J, Almony A, et al. Management and Outcomes for Neovascular Age-Related Macular Degeneration: Analysis of United States Electronic Health Records. Ophthalmology. 2020; 127(9):1179-1188. doi:10.1016/j.ophtha.2020.02.027
LIII. Del Cura Mar P, Carballés MJC, Sastre-Ibáñez M. Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice. Indian J Ophthalmol. 2023; 71(8):3091-3094. doi:10.4103/IJO. IJO_44_23
LIV. Wubben TJ, Johnson MW, Anti-VEGF Treatment Interruption Study Group. Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions. Am J Ophthalmol. 2019;204:13-18. doi:10.1016/j.ajo.2019.03.005
LV. Lubis PM, Prabaniswara MP, Victor AA. Comparison of micropulse subthreshold laser plus anti-VEGF versus anti-VEGF alone in diabetic macular edema: Systematic review. Indian J Ophthalmol. 2023; 71(11):3448-3453. doi:10.4103/IJO. IJO_519_23
LVI. Singh RP, Welch L, Longo NL, Frese M. Impact of an immerive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol. 2023; 23(1):285. doi:10.1186/s12886-023-03034-9
LVII. Singh RP, Welch L, Longo NL, Frese M. Impact of an immerive, interactive medical education initiative on guideline-based retinal disease management knowledge/competence and effectual practice change. BMC Ophthalmol. 2023; 23(1):285. doi:10.1186/s12886-023-03034-9
LVIII. Wubben TJ, Johnson MW, Anti-VEGF Treatment Interruption Study Group. Anti-Vascular Endothelial Growth Factor Therapy for Diabetic Retinopathy: Consequences of Inadvertent Treatment Interruptions. Am J Ophthalmol. 2019;204:13-18. doi:10.1016/j.ajo.2019.03.005