AEVR Hosts Virtual Congessional Briefing on Diabetic Retinopathy

Jennifer Sun MD, MPH (Joslin Diabetes Center/Harvard Medical School)
Jennifer Sun MD, MPH (Joslin Diabetes Center/Harvard Medical School)

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On May 25, the Alliance for Eye and Vision Research (AEVR) recognized May’s Healthy Vision Month by hosting its second virtual Research Saving Sight, Restoring Vision Congressional Briefing of 2022, entitled: NEI’s Diabetic Retinopathy Clinical Research (DRCR) Retinal Network: Optimizing Treatment for Diabetic Eye Disease Patients. AEVR’s Research Saving Sight, Restoring Vision Initiative is a sustained activity to educate about the value of eye and vision research and the enormous strides that National Eye Institute (NEI) funded research has made to establish improvements to diagnosis, treatments, therapies, and outcomes for eye and vision care.

The Briefing featured Lions Clubs International First Vice President, Brian Sheehan, and DRCR Co-Chair, Jennifer Sun MD, MPH (also of Joslin Diabetes Center/Harvard Medical School).

Diabetic eye disease is the leading cause of vision loss and blindness among adults in the industrialized world. The Centers for Disease Control and Prevention (CDC) estimates that 37.3 million Americans have diabetes (11.3 percent of the population), with 8.5 million undiagnosed. Another 96 million Americans are pre-diabetic. Estimates show that diabetes-related blindness costs the United States over $500 million annually. From 2021 to 2045, diabetes is expected to increase by 46% globally.

Diabetes causes damage to the blood vessels in the light-sensitive tissue in the back of the eye known as the retina. Damage to these vessels can lead to leakage of fluid into the center of the retina, known as the macula, and loss of healthy blood flow to the retina overall. Leakage or swelling in the macula is known as diabetic macular edema and is a common cause of central vision loss in people with diabetes. When capillary damage becomes more severe, blood flow is severely compromised, leading to abnormal blood vessels that can lead to severe bleeding inside the eye (vitreous hemorrhage), retinal detachment, and complete loss of vision if left untreated. These retinal changes, collectively known as diabetic retinopathy (DR) affects an estimated 7.7 million Americans (in 2010) to 14.6 million by 2050. It’s estimated that nearly half of all people with diabetes will experience some diabetic retinopathy.

During the Briefing, Brian Sheehan highlighted the Lions Clubs SightFirst grant program which supports diabetic retinopathy screening and treatment programs, as well as projects that serve patients already diagnosed with the disease worldwide. The mission of the SightFirst program is to develop or improve comprehensive eye care systems to fight blindness and vision loss and assist blind and visually impaired people in underserved communities. Brian emphasized that the best way to prevent DR is through monitoring and early detection and treatment of the disease.

Dr. Sun highlighted the strides in outcomes research from the DRCR Network over the past 20 years. Founded initially in 2002, the network is an open, collaborative network of diverse clinical sites from across North America, dedicated to scientifically rigorous, impactful clinical research of retinal diseases. Having success in addressing diabetic retinopathy in its first 15 years, the network’s scope was expanded in 2017 to research and address all retinal diseases. The network has historically received funding from the National Eye Institute (NEI) and from the Special Diabetes Program through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This federal investment has been leveraged with private funding from JDRF and private industry to maximize the impact of the network. Between 2003 and 2022, the DRCR Retina Network conducted 36 multicenter studies, produced 114 publications, and had 137 active clinical sites.

Prior to 2002, laser treatment was the primary method to treat all diabetic eye diseases, but with the establishment of the DRCR, the network published the first definitive studies showing that anti-VEGF (Vascular Endothelial Growth Factor) injection therapy is more effective than laser treatment for diabetic macular edema. Over the past 20 years, DRCR studies have resulted in significant updates to clinical interventions and protocols. A unique and important aspect of federally funded research includes the ability to look across multiple therapies and methods and utilize longitudinal data sets which proves valuable in understanding the impact of different interventions.

More recent studies and protocols have worked to understand when to use and when it may not be pertinent to use anti-VEGF therapies and the impacts of anti-VEGF therapies on Proliferative Diabetic Retinopathy (PDR). DRCR research shows that there may be times when a patient still retains good vision that physicians may be able to hold off on treatment. The data also shows that anti-VEGF treatment is very successful in treating PDR and may reduce the need for some surgical interventions.

These studies have been essential in furthering the evidence base to improve interventions and outcomes for patients with diabetic retinopathy. The data from current studies within the DRCR clearly shows that the use of early treatment can reduce rates of DME and PDR by nearly three-fold over a two-year period. The DRCR is still following these patients out to 4 years to understand if early intervention continues to have a significant impact on vision threatening progression of diabetic retinopathy. In the two-year study, while the data indicates a reduction in the prevalence of vision-threatening progression, there was not a significant change in vision results in the same period. By extending the study to four years, the DRCR will be better able to understand if early injection interventions are having a positive impact not only on the progression of the disease but also having a positive impact on the patient’s quality of life.

The DRCR continues to advance research to improve outcomes for patients with diabetic retinopathy and other retinal conditions and diseases. Moving forward, the DRCR Retina Network is continuing to build on its past research and is also looking at ways to prevent retinal disease, understand the genetic impacts on retinal disease, and is looking at how artificial intelligence, imaging, and big data can play a role in addressing retinal diseases.

There was a continued emphasis throughout the presentation on the value of federally funded research. The National Eye Institute (NEI) continues to fund research projects including artificial intelligence to improve diagnosis, improved clinical methods, and new and improved interventions, devices, and therapies that can preserve sight and restore vision.

AEVR was pleased to be able to host this Congressional Briefing during Healthy Vision Month and thanks Lions Clubs International and the Diabetic Retinopathy Clinical Research Retina Network for sharing their efforts. AEVR also thanks its supporters who helped make this event possible, including: