The Diabetic Retinopathy Pandemic: Considerations for Comprehensively Addressing this Condition

In last month’s OcuTerra Insights, we delved into how cases of both diabetes and diabetic retinopathy (DR) are expected to increase dramatically over the next decade. To extrapolate further, this underscores that currently available measures for screening, prevention and treatment of DR are not sufficiently serving people living with, and people at risk for, this condition. In fact, a February 2022 study published in Preventative Medicine Reports states that given the vast and rising global scope of diabetes, it should be considered a “modern preventable pandemic.”1

While we are most used to associating a pandemic with the spread of infectious diseases, like COVID-19, the prevalence and rise of diabetes2 has had tremendous health, social and economic impact. In this month’s OcuTerra Insights, we will shine the spotlight on long-term strategies to help make inroads in the fight against diabetes and DR.

Growing and Changing Patient Populations

While anyone with type 1 or type 2 diabetes can develop DR, certain populations have been identified as increasingly vulnerable. It is essential for healthcare providers to ensure they are reaching these new and growing populations.

Within the past year, it has been projected that cases of diabetes will surge through 2060 in those under the age of 20 in the United States3. While the CDC states that American adults aged 40 and older are at the highest risk for eye diseases4, rapid growth of diabetes in a younger population signals a need to ensure that younger individuals understand their risk for developing DR and are screened regularly during their eye exams.

Globally, it has been noted that populations based in rural areas may experience higher rates of DR compared to those in metropolitan areas – this has been attributed to reduced access to healthcare facilities5. In order to serve patients in rural areas, professionals must continue to develop and utilize telehealth tools that reduce barriers to care.

It has also been projected that racial disparities in diabetes and DR diagnoses will continue to grow over time. Black women are currently one of the highest-risk groups for developing DR, and projections through 2060 have indicated that they will see the greatest relative increase of cases in the coming decades6. Healthcare professionals must take measures to ensure that the unique needs of these groups are accounted for.

Tools to Combat Cases of DR

Public health interventions, such as educational campaigns and direct patient outreach, play a key role in any pandemic. While certain risk factors for DR cannot be controlled, many including HBA1c and hypertension can be improved by patients – particularly when doctors take the time to educate patients and support them in their efforts5. However, education alone may not be sufficient to affect change in patient behaviors. One study conducted at a health center that serves predominantly low-income minority patients found that even though nearly all diabetic patients surveyed demonstrated a strong understanding of their risk for DR, only 55% underwent vision screenings7. This signals the need for doctors to not only educate their patients, but in turn understand their individual barriers to care.

Expanded mental health resources could also play a role in helping patients manage DR. It has been shown that higher DR severity is associated with worse psychosocial outcomes including depression and anxiety5. In addition to helping patients to manage mental health concerns connected to DR, these interventions could support better clinical outcomes. Research indicates that incorporating cognitive behavioral therapy into patient interventions could improve adherence to medications and self-management measures that are intended to reduce the impact of DR5. However, in order to maximize the benefits of these interventions, it will be essential to develop new and improved treatments that actively address DR.

Novel Therapeutics are Needed to Prevent Severe Vision Loss

Unfortunately, as more patients are diagnosed with DR, there has not been an increase in available therapies to actively treat this condition. The millions of patients living with early-stage DR currently cannot be put on a therapeutic regimen to directly address this condition until their disease begins to threaten their vision. At this point, they are limited to burdensome, invasive and often painful procedures such as anti-VEGF injections to the back of the eye. These therapies, which must be administered at a doctor’s office, may also prove inaccessible to patients who live in rural or low-income areas, as they require an added investment of both time and money. 

OcuTerra is developing OTT166 as an earlier intervention that could delay, or even stop, the progression of DR. If approved, OTT166 could play a substantial role in improving the quality of care for patients with this condition. As an eye drop that is purpose engineered to enable earlier treatment for patients with DR, OTT166 could create the opportunity for millions of patients to administer their own treatment at home, and importantly, before symptoms arise. 

The DR pandemic shows no signs of slowing down, and it is essential that we continue to develop and utilize novel approaches in managing the condition. As populations of underserved DR patients continue to grow, our toolbox of strategies to improve their quality of life must do so as well. New therapeutics like OTT166 have the potential to fundamentally change the future of the DR pandemic – and that’s what motivates the OcuTerra team to push forward in our work. 

Learn more about the Phase 2 DR:EAM Clinical Trial, which is currently evaluating OTT166 for the treatment of early-stage DR.

References 

  1. Singer, M. E., Dorrance, K. A., Oxenreiter, M. M., Yan, K. R., & Close, K. L. (2022). The type 2 diabetes ‘modern preventable pandemic’ and replicable lessons from the covid-19 crisis. Preventive Medicine Reports, 25. https://doi.org/10.1016/j.pmedr.2021.101636

  2. Unnikrishnan, R., Pradeepa, R., Joshi, S. R., & Mohan, V. (2017). Type 2 diabetes: Demystifying the global epidemic. Diabetes, 66(6), 1432–1442. https://doi.org/10.2337/db16-0766

  3. Tönnies, T., Brinks, R., Isom, S., Dabelea, D., Divers, J., Mayer-Davis, E. J., Lawrence, J. M., Pihoker, C., Dolan, L., Liese, A. D., Saydah, S. H., Jr., R. B., Hoyer, A., & Imperatore, G. (2023). Projections of type 1 and type 2 diabetes burden in the US population aged <20 years through 2060: The SEARCH for diabetes in Youth Study. Diabetes Care, 46(2), 313–320. https://doi.org/10.2337/figshare.21514014

  4. Centers for Disease Control and Prevention. (2020, June 12). Vision loss and age. Centers for Disease Control and Prevention. https://www.cdc.gov/visionhealth/risk/age.htm

  5. Ting, D. S., Cheung, G. C., &amp; Wong, T. Y. (2016). Diabetic retinopathy: Global prevalence, major risk factors, screening practices and Public Health Challenges: A Review. Clinical &amp; Experimental Ophthalmology, 44(4), 260–277. https://doi.org/10.1111/ceo.12696

  6. Lin, J., Thompson, T. J., Cheng, Y. J., Zhuo, X., Zhang, P., Gregg, E., &amp; Rolka, D. B. (2018). Projection of the future diabetes burden in the United States through 2060. Population Health Metrics, 16. https://doi.org/10.1186/s12963-018-0166-4

  7. Lu, Y., Serpas, L., Genter, P., Anderson, B., Campa, D., &amp; Ipp, E. (2016). Divergent perceptions of barriers to diabetic retinopathy screening among patients and care providers, Los Angeles, California, 2014–2015. Preventing Chronic Disease, 13. https://doi.org/10.5888/pcd13.160193

Brad Good