Fighting chance: Study detects early biomarkers for risk of developing diabetic retinopathy

 Early detection gives doctors of optometry a chance to slow its progression.

In this case, the eye disease is diabetic retinopathy (DR). A study appearing in the May 2017 Journal of Diabetes and its Complications identifies two biomarkers, monocyte chemotactic protein 1 (MCP-1) and cathepsin-D, as telltale signs in young patients with Type 2 diabetes that they are at risk of developing DR. Both were found at elevated levels in patients with Type 2 diabetes.

"As both MCP-1 and cathepsin-D are molecular signatures of cellular senescence, we suggest that these biomarkers might be useful to predict the development of retinopathy in T2DM-Y patients," the study's authors wrote.

Not only will they develop DR at an earlier age but also at a greater frequency, say researchers at Madras Diabetes Research Foundation, the New Mexico School of Medicine and Translational Genomics Research Institute in Phoenix, Arizona.  

Diabetes rates rising

An estimated 29% of Americans are living with diabetes; most are 65 and older. But recent studies show the rates among younger people are rising due to sedentary lifestyles, obesity, family history and a failure by patients to follow up or manage their conditions after initial diagnoses.  

The Centers for Disease Control and Prevention (CDC) reports that the number of Americans ages 40 and older with DR and vision-threatening DR will triple by 2050. Symptoms of DR may include:      

• Seeing spots or floaters.
• Blurred vision.
• Having a dark or empty spot in the center of your vision.
• Difficulty seeing well at night.

The CDC has labeled DR the leading cause of blindness among U.S. adults between the ages of 20 and 74. A CDC study looked at eight barriers to care—and how those perceived barriers differed between patients and providers—in a diabetic population in Los Angeles, California, between 2014-2015.

"The lack of agreement between patients' perceived barriers and provider and staffers' understanding of those same barriers indicates need for more effective patient-provider communication and for patient feedback on health care delivery systems. Heightened awareness of depression and its impact on DR screening rates among low-income minority patients with diabetes is also key to improving their use of DR screening. In addition, a lack of knowledge of the importance of DR screening might prevent patients from identifying barriers that prevent them from adhering to secondary diabetes prevention, such as DR prevention and detection. Thus, patient education targeting diabetes knowledge and self-management is also crucial. Overall, these findings highlight the importance of engaging both minority patient communities and their health care providers in efforts to increase DR screening rates and prevent blindness," the study's researchers say.

Role of doctors of optometry

David Masihdas, O.D., practices in Salt Lake City, Utah, and sees many young adults dealing with the ocular consequences of diabetes. The new study results should warrant the attention of doctors of optometry, says Dr. Masihdas, a co-chair of the AOA Evidence-Based Optometry Committee. He is leading the committee review of the AOA's Evidence-Based Clinical Practice Guideline: Eye Care of the Patient with Diabetes Mellitus.  

The study reinforces doctors' role in diagnosing eye and systemic diseases with ocular manifestations, says Dr. Masihdas, who encourages doctors of optometry to ask patients about their eyes and vision and their general health. Studies have shown that controlling or better managing diabetes can slow the onset of DR.  

"It potentially provides an opportunity for doctors of optometry to be proactive," Dr. Masihdas says. "We are an easy access for patients.

"We have a great opportunity to have an impact on patients with diabetes," he adds.  

The sooner doctors of optometry can detect the biomarkers, the sooner they can educate their patients about managing their disease—with diet, exercise and medication—in co-management with their primary care physicians, Dr. Masihdas says.  

"Doctors of optometry need to be aware," he says.