Category: Eye

A short-term retrospective study published in Eye Discovery compared a new “1 + 1 + PRN” sequential regimen to the standard “3 + PRN” anti-VEGF approach for diabetic macular edema (DME). The research was done by teams at the Third Affiliated Hospital of Wenzhou Medical University, the Primasia International Eye Research Institute at the Chinese University of Hong Kong, and collaborators.

What they tested

• “1 + 1 + PRN” group: 1-2 anti-VEGF injections, then a dexamethasone intravitreal implant 4 weeks later, followed by anti-VEGF only as needed.
• “3 + PRN” group: 3 monthly anti-VEGF injections, then anti-VEGF as needed.
• Why try this? Anti-VEGF drugs target VEGF-driven leakage, but DME also involves inflammation. Dexamethasone implants work via a different anti-inflammatory mechanism and release drug slowly, potentially cutting injection frequency.

Study details

• Size: 28 eyes from 23 treatment-naïve patients
• Follow-up: 25 weeks
• Outcomes measured: Best-corrected visual acuity, central macular thickness, hyperreflective foci, and cystic changes in the deep capillary plexus using OCTA

Key findings

1. Visual + anatomical results: Both groups showed significant improvements from baseline in vision and retinal thickness. No statistically significant differences between groups, though the “1 + 1 + PRN” group showed a trend toward earlier, more stable visual gains and smoother reduction in central macular thickness.
2. Injection burden: Mean injections over 25 weeks were 2.58 for “1 + 1 + PRN” vs 4.94 for “3 + PRN”. Most sequential-group eyes needed only 2-3 injections total.
3. Safety: Elevated intraocular pressure occurred in both groups, controlled with topical meds, with no significant difference. No severe adverse events like cataract progression, retinal detachment, vitreous hemorrhage, or endophthalmitis were seen.

Limitations
The authors note this was small, retrospective, non-randomized, and short-term. Treatment was chosen by shared decision-making, not random assignment. Different anti-VEGF agents were used, and not all “1 + 1 + PRN” eyes got the same number of initial anti-VEGF shots.

Takeaway: The “1 + 1 + PRN” approach cut injection frequency nearly in half without clearly compromising early visual or anatomical outcomes at 25 weeks. The results are exploratory — larger, longer randomized trials are needed before this could become a standard option. Fewer injections could mean lower cost, less clinic burden, and reduced treatment anxiety for DME patients.

Researchers at the University of Liverpool have found that metformin, a common diabetes med, might help prevent age-related macular degeneration (AMD), the leading cause of blindness in Western countries.

In a study of 2,000 people with diabetes, those taking metformin were 37% less likely to develop intermediate AMD over 5 years. The researchers analysed eye photos and adjusted for factors like age and sex.

This is a big deal, as AMD affects 1.1-1.8 million people in the UK and costs £11.1 billion annually. And currently, there’s no treatment for geographic atrophy (dry AMD) in the UK and Europe.

Researchers at Wenzhou Medical University and the University of Coimbra have made a breakthrough in detecting early-stage retinal damage in diabetes using AI-inspired texture analysis. This method can identify subtle changes in retinal tissue before any visible signs of diabetic retinopathy (DR) appear, potentially allowing for earlier intervention and reducing the risk of blindness.

The study used optical coherence tomography (OCT) images to analyze retinal texture in diabetic rats and found significant changes in texture metrics, such as autocorrelation and homogeneity, even when structural and molecular damage was minimal. These changes occurred before any major inflammation or vascular leakage was detectable.

The researchers believe this technology could lead to the development of AI-assisted diagnostic tools that can automatically screen for preclinical DR based on retinal texture signatures. This could enable ophthalmologists to identify high-risk patients before permanent vision damage occurs, allowing for earlier treatment and better outcomes.

The study’s findings have significant implications for the early detection and treatment of DR, which affects over 130 million people worldwide and is a leading cause of blindness among working-age adults. Further clinical trials are needed to validate the results in human subjects.

A recent study presented at the European Association for the Study of Diabetes (EASD) annual meeting suggests that semaglutide, a GLP-1 receptor agonist, may provide powerful protection against diabetic retinopathy, a common complication of diabetes that can lead to sight loss. The study found that semaglutide exerted antioxidant effects that protected retinal cells against damage in diabetes-like conditions.

Key Findings

• Protection against cell death: Semaglutide-treated cells were up to twice as likely to survive as untreated cells.
• Reduced oxidative stress: Semaglutide decreased markers of oxidative stress, including apoptosis, mitochondrial superoxide production, and accumulation of advanced glycation end-products.
• Enhanced antioxidant defenses: Semaglutide upregulated genes involved in antioxidant production, indicating potential repair of damage to retinal cells.

Implications

The study’s findings suggest that GLP-1 receptor agonists like semaglutide may be effective in protecting against diabetic retinopathy, particularly in the early stages. Clinical trials are needed to confirm these protective effects in patients and explore the potential for GLP-1 receptor agonists to slow or halt disease progression.

Significance

Diabetic retinopathy is a leading cause of blindness among working-age adults, affecting over 90% of people with type 1 diabetes and 50-60% of those with type 2 diabetes. The potential for GLP-1 receptor agonists to protect against this condition could have significant implications for the management of diabetes and prevention of vision loss.