Diabetic Retinopathy With Diabetic Macular Edema
Diabetic retinopathy (DR) with diabetic macular edema (DME) progression by stage
THE RISK OF DME INCREASES WITH DR SEVERITY4,5
2014 POPULATION ESTIMATES1-3
RAT
E IVE
P R OS
LE
I FVEER
DIABETIC
R E T I N O PAT H Y
(PDR)
DR WITH DME
71% of patients with PDR have DME
75 5K
240 per 100K*
29M
9,300 per 100K*
SEVERE
N O N P R O L I F E R AT I V E
MODERATE
DIABETIC
R E T I N O PAT H Y
MILD
(NPDR)
38% of patients with moderate to severe
NPDR have DME
3% of patients with mild NPDR have DME
DIABETES MELLITUS
U. S. P O P U L AT I O N
319M
*Per 100,000 U.S. lives.
Duration of Diabetes Is Strongly Linked to Disease Progression6
•DR is the most frequent
microvascular complication
of diabetes mellitus, affecting
7.7 million people7,8
•DR is the leading cause
of blindness in the U.S.
diabetic population9
–– 28.5% of diabetic adults
≥40 years old are expected
to develop DR, and 4.4%
are at risk of vision loss2
•Within the first 5 years of
diabetes diagnosis
–– 29% of type 2 diabetes
patients will have DR10
–– 17% of type 1 diabetes
patients will have DR11
•DME can occur at any stage
of DR, and the risk increases
with severity4
Diabetic Retinopathy With Diabetic Macular Edema
Microaneurysm
DR Progression and Abnormal Neovasculature Growth
•In the early stages, NPDR causes blood vessels
in the retina to leak fluid and/or blood; signs
include hard exudates, microaneurysms,
and hemorrhages4,12
Macula
•As the disease progresses to PDR, damage to the
retina stimulates abnormal neovasculature growth,
resulting in further bleeding and/or leakage4,12
•DME manifests as the abnormal neovasculature
progresses to the macula, causing swelling, loss
of central vision, and blindness1,4
Hemorrhage
Hard
exudate
Studies have shown
that vascular endothelial
growth factor, or VEGF, plays
a critical role in abnormal
neovasculature growth13
Abnormal
neovasculature growth
Current Screening Guidelines
•The 2014 American Academy of Ophthalmology (AAO) Preferred Practice Pattern®
guidelines recommend annual eye exams in the diabetic population6
–– Glycemic control is recommended by the AAO for most cases in mild to moderate NPDR
–– To reduce the risk developing DR, the AAO recommends an HbA1c target of 7% or
lower in most patients
Since DR is initially
asymptomatic, most patients are
unaware they have the disease6,14
References: 1. Varma R, Bressler NM, Doan QV, et al. Prevalence of and risk factors for diabetic macular edema in the United States. JAMA Ophthalmol. 2014;132(11):1334-1340. 2. Centers for Disease Control and Prevention.
National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2014. http://www.cdc.gov
/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed January 29, 2015. 3. U.S. and World Population Clock. US Census Bureau website. http://www.census.gov/popclock/. Accessed February 11, 2015.
4. National Eye Institute. Facts about diabetic eye disease. https://www.nei.nih.gov/health/diabetic/retinopathy. Accessed January 6, 2014. 5. Javadzadeh A. The effect of posterior subtenon methylprednisolone acetate in the
refractory diabetic macular edema: a prospective nonrandomized interventional case series. BMC Ophthalmol. 2006;6:15. 6. American Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern® Guidelines.
Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2014. Available at: www.aao.org/ppp. 7. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2008;26(2):77-82.
8. Prevent Blindness America. Diabetic retinopathy. Vision Problems in the U.S. website. http://www.visionproblemsus.org/diabetic-retinopathy/diabetic-retinopathy-definition.html. Accessed January 28, 2014. 9. Centers for
Disease Control and Prevention. Common eye disorders. http://www.cdc.gov/visionhealth/basic_information/eye_disorders.htm. Updated April 23, 2013. Accessed
January 29, 2015. 10. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of
diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol. 1984;102(4):527-532. 11. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The
Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol.
1984;102(4):520-526. 12. The Merck Manual Professional Edition. Diabetic retinopathy. Merck Manuals website. http://www.merckmanuals.com/professional
/eye_disorders/retinal_disorders/diabetic_retinopathy.html. Revised October 2014. Accessed February 7, 2015. 13. Gupta N, Mansoor S, Sharma A, et al. Diabetic
retinopathy and VEGF. Open Ophthalmol J. 2013;7:4-10. 14. Soliman A, Silva P, Diala P, et al. Awareness of retinopathy and timeliness of follow-up among patients
presenting to a diabetes teleophthalmology program. Presented at: ARVO Annual Meeting; May 1-5, 2011; Fort Lauderdale, FL. Abstract 1287/A37.
©2015 Genentech, Inc., So. San Francisco, CA LUC/012015/0024 3/15