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Review
. 2023 Oct 31;4(3):100420.
doi: 10.1016/j.xops.2023.100420. eCollection 2024 May-Jun.

A New Approach to Staging Diabetic Eye Disease: Staging of Diabetic Retinal Neurodegeneration and Diabetic Macular Edema

Roomasa Channa  1 , Risa M Wolf  2 , Rafael Simo  3 , Mitchell Brigell  4 , Patrice Fort  5 , Christine Curcio  6 , Stephanie Lynch  7 , Frank Verbraak  8 , Michael D Abramoff  9 ; Diabetic Retinal Neurodegeneration and Macular Edema working group of the Mary Tyler Moore Vision Initiative’s Diabetic Retinal Disease Staging Update Project
Collaborators, Affiliations
Review

A New Approach to Staging Diabetic Eye Disease: Staging of Diabetic Retinal Neurodegeneration and Diabetic Macular Edema

Roomasa Channa et al. Ophthalmol Sci. .

Abstract

Topic: The goal of this review was to summarize the current level of evidence on biomarkers to quantify diabetic retinal neurodegeneration (DRN) and diabetic macular edema (DME).

Clinical relevance: With advances in retinal diagnostics, we have more data on patients with diabetes than ever before. However, the staging system for diabetic retinal disease is still based only on color fundus photographs and we do not have clear guidelines on how to incorporate data from the relatively newer modalities into clinical practice.

Methods: In this review, we use a Delphi process with experts to identify the most promising modalities to identify DRN and DME. These included microperimetry, full-field flash electroretinogram, spectral-domain OCT, adaptive optics, and OCT angiography. We then used a previously published method of determining the evidence level to complete detailed evidence grids for each modality.

Results: Our results showed that among the modalities evaluated, the level of evidence to quantify DRN and DME was highest for OCT (level 1) and lowest for adaptive optics (level 4).

Conclusion: For most of the modalities evaluated, prospective studies are needed to elucidate their role in the management and outcomes of diabetic retinal diseases.

Financial disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Biomarkers; Diabetic retinal disease; Imaging modalities; Neuro-retinal layers.

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