Retinal Biomarkers in Diabetic Retinopathy: From Early Detection to Personalized Treatment

Abstract

Diabetic retinopathy (DR) is a leading cause of vision loss globally, with early detection and intervention critical to preventing severe outcomes. This narrative review examines the role of retinal biomarkers-molecular and imaging-in improving early diagnosis, tracking disease progression, and advancing personalized treatment for DR. Key biomarkers, such as inflammatory and metabolic markers, imaging findings from optical coherence tomography and fluorescence angiography and genetic markers, provide insights into disease mechanisms, help predict progression, and monitor responses to treatments, like anti-VEGF and corticosteroids. While challenges in standardization and clinical integration remain, these biomarkers hold promise for a precision medicine approach that could transform DR management through early, individualized care.

Keywords: biomarkers; diabetes; diabetes complications; diabetic retinopathy; ophthalmology; retinal biomarkers; retinal imaging.

Figure 1

OCT biomarkers in diabetic macular edema (DME) eyes [114]. (a) A representative image of a 25–26 mm macular scans centered on the fovea by spectral domain OCT (SD-OCT). (b) An OCT of a patient with DME showing the presence of ERM, HRF, intraretinal cyst (IRC), and disorganization of the retinal inner layers (DRIL). (c) An OCT of a patient with DME showing the presence of a large outer nuclear layer cyst (LONLC), ellipsoid zone disruptions (EZD), SRF, and IRC. (d) An OCT of a patient with DME showing the presence of epiretinal membrane (ERM), subretinal fluid (SRF), and hyperreflective foci (HRF) marked with yellow arrows. (e) An OCT of a patient with DME showing the presence of a hard exudate (HE).