June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Updating the Diabetic Retinal Disease Staging System through the Restoring Vision Moonshot™
Author Affiliations & Notes
  • Jennifer K Sun
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Thomas W. Gardner
    Ophthalmology, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Michael David Abramoff
    Ophthalmology and Visual Sciences, Iowa State University, Ames, Iowa, United States
  • Lloyd P Aiello
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Helen Colhoun
    The University of Edinburgh Division of Health Sciences, Edinburgh, Edinburgh, United Kingdom
  • Adam R Glassman
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Tien-En Tan
    Singapore National Eye Centre, Singapore, Singapore, Singapore
  • Tien Wong
    Singapore National Eye Centre, Singapore, Singapore, Singapore
  • Stela Vujosevic
    San Giuseppe Hospital, Arezzo, Toscana, Italy
  • Sanjoy Dutta
    JDRF, New York, New York, United States
  • S. Robert Levine
    Mary Tyler Moore and S. Robert Levine, MD Charitable Foundation, Connecticut, United States
  • Footnotes
    Commercial Relationships   Jennifer Sun American Medical Association (JAMA Ophthalmology), American Diabetes Association, Code C (Consultant/Contractor), Adaptive Sensory Technologies, Boehringer Ingelheim, Genentech/Roche, Janssen, Physical Sciences, Inc, Novartis, Novo Nordisk, Optovue, Code F (Financial Support); Thomas Gardner None; Michael Abramoff Digital Diagnostics, Code C (Consultant/Contractor), Digital Diagnostics, Code I (Personal Financial Interest), Digital Diagnostics, Code O (Owner), University of of Iowa and Digital Diagnostics, Inc, Coralville, Iow, Code P (Patent), Digital Diagnostics, Code S (non-remunerative); Lloyd Aiello KalVista, Novo Nordisk, Code C (Consultant/Contractor), KalVista, Code I (Personal Financial Interest), KalVista, Code O (Owner); Helen Colhoun Novo Nordisk, Astra Zeneca, Bayer, Eli Lilly, Sanofi Regeneron, Code C (Consultant/Contractor), Novo Nordisk, Code F (Financial Support), Bayer, Roche, Code I (Personal Financial Interest), Novo Nordisk, Astra Zeneca, Bayer, Eli Lilly, Sanofi Regeneron, Code R (Recipient); Adam Glassman Regeneron, Optos, Genentech, Novo Nordisk, Multi Radiance, Code F (Financial Support); Tien-En Tan None; Tien Wong Bayer, Boehringer-Ingelheim, Eden Ophthalmic, Genentech, Iveric Bio, Merck, Novartis, Oxurion, Roche, Samsung, Shanghai Henlius and Zhaoke, Code C (Consultant/Contractor), EyRiS, Code O (Owner), EyRiS, Code P (Patent); Stela Vujosevic Allergan, Apellis, Bayer, Novartis, Roche, Code C (Consultant/Contractor), Iridex, Alimera, Code R (Recipient); Sanjoy Dutta None; S. Robert Levine None
  • Footnotes
    Support  JDRF, Mary Tyler Moore and S. Robert Levine, MD Charitable Foundation
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2207 – F0270. doi:
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    • Get Citation

      Jennifer K Sun, Thomas W. Gardner, Michael David Abramoff, Lloyd P Aiello, Helen Colhoun, Adam R Glassman, Tien-En Tan, Tien Wong, Stela Vujosevic, Sanjoy Dutta, S. Robert Levine; Updating the Diabetic Retinal Disease Staging System through the Restoring Vision Moonshot™. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2207 – F0270.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Despite advances in treatment, diabetic retinal disease (DRD) is a leading cause of vision loss for working-age adults worldwide. The development of novel, more effective therapies to preserve and restore vision is limited by current staging systems for DRD. These do not evaluate the neurosensory or peripheral retina, systemic health or molecular targets, and do not directly address impact of DRD on visual function or quality of life. The goal of this work was to define promising variables for a revised DRD staging system to better define DRD, stage risk of disease worsening and predict treatment response.

Methods : Six working groups conducted narrative reviews in the areas of: vascular retina, neural retina, visual function, quality of life, basic and cellular mechanisms, and systemic health to identify promising biomarkers for DRD risk, disease progression, and treatment response. Targeted reviews of the literature were conducted by a total of 50 experts in DRD from 12 countries, who used standardized evidence grids to collect information about each parameter.

Results : Selected tests and variables of interest included “traditional” ETDRS lesions, predominantly peripheral lesions on ultrawide field imaging, electroretinography, spectral domain optical coherence tomography, hemoglobin A1c, diabetes duration, and multiple molecular pathways. Visual function tests included best corrected visual acuity, contrast sensitivity, low luminance visual acuity and static automated perimetry. Quality of life instruments ranged from paper-pencil questionnaires to the RetCAT computerized adaptive testing system. Key information will be presented in each working group area to define the current level of evidence for promising parameters and to identify major gaps in knowledge that need to be addressed in future clinical and translational studies.

Conclusions : The DRD Staging System Update initiative is the first step in a Restoring Vision Moonshot™ which will expand access to data sharing and collaboration platforms to enable restoration and preservation of visual function in persons with diabetes. The second step is the establishment of a human eye tissue and the third step is development of a curated retinal image bank. The ultimate goal of this “Moonshot” is to create a world without visual loss from diabetes, a mission inspired by the late Mary Tyler Moore.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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