Updating the Diabetic Retinal Disease Staging System through the Restoring Vision Moonshot™

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.