June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Inverse Risk for Progression of Diabetic Retinopathy and Age-Related Macular Degeneration
Author Affiliations & Notes
  • Ward Fickweiler
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Cris Martin P. Jacoba
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Surya Jangolla
    Joslin Diabetes Center, Boston, Massachusetts, United States
  • John Gauthier
    Joslin Diabetes Center, Boston, Massachusetts, United States
  • Nolan Ziemniak
    Joslin Diabetes Center, Boston, Massachusetts, United States
  • I-Hsien Wu
    Joslin Diabetes Center, Boston, Massachusetts, United States
  • Jerry cavallerano
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Lloyd P Aiello
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • Jennifer K Sun
    Joslin Diabetes Center Beetham Eye Institute, Boston, Massachusetts, United States
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
  • George L King
    Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
    Medicine, Harvard Medical School, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Ward Fickweiler None; Cris Martin Jacoba None; Surya Jangolla None; John Gauthier None; Nolan Ziemniak None; I-Hsien Wu None; Jerry cavallerano None; Lloyd Aiello Kalvista, Novo Nordisk, Ceramedix, MantraBio, Code C (Consultant/Contractor), Optos, Code F (Financial Support), Kalvista, Code I (Personal Financial Interest), Optos, Code R (Recipient); Jennifer Sun Adaptive Sensory Technologies, Code F (Financial Support), Boehringer Ingelheim, Code F (Financial Support), Genentech/Roche, Code F (Financial Support), Janssen, Code F (Financial Support), Physical Sciences, Inc, Code F (Financial Support), Novo Nordisk, Code F (Financial Support), Optovue, Code F (Financial Support); George King None
  • Footnotes
    Support  American Diabetes Association (7-21-PDF-022), National Eye Institute (R01EYE26080-01), the National Institute of Diabetes and Digestive and Kidney Diseases and National Institutes of Health (DP3-DK-094333-01); JDRF (17-2013-310); the Dianne Nunnally Hoppes Fund; the Beatson Pledge Fund
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 495. doi:
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    • Get Citation

      Ward Fickweiler, Cris Martin P. Jacoba, Surya Jangolla, John Gauthier, Nolan Ziemniak, I-Hsien Wu, Jerry cavallerano, Lloyd P Aiello, Jennifer K Sun, George L King; Inverse Risk for Progression of Diabetic Retinopathy and Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2023;64(8):495.

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

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Abstract

Purpose : To evaluate the association between the presence of age-related macular degeneration (AMD) and diabetic retinopathy severity (DR).

Methods : Digital fundus images were graded for ETDRS DR severity and for AMD using the Age-Related Eye Disease Study (AREDS) classification system in people with type 1 and type 2 diabetes at the Beetham Eye Institute (BEI) of Joslin Diabetes Center, and individuals who have had insulin-dependent diabetes for 50 years or longer (Joslin 50-Year Medalist Study). Individual retinal layer thicknesses in the foveal area were assessed in eyes of Medalists (N=545). Retinol binding protein 3 (RBP3) and vascular endothelial growth factor (VEGF) concentrations were measured by ELISA in vitreous samples (N=187) obtained during vitreoretinal surgery at the BEI and from postmortem eyes of Medalists.

Results : The presence of AMD was associated with less severe DR in both Medalist (N=1163, P<0.0001) and BEI cohorts (N=58, P=0.004). In Medalists, 16.2% had any AMD, 13.2% had AREDS level 1-2, and 3.0% AREDS level 3-4. There were no eyes with neovascular AMD. All eyes with AMD in the BEI cohort had AREDS level 1-2 (10.4%). In the Medalist cohort, the presence and severity of AMD was positively associated with the presence of drusen outside the macula (P<0.0001). The presence of drusen outside the macula was associated with less severe DR in Medalists (P=0.04). In a subset of Medalists (22.9%) with longitudinal follow up, DR progression was less frequent in eyes with AMD AREDS level ≥2 (N=2) compared to eyes with AMD AREDS level <2 (N=31, 13.0% vs 7.1%, P=0.04), and milder DR at baseline was associated with increased risk of AMD (P<0.05). Increased photoreceptor thickness was associated with AMD (P=0.02) and milder DR (P=0.01). The presence of AMD and milder DR were associated with higher RBP3 to VEGF ratios in the vitreous from individuals of the Joslin BEI (P=0.03 and P=0.004, respectively), and Medalists (P=0.02 and P=0.0003, respectively).

Conclusions : The inverse correlation of clinical and biochemical changes exhibited by DR and AMD may reflect disparate metabolic pathways underlying their development or worsening and indicate that the pathogenesis of DR is likely not accelerated by similar ageing factors. Detailed retinal studies from eyes with DR and AMD may provide additional pathways to target against these common sight-threatening diseases.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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