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      Role of Oral Antioxidant Supplementation in the Current Management of Diabetic Retinopathy

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          Abstract

          Oxidative stress has been postulated as an underlying pathophysiologic mechanism of diabetic retinopathy (DR), the main cause of avoidable blindness in working-aged people. This review addressed the current daily clinical practice of DR and the role of antioxidants in this practice. A systematic review of the studies on antioxidant supplementation in DR patients was presented. Fifteen studies accomplished the inclusion criteria. The analysis of these studies concluded that antioxidant supplementation has a IIB level of recommendation in adult Type 1 and Type 2 diabetes mellitus subjects without retinopathy or mild-to-moderate nonproliferative DR without diabetic macular oedema as a complementary therapy together with standard medical care.

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          Global Prevalence and Major Risk Factors of Diabetic Retinopathy

          Joanne Yau, Sophie L. Rogers, Ryo Kawasaki … (2012)
          OBJECTIVE To examine the global prevalence and major risk factors for diabetic retinopathy (DR) and vision-threatening diabetic retinopathy (VTDR) among people with diabetes. RESEARCH DESIGN AND METHODS A pooled analysis using individual participant data from population-based studies around the world was performed. A systematic literature review was conducted to identify all population-based studies in general populations or individuals with diabetes who had ascertained DR from retinal photographs. Studies provided data for DR end points, including any DR, proliferative DR, diabetic macular edema, and VTDR, and also major systemic risk factors. Pooled prevalence estimates were directly age-standardized to the 2010 World Diabetes Population aged 20–79 years. RESULTS A total of 35 studies (1980–2008) provided data from 22,896 individuals with diabetes. The overall prevalence was 34.6% (95% CI 34.5–34.8) for any DR, 6.96% (6.87–7.04) for proliferative DR, 6.81% (6.74–6.89) for diabetic macular edema, and 10.2% (10.1–10.3) for VTDR. All DR prevalence end points increased with diabetes duration, hemoglobin A1c, and blood pressure levels and were higher in people with type 1 compared with type 2 diabetes. CONCLUSIONS There are approximately 93 million people with DR, 17 million with proliferative DR, 21 million with diabetic macular edema, and 28 million with VTDR worldwide. Longer diabetes duration and poorer glycemic and blood pressure control are strongly associated with DR. These data highlight the substantial worldwide public health burden of DR and the importance of modifiable risk factors in its occurrence. This study is limited by data pooled from studies at different time points, with different methodologies and population characteristics.
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            Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis.

            Seth R Flaxman, Rupert Bourne, Serge Resnikoff … (2017)
            Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020.
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              Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales.

              C P Wilkinson, Frederick L Ferris, Ronald E Klein … (2003)
              To develop consensus regarding clinical disease severity classification systems for diabetic retinopathy and diabetic macular edema that can be used around the world, and to improve communication and coordination of care among physicians who care for patients with diabetes. Report regarding the development of clinical diabetic retinopathy disease severity scales. A group of 31 individuals from 16 countries, representing comprehensive ophthalmology, retina subspecialties, endocrinology, and epidemiology. An initial clinical classification system, based on the Early Treatment Diabetic Retinopathy Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy publications, was circulated to the group in advance of a workshop. Each member reviewed this using e-mail, and a modified Delphi system was used to stratify responses. At a later workshop, separate systems for diabetic retinopathy and macular edema were developed. These were then reevaluated by group members, and the modified Delphi system was again used to measure degrees of agreement. Consensus regarding specific classification systems was achieved. A five-stage disease severity classification for diabetic retinopathy includes three stages of low risk, a fourth stage of severe nonproliferative retinopathy, and a fifth stage of proliferative retinopathy. Diabetic macular edema is classified as apparently present or apparently absent. If training and equipment allow the screener to make a valid decision, macular edema is further categorized as a function of its distance from the central macula. There seems to be a genuine need for consistent international clinical classification systems for diabetic retinopathy and diabetic macular edema that are supported with solid evidence. The proposed clinical classification systems provide a means of appropriately categorizing diabetic retinopathy and macular edema. It is hoped that these systems will be valuable in improving both screening of individuals with diabetes and communication and discussion among individuals caring for these patients.
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                Author and article information

                Contributors
                Alexander V. Ljubimov: Role: Academic Editor
                Journal
                Journal ID (nlm-ta): Int J Mol Sci
                Journal ID (iso-abbrev): Int J Mol Sci
                Journal ID (publisher-id): ijms
                Title: International Journal of Molecular Sciences
                Publisher: MDPI
                ISSN (Electronic): 1422-0067
                Publication date (Electronic): 13 April 2021
                Publication date Collection: April 2021
                Volume: 22
                Issue: 8
                Electronic Location Identifier: 4020
                Affiliations
                [1 ]FISABIO-Oftalmología Médica (FOM), Vitreoretinal Unit, 46015 Valencia, Spain; enalmuo@ 123456gmail.com (E.A.A.-M.); jorge.mataix@ 123456gmail.com (J.M.B.)
                [2 ]Servicio de Oftalmología, Hospital General Universitario de Castellón, 12004 Castellón, Spain; raquelburggraaf@ 123456gmail.com
                [3 ]Servicio de Oftalmología, Hospital Universitario San Juan, 03550 Alicante, Spain; jcmm.molina@ 123456gmail.com
                Author notes
                [* ]Correspondence: carmen.desco@ 123456uv.es
                Author information
                https://orcid.org/0000-0002-1838-2380
                https://orcid.org/0000-0002-5163-5343
                https://orcid.org/0000-0002-7018-3506
                https://orcid.org/0000-0002-9259-5579
                https://orcid.org/0000-0002-9239-7847
                Article
                Publisher ID: ijms-22-04020
                DOI: 10.3390/ijms22084020
                PMC ID: 8069935
                SO-VID: 215ab8f0-1a1c-4e7f-9d4c-b112d3fd043a
                Copyright © © 2021 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 02 March 2021
                Date accepted : 09 April 2021
                Categories
                Subject: Review

                ScienceOpen disciplines: Molecular biology
                Keywords: diabetic retinopathy,antioxidants,oxidative stress,management,clinical practice,ophthalmology,retina,nutrition,nutraceuticals,multivitamin complex
                Data availability:
                ScienceOpen disciplines: Molecular biology
                Keywords: diabetic retinopathy, antioxidants, oxidative stress, management, clinical practice, ophthalmology, retina, nutrition, nutraceuticals, multivitamin complex

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