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New biomarkers to predict the success of diabetic macular edema treatment

Researchers have found new biomarkers that predict prognosis following current treatments for diabetic macular edema. The research was led by Dr. Rajeev Muni, a vitreoretinal surgeon at St. Michael’s Hospital. The study is published in the journal JAMA Ophthalmology.

Diabetic macular edema is one the common complication of Diabetes. It is associated with the accumulation of fluid in the macula, an area in the center of the retina responsible for sharp vision. The fluid buildup causes the macula to swell and thicken, which causes vision problems. Dr. Muni said diabetic macular edema is the leading cause of vision loss in people under the age of 65 in North America.

Treatment for diabetic macular edema requires a sometimes painful injection in the eye, in some cases as often as once a month. Dr. Rajeev Muni said that while this treatment has been a “game-changer,” preserving and even restoring vision in people who might otherwise have gone blind, some people respond to it better than others.

In this study, researchers took fluid samples from the anterior, chamber of the eyes from 48 patients who were then treated with a ranibizumab injection. They found that low levels of vascular endothelial growth factor (VEGF) and high levels of intercellular adhesion molecule 1 (ICAM-1) are associated with the good response following ranibizumab injection.

“Now we have a novel biomarker to determine who will respond best to treatment,” said Dr. Rajeev Muni. “The prospect of ongoing injections in the eye is daunting for patients. The fact that we can now measure a protein in the eye that allows us to predict which patients are less likely respond to treatment could lead to more personalized and tailored medicine and fewer injections. This could alleviate the treatment burden on patients and the health-care system.”

Citation: Hillier, Roxane J., Elvis Ojaimi, David T. Wong, Michael Y. K. Mak, Alan R. Berger, Radha P. Kohly, Peter J. Kertes, Farzin Forooghian, Shelley R. Boyd, Kenneth Eng, Filiberto Altomare, Louis R. Giavedoni, Rosane Nisenbaum, and Rajeev H. Muni. “Aqueous Humor Cytokine Levels and Anatomic Response to Intravitreal Ranibizumab in Diabetic Macular Edema.” JAMA Ophthalmology, 2018. doi:10.1001/jamaophthalmol.2018.0179.

Research funding: Novartis Pharmaceuticals Canada Inc., Retina Foundation of Canada.

Adapted from press release by St. Michael’s Hospital.

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