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Diabetic Retinopathy

Diabetic Retinopathy

DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...

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Regenerative Therapy by Suprachoroidal Cell Autograft in Dry Age-related Macular Degeneration: Preliminary In Vivo Report

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Enhancing Diabetic Macular Edema Treatment Outcomes: Exploring the ESASO Classification and Structural OCT

Giacomo Panozzo^1,2, Maria V Cicinelli³, Giulia Dalla Mura⁴

¹Ophthalmology Unit, Clinica San Francesco, Verona, Italy. g.panozzo@iol.it.

Ophthalmology and Therapy

|March 26, 2024

Summary

The European School of Advanced Studies in Ophthalmology (ESASO) classification effectively predicts visual outcomes for diabetic macular edema (DME) treatments. Early-stage DME (stages 1-2) shows significant visual acuity improvement, unlike advanced stages indicating irreversible damage.

Keywords:

Anti-VEGF Diabetic macular edema ESASO classification OCT Biomarkers Optical coherence tomography Retinal Neurovascular Unit Steroid Treatment outcomes in DME

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Area of Science:

Ophthalmology
Diabetology
Medical Imaging

Background:

Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
Predicting treatment response in DME is crucial for effective management.
The European School of Advanced Studies in Ophthalmology (ESASO) classification offers a comprehensive staging system for DME.

Purpose of the Study:

To evaluate the prognostic value of the ESASO classification for predicting intravitreal therapy outcomes in diabetic macular edema.
To assess the correlation between DME stage and visual acuity improvement after treatment.
To determine if the ESASO classification is superior to single biomarkers in predicting functional response.

Main Methods:

A retrospective, multicenter study involving 560 patients aged over 50 with type 1 or 2 diabetes and DME.
Patients received intravitreal anti-VEGF agents or steroids.
Visual acuity (VA) change was measured 4-16 weeks post-treatment, stratified by initial DME stage (1-4) according to the ESASO classification.

Main Results:

Visual acuity improved significantly in ESASO stages 1 and 2 (0.12-0.15 decimals), but minimally in stages 3 (0.03 decimals) and 4 (0.01 decimals).
Central subfield thickness (CST) improved most in stage 3, but this did not correlate with VA gains, unlike in stages 1 and 2.
Baseline retinal structural integrity (disorganization of retinal inner layers, ellipsoid zone/external limiting membrane damage) did not impact VA improvement in early DME stages.

Conclusions:

The ESASO classification, integrating multiple biomarkers, is a superior predictor of visual outcomes in DME compared to single biomarkers.
Significant functional improvement was observed only in ESASO stages 1 and 2, suggesting reversible retinal damage.
ESASO stages 3 and 4 likely represent irreversible damage, indicating a poorer prognosis for visual recovery.