Effect of systemic medications on onset and progression of diabetic retinopathy.
Diabetic retinopathy remains a leading cause of visual loss worldwide. Patients with diabetes mellitus commonly have multiple comorbidities treated with a wide variety of medications. Systemic medications that target glycemic control and coexisting conditions may have beneficial or deleterious effects on the onset or progression of diabetic retinopathy. In addition, data is accumulating to suggest that the use of systemic therapy primarily to address ocular complications of diabetic retinopathy may be a promising therapeutic approach. This article reviews our current understanding of the ocular-specific effects of systemic medications commonly used by patients with diabetes mellitus, including those directed at control of hyperglycemia, dyslipidemia, hypertension, cardiac disease, anemia, inflammation and cancer. Current clinical evidence is strongest for the use of angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers in preventing the onset or slowing the progression of early diabetic retinopathy. To a more limited extent, evidence of a benefit of fibrates for diabetic macular edema exists. Numerous other agents hold considerable promise or potential risk. Thus, these compounds must undergo further rigorous study to determine the actual clinical efficacy and adverse effects before definitive therapeutic care recommendations can be offered.
Silva
Paolo S
PS
Beetham Eye Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical School, 1 Joslin Place, Boston, MA 02215, USA.
Cavallerano
Jerry D
JD
Sun
Jennifer K
JK
Aiello
Lloyd M
LM
Aiello
Lloyd Paul
LP
D017668:Age of Onset; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy; D003930:Diabetic Retinopathy / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D018450:Disease Progression; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D008954:Models, Biological; D019338:Polypharmacy
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents