title: Phenotypes and biomarkers of diabetic retinopathy.
abstract: Diabetic retinopathy (DR) remains a major cause of blindness as the prevalence of diabetes is expected to approximately double globally between 2000 and 2030. DR progresses over time at different rates in different individuals with only a limited number developing significant vision loss due to the two major vision-threatening complications, clinically significant macular edema and proliferative retinopathy. Good metabolic control is important to prevent and delay progression, but whereas some patients escape vision loss even with poor control, others develop vision loss despite good metabolic control. Our research group has been able to identify three different DR phenotypes characterized by different dominant retinal alterations and different risks of progression to vision-threatening complications. Microaneurysm turnover has been validated as a prognostic biomarker of development of clinically significant macular edema, whereas subclinical macular edema identified by OCT and mfERG appear to be also good candidates as organ-specific biomarkers of DR. Hemoglobin A1c remains the only confirmed systemic prognostic biomarker of DR progression. The availability of biomarkers of DR progression and the identification of different phenotypes of DR with different risks for development of vision-threatening complications offers new perspectives for understanding DR and for its personalized management.
authors.affiliation: Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Polo III, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal. Electronic address: cunhavaz@aibili.pt.
authors.forename: José
authors.initials: J
authors.lastname: Cunha-Vaz
authors.affiliation: Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Polo III, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal. Electronic address: lr@aibili.pt.
authors.forename: Luisa
authors.initials: L
authors.lastname: Ribeiro
authors.affiliation: Association for Innovation and Biomedical Research on Light and Image (AIBILI), Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Polo III, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal. Electronic address: clobo@aibili.pt.
authors.forename: Conceição
authors.initials: C
authors.lastname: Lobo
mesh_terms: D000783:Aneurysm / Q000473:pathology; D015415:Biomarkers; D003930:Diabetic Retinopathy / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008269:Macular Edema / Q000473:pathology; D010641:Phenotype; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D015415:Biomarkers
keywords: Biomarkers; Diabetic retinopathy; Macular edema; Microaneurysm; Optical coherence tomography; Phenotypes