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    Diabetic retinopathy: a complex pathophysiology requiring novel therapeutic strategies

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    Author
    Whitehead, M; Wickremasinghe, S; Osborne, A; Van Wijngaarden, P; Martin, KR
    Date
    2018-12-02
    Source Title
    Expert Opinion on Biological Therapy
    Publisher
    TAYLOR & FRANCIS LTD
    University of Melbourne Author/s
    Wickremasinghe, Sanjeewa; van Wijngaarden, Peter; Martin, Keith
    Affiliation
    Ophthalmology (Eye & Ear Hospital)
    Metadata
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    Document Type
    Journal Article
    Citations
    Whitehead, M., Wickremasinghe, S., Osborne, A., Van Wijngaarden, P. & Martin, K. R. (2018). Diabetic retinopathy: a complex pathophysiology requiring novel therapeutic strategies. EXPERT OPINION ON BIOLOGICAL THERAPY, 18 (12), pp.1257-1270. https://doi.org/10.1080/14712598.2018.1545836.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253122
    DOI
    10.1080/14712598.2018.1545836
    Abstract
    INTRODUCTION: Diabetic retinopathy (DR) is the leading cause of vision loss in the working age population of the developed world. DR encompasses a complex pathology, and one that is reflected in the variety of currently available treatments, which include laser photocoagulation, glucocorticoids, vitrectomy and agents which neutralize vascular endothelial growth factor (VEGF). Whilst these options demonstrate modest clinical benefits, none is yet to fully attenuate clinical progression or reverse damage to the retina. This has led to an interest in developing novel therapies for the condition, such as mediators of angiopoietin signaling axes, immunosuppressants, nonsteroidal anti-inflammatory drugs (NSAIDs), oxidative stress inhibitors and vitriol viscosity inhibitors. Further, preclinical research suggests that gene therapy treatment for DR could provide significant benefits over existing treatments options. AREAS COVERED: Here we review the pathophysiology of DR and provide an overview of currently available treatments. We then outline recent advances made towards improved patient outcomes and highlight the potential of the gene therapy paradigm to revolutionize DR management. EXPERT OPINION: Whilst significant progress has been made towards our understanding of DR, further research is required to enable the development of a detailed spatiotemporal model of the disease. In addition, we hope that improvements in our knowledge of the condition facilitate therapeutic innovations that continue to address unmet medical need and improve patient outcomes, with a focus on the development of targeted medicines.

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