The Lasker/IRRF Initiative
for Innovation in Vision Science
Diabetic Retinopathy: A Path to Progress
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Degenerative diseases of the retina are devastating conditions leading to severe visual impairment and blindness; their causes and paths of treatment have long evaded scientists.
Since 2008, the Lasker Foundation and the International Retinal Research Foundation (IRRF) have been engaged in a collaborative effort to accelerate discovery of sight-saving treatments and ways to prevent retinal degenerative diseases. To date, the Initiative for Innovation in Vision Science has produced two reports that identify knowledge gaps in research and apply innovative solutions to retinal diseases. The first report, on astrocytes and glaucomatous neurodegeneration, may be downloaded here.
The Initiative's second report, released in 2012, addresses diabetic retinopathy, the most common and most serious of the ocular complications of diabetes mellitus. In the U.S. alone, the most recent (2007) estimate from the Centers for Disease Control and Prevention indicated that some 23.6 million individuals, 7.8 percent of the entire U.S. population, have diabetes. Of these, nearly 30 percent have retinopathy, and an estimated 4.4 percent, or about one million individuals, have advanced, vision-threatening retinopathy. A very large proportion of these are from minority populations. Although the best data come from the U.S., the problem is global. Moreover, diabetic retinopathy afflicts people with both type 1 and type 2 diabetes; because the incidence of type 2 diabetes is rising, due at least in part to the worldwide increase in obesity, diabetic retinopathy is a growing concern.
Since it was first described in the nineteenth century, diabetic retinopathy has been considered a disease of the retinal blood vessels. However, a variety of highly sensitive techniques that have recently been developed suggest that much earlier anatomic, biochemical, and physiologic abnormalities in the neuronal and glial cells of the retina precede these vascular lesions, and lead to the question of whether these are true predecessors of the vascular disorder and may be appropriately called "preclinical" diabetic retinopathy. Research conducted during the past half century has demonstrated unequivocally that control of blood glucose to near-normal levels reduces the incidence and progression of retinopathy and other complications in both types of diabetes. Additional evidence indicates that mechanisms other than hyperglycemia also affect the development of diabetic retinopathy, including classical genetic influences. Finally, unique features of the retina may be responsible for its high susceptibility to complications of diabetes.
These observations from past basic and clinical investigations serve as a backdrop for the Lasker/IRRF Initiative on Diabetic Retinopathy. The investigation of this disease included two 2011 workshops of experts in a wide range of scientific disciplines, at which the complex links between the rise in blood glucose levels and changes in neuronal/glial function and vascular changes that eventually can destroy vision in an eye were explored. From these discussions, the group identified nine specific areas for further scrutiny:
- Early Signs of Diabetic Retinopathy
- Role of Glucose, Lipids and Oxygen in Diabetic Retinopathy
- Diagnostic Methods
- Genetics and Environmental Susceptibility
- Epidemiology and Unusual Cohorts
- Present and Proposed Approaches to Therapeutics
- Pathogenesis of Diabetic Retinopathy
- Vascular and Retinal Repair
- Animal Models
At a plenary session of all workshop participants, held in March 2012, scientists examined these targeted areas, pinpointed key research hurdles that impede research progress, and developed a series of innovative proposals for new research, using novel approaches and cutting edge technologies. The report Diabetic Retinopathy: What We Know and A Path to Progress, published in November 2012, summarizes the findings of the Initiative. It provides a path to new ideas and experiments that will increase our understanding of this disease and lead to the development of effective therapies for preventing this devastating disease.
The Initiative is now engaged in its third program, focused on restoring vision to the blind. This endeavor will examine the newest insights and cutting edge technologies that might re-establish light sensitivity and restore visual perception damaged or destroyed by retinal degenerations to answer a major question: Which approaches are most promising and most likely to benefit the greatest number of blind individuals and how can they be advanced?
The Initiative is currently identifying scientists for invitation to participate, including leaders in retinal degeneration, ocular genetics, electrophysiology and sensorimotor research, molecular biology, neuro-ophthalmology, nanotechnology and regenerative medicine, ophthalmic imaging and other disciplines relevant to the project. The collaborative nature of this multi-disciplinary approach is designed to bridge the gaps between scientific disciplines and encourage the best minds to define the most creative solutions to daunting scientific problems; to design streamlined approaches that use all available tools; to accelerate discovery, and to facilitate translational research leading to new treatments to reverse retinal degenerative vision loss.