Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment

Sameer P Leley,1 Thomas A Ciulla,2– 4 Ashay D Bhatwadekar2 1Indiana University School of Medicine, Indianapolis, IN, USA; 2Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA; 3Clearside Biomedical, Inc., Alpharetta, GA, USA; 4Midwest Eye In...

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Autores principales:	Leley SP, Ciulla TA, Bhatwadekar AD
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	diabetic retinopathy aging vascular endothelial growth factor adherence pharmacodynamic pharmacokinetic Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/c00338969d81440dadaaa909362eb7ab
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spelling	oai:doaj.org-article:c00338969d81440dadaaa909362eb7ab2021-12-02T18:26:43ZDiabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment1178-1998https://doaj.org/article/c00338969d81440dadaaa909362eb7ab2021-07-01T00:00:00Zhttps://www.dovepress.com/diabetic-retinopathy-in-the-aging-population-a-perspective-of-pathogen-peer-reviewed-fulltext-article-CIAhttps://doaj.org/toc/1178-1998Sameer P Leley,1 Thomas A Ciulla,2– 4 Ashay D Bhatwadekar2 1Indiana University School of Medicine, Indianapolis, IN, USA; 2Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA; 3Clearside Biomedical, Inc., Alpharetta, GA, USA; 4Midwest Eye Institute, Indianapolis, IN, USACorrespondence: Ashay D BhatwadekarDepartment of Ophthalmology, Eugene and Marilyn Glick Eye Institute, 1160 W. Michigan Street, GK-305P, Indianapolis, IN, 46202, USATel +1 317-278-5075Fax +1 317-274-2277Email abhatwad@iupui.eduAbstract: The elderly population in the United States is projected to almost double by the year 2050. In addition, the numbers of diabetics are rising, along with its most common complication, diabetic retinopathy (DR). To effectively treat DR within the elderly population, it is essential first to consider the retinal changes that occur due to aging, such as decreased blood flow, retinal thinning, and microglial changes, and understand that these changes can render the retina more vulnerable to oxidative and ischemic damage. Given these considerations, as well as the pathogenesis of DR, specific pathways could play a heightened role in DR progression in elderly patients, such as the polyol pathway and the vascular endothelial growth factor (VEGF) axis. Current ocular treatments include intravitreal corticosteroids, intravitreal anti-VEGF agents, laser photocoagulation and surgical interventions, in addition to better control of underlying diabetes with an expanding range of systemic treatments. While using therapeutics, it is also essential to consider how pharmacokinetics and pharmacodynamics change with aging; oral drug absorption can decrease, and ocular drug metabolism might affect the dosing and delivery methods. Also, elderly patients may more likely be nonadherent to their medication regimen or appointments than younger patients, and undertreatment with anti-VEGF drugs often leads to suboptimal outcomes. With a rising number of elderly DR patients, understanding how aging affects disease progression, pharmacological metabolism, and adherence are crucial to ensuring that this population receives adequate care.Keywords: diabetic retinopathy, aging, vascular endothelial growth factor, adherence, pharmacodynamic, pharmacokineticLeley SPCiulla TABhatwadekar ADDove Medical Pressarticlediabetic retinopathyagingvascular endothelial growth factoradherencepharmacodynamicpharmacokineticGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 16, Pp 1367-1378 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetic retinopathy aging vascular endothelial growth factor adherence pharmacodynamic pharmacokinetic Geriatrics RC952-954.6
spellingShingle	diabetic retinopathy aging vascular endothelial growth factor adherence pharmacodynamic pharmacokinetic Geriatrics RC952-954.6 Leley SP Ciulla TA Bhatwadekar AD Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
description	Sameer P Leley,1 Thomas A Ciulla,2– 4 Ashay D Bhatwadekar2 1Indiana University School of Medicine, Indianapolis, IN, USA; 2Department of Ophthalmology, Eugene and Marilyn Glick Eye Institute, Indiana University, Indianapolis, IN, USA; 3Clearside Biomedical, Inc., Alpharetta, GA, USA; 4Midwest Eye Institute, Indianapolis, IN, USACorrespondence: Ashay D BhatwadekarDepartment of Ophthalmology, Eugene and Marilyn Glick Eye Institute, 1160 W. Michigan Street, GK-305P, Indianapolis, IN, 46202, USATel +1 317-278-5075Fax +1 317-274-2277Email abhatwad@iupui.eduAbstract: The elderly population in the United States is projected to almost double by the year 2050. In addition, the numbers of diabetics are rising, along with its most common complication, diabetic retinopathy (DR). To effectively treat DR within the elderly population, it is essential first to consider the retinal changes that occur due to aging, such as decreased blood flow, retinal thinning, and microglial changes, and understand that these changes can render the retina more vulnerable to oxidative and ischemic damage. Given these considerations, as well as the pathogenesis of DR, specific pathways could play a heightened role in DR progression in elderly patients, such as the polyol pathway and the vascular endothelial growth factor (VEGF) axis. Current ocular treatments include intravitreal corticosteroids, intravitreal anti-VEGF agents, laser photocoagulation and surgical interventions, in addition to better control of underlying diabetes with an expanding range of systemic treatments. While using therapeutics, it is also essential to consider how pharmacokinetics and pharmacodynamics change with aging; oral drug absorption can decrease, and ocular drug metabolism might affect the dosing and delivery methods. Also, elderly patients may more likely be nonadherent to their medication regimen or appointments than younger patients, and undertreatment with anti-VEGF drugs often leads to suboptimal outcomes. With a rising number of elderly DR patients, understanding how aging affects disease progression, pharmacological metabolism, and adherence are crucial to ensuring that this population receives adequate care.Keywords: diabetic retinopathy, aging, vascular endothelial growth factor, adherence, pharmacodynamic, pharmacokinetic
format	article
author	Leley SP Ciulla TA Bhatwadekar AD
author_facet	Leley SP Ciulla TA Bhatwadekar AD
author_sort	Leley SP
title	Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
title_short	Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
title_full	Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
title_fullStr	Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
title_full_unstemmed	Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment
title_sort	diabetic retinopathy in the aging population: a perspective of pathogenesis and treatment
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/c00338969d81440dadaaa909362eb7ab
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Diabetic Retinopathy in the Aging Population: A Perspective of Pathogenesis and Treatment

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