The effect of select systemic medications on outcomes in diabetics with central retinal vein occlusion.

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2022-01

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Abstract

Background

Diabetes mellitus is a risk factor for central retinal vein occlusion (CRVO); however, it is unclear whether certain commonly used medications among diabetics or glycemic control impact visual outcomes in diabetic eyes with CRVO.

Purpose

To evaluate the effect of select systemic medications and glycemic control on presenting features, treatment burden, and outcomes in patients with diabetes who develop a central retinal vein occlusion (CRVO).

Methods

Retrospective longitudinal cohort study at a single tertiary academic referral center from 2009-2017 investigating eyes of patients being treated for diabetes mellitus at CRVO onset. Eyes with a prior history of anti-vascular endothelial growth factor (anti-VEGF) therapy or laser treatment within the year prior to CRVO onset were excluded. Main outcomes and measures were visual acuity (VA), central subfield thickness (CST), cystoid macular edema (CME), and number of intravitreal injections and laser treatment throughout follow-up.

Results

We identified 138 eyes of 138 participants who were diabetic at CRVO onset. Of these, 49% had an ischemic CRVO. Median follow-up time was 25.5 months. Fifty-five eyes (40%) had a HbA1c within 6 months of CRVO presentation. HbA1c was positively correlated with both presenting CST (p = 0.04) and presence of CME (p < 0.01). In all 138 eyes, mean presenting VA was 20/246, and mean final VA was 20/364. Better-presenting VA was significantly associated with aspirin 325 mg use (p = 0.04). Lower CST at presentation was significantly associated with metformin use (p = 0.02). Sitagliptin use at CRVO onset was associated with a lower prevalence of CME at final follow-up (p < 0.01). Lower final CST was significantly associated with glipizide use at CRVO onset (p = 0.01). There were no significant associations between systemic medications or HbA1c and treatment burden or final VA (p > 0.05).

Conclusion

Although aspirin 325 mg, metformin, sitagliptin, and glipizide were associated with better-presenting VA, lower-presenting CST, lower prevalence of macular edema at final visit, and lower final CST, respectively, none of these systemic agents or glycemic control were associated with decreased treatment burden or improved visual outcomes in diabetics with CRVO.

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10.1177/25158414211063076

Publication Info

Simmons, Kirsten, Pali Singh, Durga S Borkar, Faith Birnbaum, Akshay S Thomas and Sharon Fekrat (2022). The effect of select systemic medications on outcomes in diabetics with central retinal vein occlusion. Therapeutic advances in ophthalmology, 14. p. 25158414211063076. 10.1177/25158414211063076 Retrieved from https://hdl.handle.net/10161/26947.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Fekrat

Sharon Fekrat

Professor of Ophthalmology

Sharon Fekrat, MD, FACS, FASRS is a board-certified, fellowship-trained vitreoretinal surgeon and an accomplished educator, clinical researcher, and administrator. She was the first woman Assistant Chief of Service who was on-call handling ocular trauma and retinal emergencies continuously for 365 days at Johns Hopkins Wilmer Eye Institute, one of the top institutions in the world, before she was recruited to Duke. Dr. Fekrat's achievements in patient care and vitreoretinal surgery have been recognized by her peers in "best doctors" lists, including in Business North Carolina since 2005, Newsweek, Ocular Surgery News, as well as her induction into the Retina Hall of Fame. Dr. Fekrat was awarded the Secretariat Award and Achievement Award from the American Academy of Ophthalmology, Rhett Buckler Trophies for surgical video competition and Senior Honor Award from the American Society of Retina Specialists, the Janet M. Glasgow Memorial Achievement Award from the American Medical Women's Association, Ronald G. Michels Fellowship Foundation Award (first woman), and Heed and Heed-Knapp Awards.

Dr. Fekrat is an inspirational and committed teacher, mentor, and sponsor of future ophthalmologists and retina specialists whom she trains. She has received the Faculty Instructor of the Year from Duke Ophthalmic Medical Technician Training Program, Golden Globe Award from the Duke Ophthalmology Residents, and the 2022 ASRS Crystal Apple Award from the Young Career Section of the American Society of Retina Specialists. She taught vitreoretinal surgery fellows as invited faculty at the Fort Worth Vitreoretinal Surgery Training Course and Wetlab and the Duke Fellows Advanced Vitreous Surgery Course and Wetlab. Dr. Fekrat also mentors numerous undergraduates, medical students, residents, and fellows in clinical research, publishing from her retinal vein occlusion, endophthalmitis, vitreomacular traction, keratoprosthesis, and submacular hemorrhage databases. 

Dr. Fekrat founded and leads the iMIND international multidisciplinary clinical research team evaluating multimodal retinal, choroidal, and optic nerve imaging for the diagnosis of Alzheimer's disease and other neurodegenerations and is collaborating with Duke engineers and computer scientists to train machine learning models for the diagnosis of Alzheimer's, Parkinson's, and mild cognitive impairment as well as image quality assessment. Her team published the first paper demonstrating proof of concept that a machine learning model can differentiate individuals with Alzheimer's disease from those with normal cognition using retinal images. She is also studying Alzheimer's proteins in the aqueous humor of the eye. Her team's work has been featured on ABC, CBS, Fox, Reuters, Newsweek, People's Pharmacy, and several hundred news outlets around the world. Her research work has been recognized with numerous awards including the VitreoRetinal Surgery Foundation Award, Karen L Wrenn Alzheimer's Disease Travel Award, Robert Machemer Resident Research Award, American Society of Retina Specialists Journal of VitreoRetinal Diseases Distinguished Contributor Award, Research to Prevent Blindness Departmental Small Grant Award, Research to Prevent Blindness Medical Student Eye Research Fellowship, Vit-Buckle Society BullDogger and Academic Grant Awards, Women in Retina Travel Grant, Gerhard Zinser Memorial Travel Grant, Alzheimer's Disease Drug Discovery Foundation, and many more. As an invited speaker, she was keynote speaker at Research to Prevent Blindness' Vision Research Funding Partnership speaking on Artificial Intelligence and the Retina: Potential for Diagnosis, Challenges for Progress. She also gave invited testimony on her iMIND work to the United States Senate Special Committee on Aging. 

Dr. Fekrat has published extensively not only in medical journals but also in textbooks. She has co-authored over 200 publications in peer-reviewed medical journals and over 50 textbook chapters. She is chief Editor of Duke Eye Center’s All About Your Eyes for the lay public, Wolters Kluwer's The Duke Manual of Vitreoretinal Surgery and both editions of SLACK's Curbside Consultation in Retina as well as Series Editor for The Duke Manuals of Ophthalmic Surgery for ophthalmic microsurgeons all over the world. Dr Fekrat is Faculty Editor-in-Chief of the Duke Journal of Case Reports in Ophthalmology which she founded. Several scientific and scholarly journals have sought Dr. Fekrat's expertise and recognized her research leadership by naming her to their editorial boards and seeking her assistance in reviewing the work of other investigators and scientists. She serves on the editorial board of Retinal Physician, Ophthalmology Times, Ophthalmic Surgery Lasers Imaging Retina, and American Society of Retina Specialists' Retina Times, and is an Executive Editor of the American Journal of Ophthalmology. She has also served as Retina Section Editor and Ophthalmic Pearls section Co-Editor of EyeNet, published by the American Academy of Ophthalmology.

Dr. Fekrat is a natural leader and administrator evident in the breadth and depth of her leadership roles. To mention a few, she has been Director of Duke Medical Student Ophthalmology Education, Director of the Duke Vitreoretinal Surgery Fellowship Program (one of the best in the world), Director of Ophthalmology Faculty Mentoring and Career Development, President of the North Carolina Society of Eye Physicians and Surgeons, Vice Chair of Duke Clinical Sciences Appointments, Promotions, and Tenure Committee, and is currently Vice Chair of Faculty Affairs and Director of Duke iMIND Research Group. She was appointed as the sole physician on the Steering Committee for Strategic Education on Research, Translation, and Commercialization that advised the Duke Board of Trustees. At Duke's VA affiliate (Durham VA Health Care System), she has served as Chief of Ophthalmology, Interim Chief of Surgery (leading 80 Duke surgeons across all surgical specialties), Interim Deputy Chief of Staff, and is currently Associate Chief of Staff of Microsurgery and Specialty Services. 

Dr. Fekrat has an impressive educational pedigree. After graduating as valedictorian of her high school, she received her Bachelors of Science degree from Georgetown University graduating magna cum laude and Phi Beta Kappa and spent one year at Oxford University in England. She received her MD from the University of Chicago Pritzker School of Medicine, recognized by Alpha Omega Alpha Honor Society. She completed her ophthalmology residency training at the prestigious Johns Hopkins Wilmer Eye Institute where she also completed her two year fellowship in medical and surgical vitreoretinal diseases with the giants in the field of ophthalmology and retina.

https://dukeeyecenter.duke.edu/research/clinical-research/clinical-research-programs/imind
https://dukeeyecenter.duke.edu/djcro
https://www.linkedin.com/in/sharon-fekrat-md-facs-fasrs-315a31a6/


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