Drug, delivery and devices for diabetic retinopathy (3Ds in DR)

ABSTRACT

Introduction: Diabetic Retinopathy (DR) is one of the most common causes of blindness among the working population worldwide. Clearly, there is an unmet clinical need to find better treatment options for DR.

Areas covered: The literature search was conducted on PubMed with no limitation on language or year of publication. The review focuses on the clinically used drugs/proteins along with a brief background on the pathophysiology of DR. The major focus of this review revolves around three treatment approaches involving drugs/proteins, drug delivery formulations and drug delivery devices. In each category, major advances are discussed along with the possible solutions. We have also discussed the various modes of administration that are currently being evaluated in the clinic. An attempt has been made to address the potential targeted site of action for DR drug delivery, and also to understand the role of Blood Retinal Barrier (BRB).

Expert Opinion: In the current scenario, although there have been some advances in the drug delivery devices for delivering drugs/proteins, there are still challenges to be overcome with regard to the particulate systems. For long-term success of DR therapeutics, research options should consider taking into account the 3Ds (drug, delivery and devices).

KEYWORDS:

• Diabetic retinopathy
• anti-VEGF
• drugs
• delivery systems
• delivery devices

Article highlights

• The plethora of drugs, drug delivery systems and drug delivery devices (3D’s) which are developed and under development are summarized

• The readers will get an insight about how VEGF and inflammation plays a role in the progression of diabetic retinopathy.

• The current treatment options for DR in clinics and its routes of delivery and potential alternative routes for future therapeutics have been discussed

• Advantages and disadvantages of topical, intravitreal and periocular routes for DR therapeutics are demonstrated.

• Various particulate drug delivery systems for anti-vegf and nonanti-vegf agents which are under development are reviewed

• The current status of devices (implants) for DR therapeutics is covered.

This box summarizes key points contained in the article.

Declaration of interests

The project is funded by National Thematic Research Grant, Ageing Research Grant and Nanyang Technological University – National Healthcare Group Metabolic disease grant administered by National Healthcare Group, Singapore. Nirmal J is a post doctorate fellow working under National Thematic Research Grant, R Agrawal is the clinical Principal investigator and Prof Subbu Venkatraman is the technical Principal investigator. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.