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Angiopoietin-like 4 as an Emerging Therapeutic Target for Diabetic Eye Disease

Akrit Sodhi, MD, PhD1; Silvia Montaner, PhD, MPH2,3
[+] Author Affiliations
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Oncology and Diagnostic Sciences, School of Dentistry, Greenebaum Cancer Center, University of Maryland, Baltimore
3Department of Pathology, School of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore
JAMA Ophthalmol. 2015;133(12):1375-1376. doi:10.1001/jamaophthalmol.2015.3723.
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This Viewpoint discusses the role of angiopoietin-like 4 in the pathogenesis of diabetic eye disease.

Diabetic eye disease is the most common microvascular complication in the diabetic population and remains a leading cause of blindness among working-age adults in the developed world. The recent introduction of therapies targeting the vascular permeability factor and angiogenic mediator vascular endothelial growth factor (VEGF) has had a profound impact on the treatment of patients with diabetic eye disease. Clinical trials assessing the efficacy of anti-VEGF therapies have demonstrated a response to treatment in most patients with diabetic macular edema (DME). However, whether or not patients respond to anti-VEGF therapy, they require multiple (monthly) treatments, and most will have persistent DME despite aggressive therapy.1 A major improvement in visual acuity (ie, a gain of at least 15 letters—or 3 lines—on the Early Treatment Diabetic Retinopathy Study visual acuity chart) is observed in only a minority (approximately 40%) of treated patients with DME.1 While vision improvement in these clinical trials may be limited by a ceiling effect in those patients who have a relatively modest reduction of baseline (pretreatment) visual acuity, these results suggest that anti-VEGF therapy alone may not be sufficient to adequately treat DME in some diabetic patients.

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