Addressing the challenges of DMO management by identifying structural and functional markers of progression or response to treatment

Abstract

Diabetic Retinopathy (DR) and maculopathy are the leading causes of vision loss worldwide, yet early detection and effective monitoring remain challenging. This PhD project assessed the utility of the most used psychophysical tests to discriminate between DR severity, monitor change over time or detect response to treatment in patients receiving anti-vascular endothelial growth factor (anti-VEGF) in Chapter 2. Chapter 3 dives into the potential of psychophysical tests to serve as sensitive tools for monitoring and predicting the prognosis of DR using retinal structural parameters and function. It includes developing a grading system to detect the most subtle structural changes in retinal images so that how these relate to visual function can be explored. The focus extends further in Chapter 4 to assess how these tests can evaluate short-term responses to anti-VEGF treatments. In Chapter 3 & 4, diabetic macular oedema (DMO) development or persistence was examined to investigate the effects of progression and anti-VEGF therapy on the retinal structure using spectral domain optical coherence tomography (SD-OCT), and the oxygen saturation in retinal vessels using the Oximetry, alongside the patients' visual function by measuring visual acuity, contrast sensitivity, and retinal sensitivity. While we recognise the importance of monitoring patients’ visual function, we also explore the possibility of deploying visual function testing. Therefore, Chapter 5 sought evidence of patients’ acceptability to use a hypothetical visual function home monitoring (HM) app. By positing a hypothetical app, a questionnaire was refined and deployed to explore patients’ perception of using such technology, revealing several concerns that need to be considered in building the HM app before implementation for DR management. Overall, this project sought to respond to DR/DMO management by exploring the utility of visual function assessment in potentially improving the clinical management and enhancing early detection, monitoring, and prediction of DMO complications.

Date of Award	Jul 2025
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	King Saud University
Supervisor	Ruth Hogg (Supervisor) & Tunde Peto (Supervisor)