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Milluzzo et al. Metab Target Organ Damage 2024;4:5 https://dx.doi.org/10.20517/mtod.2023.43 Page 11 of 14

dose, the extent and reversibility of symptoms, and the need to discontinue the cancer therapy, the latter
representing a difficult choice considering the life-saving role of these treatments. Future research should
also address the detection of clinical and easily available predictors of retinal damage in order to carry out,
mostly in subjects particularly at risk, a careful retinal evaluation before and after starting cancer therapies.
In fact, early diagnosis is essential to prevent the progression of retinal damage and related visual
impairment.

The management of these patients is often uncoordinated and too compartmentalised. The clinical
complexity and comorbidities of cancer subjects also affected by diabetes make necessary a patient-centred,
personalised approach that must involve multiple healthcare professionals organised in a multidisciplinary
team (MDT) [Figure 1]. A similar approach, based on periodic, usually weekly, meetings, already exists in
medical centres with a huge volume of patients. Oncologists, ophthalmologists, diabetologists, and
pharmacologists should work in a coordinated team, sharing intervention strategies, in order to optimise
human and economic resources, achieve the best clinical results, and minimize the ocular burden, visual
loss, and subject’s quality of life impairment.

Figure 1. Schematic representation of the network for the prevention and management of retinal adverse outcomes in subjects with
diabetes treated with anticancer drugs. Diabetologists and oncologists, the leading figures of the team, collaborate with
ophthalmologists and pharmacologists to prevent or treat retinal injury related to cancer therapies, in order to mitigate visual
impairment and loss.

DECLARATIONS
Authors’ contribution
Conceived the study: Milluzzo A, Sciacca L
Researched references Milluzzo A, Manuella L
Wrote, reviewed/edited the manuscript draft, contributed to manuscript revision, and approved the
submitted version: Milluzzo A, Manuella L, Frittitta L, Sciacca L

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.