Diabetic Retinopathy Management

The 2017 American Diabetes Association (ADA) Position Statement on Diabetic Retinopathy notes that diagnostic assessment and treatment options have improved dramatically since the 2002 ADA Position Statement.1 These improvements include the widespread adoption of optical coherence tomography (OCT) to assess retinal thickness and intraretinal pathology and wide-field fundus photography to reveal clinically silent microvascular lesions.1

Macular photocoagulation was demonstrated as a treatment for clinically significant macular edema (CSME) by the Early Treatment Diabetic Retinopathy Study (ETDRS) in 1985 and is considered to be a standard of care for diabetic macular edema (DME)2-6 and is useful in patients with PDR and high-risk characteristics.1 However, a substantial group of patients are unresponsive and fail to improve after laser photocoagulation.2-4 Clinical trials using intravitreal pharmacotherapies have reported many favorable outcomes for DME. (see next section for more description)

Treatment of DME is now achieved by intravitreous injection of anti–vascular endothelial growth factor (VEGF) agents, and the same agents are now used for PDR;1 some of which are being studied in NPDR patients, as well.

References

  1. Solomon SD, Chew E, Duh EJ, et al [2017 ADA Position Statement]. Diabetic retinopathy: A position statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412–418.
  2. Bandello F, Casalino G, Loewenstein A, Goldstein M, Pelayes D, Battaglia Parodi M. Pharmacological approach to diabetic macular edema. Ophthalmic Res. 2014;51:88-95.
  3. Ford JA, Lois N, Royle P, Clar C, Shyangdan D, Waugh N. Current treatments in diabetic macular oedema: systematic review and meta-analysis. BMJ Open. 2013;3:e002269.
  4. Thomas BJ, Shienbaum G, Boyer DS, Flynn Jr HW. Evolving strategies in the management of diabetic macular edema: clinical trials and current management. Can J Ophthalmol. 2013;48:22-30.
  5. Lim JI. Unmet needs in diabetic macular edema. US Ophthalmic Rev. 2011;4(1):101-104.
  6. Tarr JM, Kaul K, Kohner EM, Chibber R. Diabetic retinopathy: major unmet medical challenge. Endocrinol Studies. 2011;1(e7):28-36.
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Clinician Scientific & Educational Resources

The RELIEF Clinical Toolkit is an online tool that aims to provide clinicians with up-to-date information on the presentation, prognosis, pathophysiology, and treatment strategies for diabetic retinopathy (DR) in patients with diabetes who have or are at risk for developing DR. Click on one of the options below to learn more about DR.

This activity is provided by Med Learning Group. This activity is co-provided by Ultimate Medical Academy/CCM.
This activity is supported by an educational grant from Regeneron Pharmaceuticals, Inc.

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Scientific Council

Neil M. Bressler, MD

James P. Gills Professor of Ophthalmology
Professor of Ophthalmology, Johns Hopkins University School of Medicine
Wilmer Eye Institute, Johns Hopkins Medicine
Baltimore, MD

A. Paul Chous, MA, OD, FAAO

Specializing in Diabetes Eye Care & Education, Chous Eye Care Associates
Adjunct Professor of Optometry, Western University of Health Sciences
AOA Representative, National Diabetes Education Program
Tacoma, WA

Steven Ferrucci, OD, FAAO

Chief of Optometry, Sepulveda VA Medical Center
Professor, Southern California College of Optometry at Marshall B. Ketchum University
Sepulveda, CA

Julia A. Haller, MD

Ophthalmologist-in-Chief
Wills Eye Hospital
Philadelphia, PA

Allen C. Ho, MD, FACS

Director, Retina Research
Wills Eye Hospital
Professor and Chair of the Department of Ophthalmology
Thomas Jefferson University Hospitals
Philadelphia, PA

Charles C. Wykoff, MD, PhD

Director of Research, Retina Consultants of Houston
Associate Professor of Clinical Ophthalmology
Blanton Eye Institute & Houston Methodist Hospital
Houston, TX