New technologies and drugs in the management of diabetic retinopathy

Diabetic retinopathy remains one of the most common and most feared causes of blindness and visual impairment in adults of working age despite the availability of effective treatment for more than 30 years. Sight-threatening diabetic retinopathy consists of two distinct clinical entities: proliferative diabetic retinopathy (PDR) and diabetic macular oedema (DMO or maculopathy) which may coexist, both of which can be detected by clinical or photographic screening before vision is affected, thereby allowing treatment to be offered before visual impairment has developed. Laser photocoagulation has been the mainstay of treatment of PDR and DMO since landmark studies in the 1980s proved its effectiveness. The more recent elucidation of the role of vascular endothelial growth factor (VEGF) in the pathogenesis of both types of diabetic retinopathy, and the ability to specifically inhibit VEGF effects by the intraocular injection of blocking agents offer new options of non-destructive treatment with better visual outcomes than laser. Diabetic macular oedema may also respond to intraocular steroid therapy, and the development of slow-release delivery systems can now provide drug delivery for three years from a single injection. The assessment of DMO has been revolutionised by non-invasive imaging with ocular coherence tomography (OCT) which allows microscopic visualisation of macular detail and serial quantitative measurement of the structural response to treatment. These new therapeutic options are improving visual outcomes for DMO, but are also creating enormous logistical problems for both patients and eye clinics as they are much more demanding in terms of frequent clinic visits and use of ophthalmology imaging services than conventional but less effective laser treatment. Copyright © 2014 John Wiley & Sons. Practical Diabetes 2014; 31(7): 275–280