From the Guidelines
Patients with diabetic retinopathy should be promptly referred to an ophthalmologist for treatment, which may include intravitreous injections of anti–vascular endothelial growth factor or panretinal laser photocoagulation therapy, depending on the severity of the condition. The management of diabetic retinopathy involves a comprehensive approach, including regular eye exams, controlling underlying conditions like diabetes or hypertension, and specific interventions based on severity 1. For diabetic retinopathy, medications such as anti-VEGF injections (ranibizumab, aflibercept, or bevacizumab) may be administered directly into the eye every 4-6 weeks initially 1.
Key Treatment Considerations
- Controlling blood glucose levels (aiming for HbA1c below 7%) is essential for preventing progression 1.
- Managing blood pressure (target below 130/80 mmHg) and maintaining healthy cholesterol levels are also crucial 1.
- Laser photocoagulation can seal leaking blood vessels, while more advanced cases might require vitrectomy surgery to remove blood or scar tissue 1.
- Regular follow-up appointments are crucial, typically every 3-12 months depending on severity, to monitor progression and adjust treatment as needed 1.
Emerging Therapies and Recommendations
- Other emerging therapies for retinopathy that may use sustained intravitreal delivery of pharmacologic agents are currently under investigation 1.
- The FDA approved ranibizumab for the treatment of diabetic retinopathy in 2017, highlighting the importance of anti-VEGF therapy in managing the condition 1.
- Current data from well-designed clinical trials demonstrate that intravitreal anti-VEGF agents provide a more effective treatment regimen for central-involved diabetic macular edema than monotherapy or even combination therapy with a laser 1.
From the Research
Types of Retinopathy
- Diabetic retinopathy (DR) is a common cause of vision loss worldwide, resulting from abnormal permeability and occlusion of the retinal vasculature, with ischemia and subsequent neovascularization 2, 3
- Radiation retinopathy is a chronic, progressive, vision-threatening complication from exposure to various radiation sources 4
- Mitochondrial retinopathy is associated with genetic and systemic findings, including chronic progressive external ophthalmoplegia (CPEO), maternally inherited diabetes and deafness (MIDD), and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) 5
Treatment and Management
- Specific treatment options for diabetic retinopathy include intravitreal administration of anti-vascular endothelial growth factor (VEGF) agents or corticosteroids, laser photocoagulation, and vitreous surgery 2
- Treatment modalities for radiation retinopathy are available, but proper management is a continuing challenge with no consensus on the most efficacious 4
- Ginkgo biloba extracts may be a good option to improve certain neurodegenerative retinal diseases, but more research is needed to determine the safety and efficacy of G. biloba in these retinal degenerative processes 6