From the Guidelines
The first line treatment for diabetic retinopathy is intravitreous injections of anti-vascular endothelial growth factor (anti-VEGF) for most eyes with diabetic macular edema that involves the foveal center and impairs vision acuity, as well as for proliferative diabetic retinopathy, based on the most recent evidence from 2024 1.
Key Considerations
- For non-proliferative diabetic retinopathy without macular edema, regular monitoring every 6-12 months is recommended rather than immediate intervention.
- Anti-VEGF injections, such as ranibizumab (Lucentis), aflibercept (Eylea), or bevacizumab (Avastin), are the preferred initial treatments for diabetic macular edema, typically administered monthly until stabilization occurs.
- Panretinal photocoagulation (PRP) laser therapy remains a standard treatment for proliferative diabetic retinopathy, though anti-VEGF injections are increasingly used as first-line therapy in many cases.
Management Approach
- Optimizing glycemic control through careful management of blood glucose levels, aiming for a target HbA1c of less than 7.0% through appropriate medication, diet, and lifestyle modifications.
- Controlling other risk factors, including maintaining blood pressure below 130/80 mmHg and managing lipid levels with appropriate medications.
Evidence Basis
- The 2024 standards of care in diabetes 1 support the use of anti-VEGF injections as first-line treatment for most eyes with diabetic macular edema and proliferative diabetic retinopathy.
- The 2025 standards of care in diabetes 1 also discuss the benefits of panretinal photocoagulation for high-risk proliferative diabetic retinopathy, but this is now largely considered a second-line treatment for diabetic macular edema.
Clinical Decision Making
- The choice of treatment should be individualized based on the patient's specific condition, including the severity of diabetic retinopathy and the presence of macular edema.
- Regular monitoring and follow-up are essential to adjust treatment as needed and prevent vision loss.
From the FDA Drug Label
The provided drug labels do not directly address the first-line treatment for diabetic retinopathy. The FDA drug label does not answer the question.
From the Research
Treatment Options for Diabetic Retinopathy
The first line treatment for diabetic retinopathy depends on the stage and severity of the disease.
- For non-proliferative diabetic retinopathy (NPDR) without diabetic macular edema (DME), the standard of care has been a wait-and-watch approach 2.
- However, recent studies have shown that early intervention with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections may be beneficial in improving the diabetic retinopathy severity scale (DRSS) and reducing vision-threatening complications of DR 3, 4.
- For proliferative diabetic retinopathy (PDR) without DME, panretinal photocoagulation (PRP) is the established standard of care 5, 2.
- Anti-VEGF treatment has also been shown to be effective in regressing neovascularization and improving DRSS levels in patients with PDR 2.
Key Considerations
- Tight glycemic and blood pressure control remains the cornerstone in the primary prevention of diabetic retinopathy 5.
- The choice of treatment should be tailored to the individual patient, taking into account the severity of the disease, the presence of DME, and other factors 2.
- Further studies are needed to determine the optimal treatment frequency, duration, and retreatment criteria for anti-VEGF treatment in patients with diabetic retinopathy 2.