From the Guidelines
Diabetic retinopathy treatment is indicated when the condition progresses to either proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME), as these stages threaten vision, and the most recent guidelines from 2025 support prompt referral to an ophthalmologist for any level of macular edema, severe nonproliferative diabetic retinopathy, or any PDR 1. The primary indications for treatment include:
- Proliferative diabetic retinopathy (PDR) characterized by abnormal blood vessel growth
- Diabetic macular edema (DME) that affects the central macula
- Neovascularization of the disc or elsewhere in the retina
- Vitreous hemorrhage
- Retinal detachment
- Central-involved macular edema with decreased visual acuity The primary treatments include:
- Laser photocoagulation (panretinal for PDR, focal/grid for DME)
- Intravitreal anti-VEGF injections (ranibizumab, aflibercept, or bevacizumab) typically given monthly initially
- Vitrectomy surgery for complications like persistent vitreous hemorrhage or tractional retinal detachment Intravitreal steroid implants (dexamethasone or fluocinolone) may be used for DME in select cases, as supported by recent guidelines 1. Early treatment is crucial as diabetic retinopathy damage is often irreversible, and the underlying mechanism involves vascular damage from chronic hyperglycemia, leading to ischemia and pathologic angiogenesis, which is why strict glycemic control (HbA1c <7%), blood pressure management, and lipid control are essential adjunctive measures to reduce progression, as emphasized in recent studies 1. It's also important to note that the presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as aspirin does not increase the risk of retinal hemorrhage, according to recent findings 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE EYLEA is indicated for the treatment of:
1.4 Diabetic Retinopathy (DR) The indications for treating diabetic retinopathy include the use of aflibercept (IV), as stated in the drug label 2.
- The drug EYLEA is specifically indicated for the treatment of Diabetic Retinopathy (DR).
- Diabetic Retinopathy is a direct indication for the use of this medication.
From the Research
Indications for Treating Diabetic Retinopathy
The indications for treating diabetic retinopathy include:
- Nonproliferative diabetic retinopathy (NPDR) with macular edema 3, 4, 5
- Proliferative diabetic retinopathy (PDR) 4, 5
- Diabetic macular edema (DME) 3, 4, 6, 7
- Vision-threatening macular edema 3
Treatment Options
Treatment options for diabetic retinopathy include:
- Intraocular injections of anti-vascular endothelial growth factor (VEGF) antibodies (e.g. ranibizumab, aflibercept, bevacizumab) 3, 4, 6, 7
- Laser treatments 4, 5
- Vitrectomy 5
Patient Selection
Patient selection for treatment is based on the severity of the disease, with patients having moderately severe or severe nonproliferative DR and macular edema being more likely to benefit from treatment 3.
Clinical Trial Data
Clinical trial data have shown that intraocular inhibition of VEGF is a rational approach for the management of DR, with approximately one-third of patients with DR and macular edema experiencing a clinically significant improvement after 1 year of treatment with either ranibizumab or aflibercept 3.