From the Guidelines
Diabetic retinopathy is a serious eye condition that affects people with diabetes and is the leading cause of blindness in working-age adults, and the most effective way to manage it is by controlling blood sugar, blood pressure, and cholesterol levels, as well as regular eye exams and timely treatment with laser therapy, anti-VEGF injections, or vitrectomy surgery, as recommended by the most recent guidelines 1.
Overview of Diabetic Retinopathy
Diabetic retinopathy occurs when high blood sugar levels damage the blood vessels in the retina, causing them to leak fluid or bleed, which distorts vision. There are two main stages: non-proliferative diabetic retinopathy (early stage) where blood vessels weaken and may leak, and proliferative diabetic retinopathy (advanced stage) where new, abnormal blood vessels grow on the retina's surface. Symptoms often don't appear until the condition is advanced and may include:
- Blurry vision
- Floaters
- Dark spots
- Difficulty seeing at night
- Eventually vision loss if untreated
Risk Factors
Risk factors for diabetic retinopathy include:
- Poor blood sugar control
- High blood pressure
- High cholesterol
- Longer diabetes duration
- Smoking
Management
Management of diabetic retinopathy focuses on:
- Controlling blood sugar (maintaining HbA1c below 7%) 1
- Controlling blood pressure (below 130/80 mmHg) 1
- Controlling cholesterol levels through medication and lifestyle changes
- Regular eye exams, which should be done annually for most diabetics or more frequently if retinopathy is present 1
Treatment Options
Treatment options for diabetic retinopathy include:
- Laser therapy to seal leaking vessels
- Anti-VEGF injections like bevacizumab (Avastin), ranibizumab (Lucentis), or aflibercept (Eylea) to reduce abnormal vessel growth
- Steroid injections to decrease inflammation
- Vitrectomy surgery for advanced cases Early detection through regular screening is vital as treatment is most effective before symptoms develop and vision loss occurs, as supported by the latest research 1.
From the FDA Drug Label
In Studies D-1 and D-2, patients received monthly ranibizumab 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections during the 24-month controlled treatment period. All enrolled patients in Studies D-1 and D-2 had DR and DME at baseline. Study D-3 enrolled DR patients with and without DME; 88 (22%) eyes with baseline DME and 306 (78%) eyes without baseline DME and balanced across treatment groups At baseline, 62% of patients had non-proliferative diabetic retinopathy (NPDR) (ETDRS-DRSS less than 60) and 31% had proliferative diabetic retinopathy (PDR) (ETDRS-DRSS greater than or equal to 60) After monthly treatment with ranibizumab 0. 3 mg, the following clinical results were observed: Table 7 ≥3-Step and ≥2-Step Improvement at Month 24 in Study D-1 and Study D-2 Outcome Measure | Study* | Sham | Ranibizumab 0.3 mg | Estimated Difference (95% CI)† ≥3-step improvement from baseline | D-1: Sham, n=124; | 2% | 17% | 15% (7%, 22%) in ETDRS-DRSS | ranibizumab 0.3 mg, n=117 | | | | D-2: Sham, n=115; | 0% | 9% | 9% (4%, 14%) | ranibizumab 0.3 mg, n=117 | | | ≥2-step improvement from baseline | D-1: Sham, n=124; | 4% | 39% | 35% (26%, 44%) in ETDRS-DRSS | ranibizumab 0.3 mg, n=117 | | | | D-2: Sham, n=115; | 7% | 37% | 31% (21%, 40%) | ranibizumab 0.3 mg, n=117 | | |
Diabetic Retinopathy (DR) is a condition where patients have damage to the blood vessels in the retina due to diabetes.
- Non-proliferative diabetic retinopathy (NPDR) is an early stage of DR where the blood vessels in the retina become weakened and start to leak.
- Proliferative diabetic retinopathy (PDR) is a more advanced stage of DR where new, fragile blood vessels grow in the retina and can cause vision loss. The ETDRS-DRSS is a scale used to measure the severity of DR, ranging from 10 to 75. In Studies D-1 and D-2, patients with DR and DME were treated with monthly ranibizumab 0.3 mg or 0.5 mg intravitreal injections or monthly sham injections. The results showed that after monthly treatment with ranibizumab 0.3 mg, there was a significant improvement in DR severity, with 17% of patients achieving a ≥3-step improvement and 39% achieving a ≥2-step improvement in ETDRS-DRSS at Month 24. These results suggest that ranibizumab 0.3 mg can be effective in improving DR severity in patients with DR and DME 2.
From the Research
Definition and Classification of Diabetic Retinopathy
- Diabetic retinopathy (DR) is a microvascular complication of diabetes that damages the retina, leading to blindness 3.
- It can be divided into two primary categories: Proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) 3.
Risk Factors for Diabetic Retinopathy
- Risk factors for the onset and progression of diabetic retinopathy include hypertension, obesity, smoking, duration of diabetes, and genetics 3.
- People with type 1 diabetes are at greater risk of developing DR than people with type 2 diabetes 3.
Pathophysiology of Diabetic Retinopathy
- The vitreous fluid in diabetic retinopathy exhibits rises in angiogenic factors like platelet-derived growth factor (PDGF) or vascular endothelial growth factor (VEGF) or declines in antiangiogenic factors like pigment epithelium-derived factor (PEDF) 3.
- VEGF plays a pivotal role in the retinal microvascular complications of diabetes, making it a target for therapeutic intervention in diabetic retinopathy 4.
Prevention and Treatment of Diabetic Retinopathy
- More physical activity and less sedentary behavior are linked to a reduced likelihood of DR 3.
- Supplementing with nutraceuticals containing vitamins and minerals can help decrease or avoid an outbreak of DR 3.
- Laser photocoagulation and Anti-vascular endothelial growth factor (Anti-VEGF) injections are advised as favorable therapies in severe retinopathy 3, 5.
- Anti-VEGF therapy is slightly better than panretinal photocoagulation at preventing vision loss, and superior to panretinal photocoagulation at preventing macular oedema and vitreous haemorrhage 5.
Surgical Treatment Options for Diabetic Retinopathy
- Surgical treatment options for diabetic retinopathy include vitrectomy, scleral buckling, epiretinal membrane peeling, and retinal detachment repair 6.
- These surgical techniques can help to address the underlying causes of vision loss and prevent further complications from developing or worsening 6.