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 best approach to managing it is through prevention by maintaining tight glucose control, 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, potentially causing severe vision loss.
Risk Factors and Symptoms
Risk factors for diabetic retinopathy include poor blood sugar control, high blood pressure, high cholesterol, longer duration of diabetes, and smoking. Symptoms often don't appear until the condition is advanced and may include:
- Blurry vision
- Floaters
- Dark spots
- Difficulty perceiving colors
- Vision loss
Management and Treatment
Management focuses on controlling blood sugar levels (maintaining HbA1c below 7%), blood pressure (below 130/80 mmHg), and cholesterol. Regular eye exams are crucial—annually for most diabetics, but more frequently if retinopathy is present. Treatment options include:
- Laser therapy to seal leaking vessels or remove abnormal ones
- Anti-VEGF injections like ranibizumab (Lucentis) or aflibercept (Eylea) to reduce vessel growth and swelling
- Steroid injections to decrease inflammation
- Vitrectomy surgery for advanced cases
Prevention and Recommendations
The most recent guidelines recommend implementing strategies to help people with diabetes reach glycemic goals to reduce the risk or slow the progression of diabetic retinopathy 1. Additionally, optimizing blood pressure and serum lipid control is also crucial in reducing the risk or slowing the progression of diabetic retinopathy 1. Effective communication and care coordination among healthcare practitioners are necessary to optimize care for patients with diabetic retinopathy 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 Causes of Diabetic Retinopathy
- Diabetic retinopathy (DR) is a common microvascular complication of diabetes that damages the retina, leading to blindness 3.
- It is caused by chronic hyperglycemia, which destroys the blood vessels in the retina, resulting in leakage of fluid and blood into the retina, causing edema, hemorrhages, and ischemia 4.
- The risk factors for the onset and progression of diabetic retinopathy include hypertension, obesity, smoking, duration of diabetes, and genetics 3.
Types of Diabetic Retinopathy
- Diabetic retinopathy may be divided into two primary categories: Proliferative diabetic retinopathy (PDR) and non-proliferative diabetic retinopathy (NPDR) 3.
- Proliferative diabetic retinopathy is a major cause of sight loss in people with diabetes, with a high risk of vitreous haemorrhage, tractional retinal detachment, and other complications 5, 6.
Treatment Options for Diabetic Retinopathy
- Laser photocoagulation and Anti-vascular endothelial growth factor (Anti-VEGF) injections are advised as favorable therapies in severe retinopathy 3.
- Anti-VEGF therapy has been shown to be slightly better than panretinal photocoagulation at preventing vision loss, measured as best corrected visual acuity, at up to 2 years follow-up 5.
- Anti-VEGF therapy may have greater benefits for preventing complications such as macular oedema and vitreous haemorrhage 5, 6.
- Surgical treatment options, including vitrectomy, scleral buckling, epiretinal membrane peeling, and retinal detachment repair, can help to address the underlying causes of vision loss and prevent further complications from developing or worsening 4.
Prevention and Management of Diabetic Retinopathy
- More physical activity and less sedentary behavior have been 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.
- Regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy 7.
- Adequate control of blood glucose and blood pressure levels can greatly reduce the incidence or progression of potentially blinding complications 7.