Diabetic retinopathy: Battling the global epidemic.

Abstract

In 1969, William Beetham published his work in the journal, Transactions of the American Ophthalmological Society about the efficacy of ruby laser in patients with proliferative diabetic retinopathy (PDR).[1] Encouraged by these findings, the Diabetic Retinopathy Study, a National Institute of Health-sponsored landmark clinical trial confirmed the benefits of the panretinal photocoagulation (PRP) laser in PDR patients. Since then, the argon PRP laser became the main-stay treatment in these patients. In the same paper, the authors attributed the successful results to the “reduction in the functioning retina., or the vasoformative factor, or both.” Later this vasoformative factor proved to be vascular endothelial growth factor (VEGF) and was targeted in many clinical trials in different retinal diseases. Almost four decades later, another landmark clinical trial, Diabetic Retinopathy Clinical Research Network just published that monthly anti-VEGF injections are no inferior to the gold standard PRP laser treatment and have the advantages of no visual field loss seen with the PRP laser.[2] Thus, we have now two effective evidence-based treatments available for regression of retinal neovascularization in PDR patients. Many other large randomized trials in diabetic retinopathy (DR) in between have taught us how to treat DR patients effectively in DME, PDR, and even in early stages of DR. Ophthalmologists have now several novel drugs including anti-VEGF drugs and steroid implants available in their armamentarium for treating patients with DME and PDR. Many more drugs are in the pipeline in different phases of clinical trials.