Release Date: 2023-09-14

Current Treatment Approach to Diabetic Retinopathy

Ali Kucukoduk (Author), Fatih Kaya (Author)

Release Date: 2023-09-14

The current treatment approach to diabetic retinopathy (DR) emphasizes early detection, aggressive management of risk factors, and timely intervention to prevent vision loss. Tight glycemic control remains foundational, as it significantly reduces the onset and progression of DR by minimizing microvascular damage. Regular ophthalmic screenings, including comprehensive dilated eye examinations, are crucial for early detection [...]

Media Type
    Buy from

    Price may vary by retailers

    Work TypeBook Chapter
    Published inCurrent Perspective on Diabetes Mellitus in Clinical Sciences
    First Page181
    Last Page193
    DOIhttps://doi.org/10.69860/nobel.9786053359111.16
    LanguageENG
    Page Count13
    Copyright HolderNobel Tıp Kitabevleri
    Licensehttps://nobelpub.com/publish-with-us/copyright-and-licensing

    The current treatment approach to diabetic retinopathy (DR) emphasizes early detection, aggressive management of risk factors, and timely intervention to prevent vision loss. Tight glycemic control remains foundational, as it significantly reduces the onset and progression of DR by minimizing microvascular damage. Regular ophthalmic screenings, including comprehensive dilated eye examinations, are crucial for early detection of retinal changes. For non-proliferative diabetic retinopathy (NPDR), management focuses on optimizing systemic control of blood pressure and lipids to slow progression. In cases of clinically significant macular edema (CSME), focal/grid laser photocoagulation and intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents have shown efficacy in reducing macular thickening and improving visual acuity. For proliferative diabetic retinopathy (PDR), prompt treatment with pan-retinal photocoagulation (PRP) is essential to reduce neovascularization and prevent complications such as vitreous hemorrhage or tractional retinal detachment. Surgical options like vitrectomy may be necessary in advanced cases. Individualized management plans tailored to the severity and specific characteristics of DR are critical to preserving vision and optimizing outcomes for diabetic patients.

    Ali Kucukoduk (Author)
    Assistant Professor, Karamanoglu Mehmetbey University
    https://orcid.org/0000-0001-8024-4758

    Fatih Kaya (Author)
    MD, Karamanoglu Mehmetbey University
    https://orcid.org/0000-0003-1827-5515

    • Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-86.

    • Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837-53.

    • Frank RN. Diabetic retinopathy. N Engl J Med. 2004;350(1):48-58.

    • Ruberte J, Ayuso E, Navarro M, Carretero A, Nacher V, Haurigot V, et al. Increased ocular levels of IGF-1 in transgenic mice lead to diabetes-like eye disease. J Clin Invest. 2004;113(8):1149-57.

    • Zhang L, Krzentowski G, Albert A, Lefebvre PJ. Risk of developing retinopathy in Diabetes Control and Complications Trial type 1 diabetic patients with good or poor metabolic control. Diabetes Care. 2001;24(7):1275-9.

    • Estacio RO, McFarling E, Biggerstaff S, Jeffers BW, Johnson D, Schrier RW. Overt albuminuria predicts diabetic retinopathy in Hispanics with NIDDM. Am J Kidney Dis. 1998;31(6):947-53.

    • Chung YR, Park SW, Choi SY, Kim SW, Moon KY, Kim JH, et al. Association of statin use and hypertriglyceridemia with diabetic macular edema in patients with type 2 diabetes and diabetic retinopathy. Cardiovasc Diabetol. 2017;16(1):4.

    • Kohner EM. Diabetic retinopathy and high blood pressure: defi ning the risk. Am J Hypertens. 1997;10(9 Pt 2):181s-3s.

    • Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387(10017):435-43.

    • Nathan DM, Bebu I, Hainsworth D, Klein R, Tamborlane W, Lorenzi G, et al. Frequency of Evidence- Based Screening for Retinopathy in Type 1 Diabetes. N Engl J Med. 2017;376(16):1507-16.

    • Davis MD, Fisher MR, Gangnon RE, Barton F, Aiello LM, Chew EY, et al. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study Report #18. Invest Ophthalmol Vis Sci. 1998;39(2):233-52.

    • Kilpatrick ES, Rigby AS, Atkin SL, Frier BM. Does severe hypoglycaemia infl uence microvascular complications in Type 1 diabetes? An analysis of the Diabetes Control and Complications Trial database. Diabet Med. 2012;29(9):1195-8.

    • Chew EY, Davis MD, Danis RP, Lovato JF, Perdue LH, Greven C, et al. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology. 2014;121(12):2443-51.

    • Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. Jama. 2007;298(8):902-16.

    • Perais J, Agarwal R, Evans JR, Loveman E, Colquitt JL, Owens D, et al. Prognostic factors for the development and progression of proliferative diabetic retinopathy in people with diabetic retinopathy. Cochrane Database Syst Rev. 2023;2(2):Cd013775.

    • Do DV, Han G, Abariga SA, Sleilati G, Vedula SS, Hawkins BS. Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2023;3(3):Cd006127.

    • Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. Bmj. 1998;317(7160):703-13.

    • Van Leiden HA, Dekker JM, Moll AC, Nijpels G, Heine RJ, Bouter LM, et al. Blood pressure, lipids, and obesity are associated with retinopathy: the hoorn study. Diabetes Care. 2002;25(8):1320-5.

    • Lyons TJ, Jenkins AJ, Zheng D, Lackland DT, McGee D, Garvey WT, et al. Diabetic retinopathy and serum lipoprotein subclasses in the DCCT/EDIC cohort. Invest Ophthalmol Vis Sci. 2004;45(3):910-8.

    • Praidou A, Harris M, Niakas D, Labiris G. Physical activity and its correlation to diabetic retinopathy. J Diabetes Complications. 2017;31(2):456-61.

    • Lee MY, Hsiao PJ, Huang JC, Hsu WH, Chen SC, Shin SJ. Association Between Metabolic Syndrome and Microvascular and Macrovascular Disease in Type 2 Diabetic Mellitus. Am J Med Sci. 2018;355(4):342-9.

    • Tan NYQ, Chew M, Tham YC, Nguyen QD, Yasuda M, Cheng CY, et al. Associations between sleep duration, sleep quality and diabetic retinopathy. PLoS One. 2018;13(5):e0196399.

    • Effects of aspirin treatment on diabetic retinopathy. ETDRS report number 8. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5 Suppl):757-65.

    • Chew EY, Klein ML, Murphy RP, Remaley NA, Ferris FL, 3rd. Effects of aspirin on vitreous/preretinal hemorrhage in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report no. 20. Arch Ophthalmol. 1995;113(1):52-5.

    • Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Ophthalmology. 1995;102(4):647-61.

    • ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S203-s15.

    • Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. Retinopathy in young-onset diabetic patients. Diabetes Care. 1985;8(4):311-5.

    • Krolewski AS, Warram JH, Rand LI, Christlieb AR, Busick EJ, Kahn CR. Risk of proliferative diabetic retinopathy in juvenile-onset type I diabetes: a 40-yr follow-up study. Diabetes Care. 1986;9(5):443-52.

    • Klein BE, Moss SE, Klein R. Effect of pregnancy on progression of diabetic retinopathy. Diabetes Care. 1990;13(1):34-40.

    • Effect of pregnancy on microvascular complications in the diabetes control and complications trial. The Diabetes Control and Complications Trial Research Group. Diabetes Care. 2000;23(8):1084-91.

    • Petrou P, Georgalas I, Giavaras G, Anastasiou E, Ntana Z, Petrou C. Early loss of pregnancy after intravitreal bevacizumab injection. Acta Ophthalmol. 2010;88(4):e136.

    • Ferris FL, 3rd. How effective are treatments for diabetic retinopathy? Jama. 1993;269(10):1290-1.

    • Bergerhoff K, Clar C, Richter B. Aspirin in diabetic retinopathy. A systematic review. Endocrinol Metab Clin North Am. 2002;31(3):779-93.

    • Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985;103(12):1796-806.

    • Elman MJ, Qin H, Aiello LP, Beck RW, Bressler NM, Ferris FL, 3rd, et al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology. 2012;119(11):2312-8.

    • Do DV, Nguyen QD, Khwaja AA, Channa R, Sepah YJ, Sophie R, et al. Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment. JAMA Ophthalmol. 2013;131(2):139-45.

    • Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fl uorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Early Treatment Diabetic Retinopathy Study Research Group. Arch Ophthalmol. 1995;113(9):1144-55.

    • Virgili G, Parravano M, Evans JR, Gordon I, Lucenteforte E. Anti-vascular endothelial growth factor for diabetic macular oedema: a network meta-analysis. Cochrane Database Syst Rev. 2018;10(10):Cd007419.

    • Dafer RM, Schneck M, Friberg TR, Jay WM. Intravitreal ranibizumab and bevacizumab: a review of risk. Semin Ophthalmol. 2007;22(3):201-4.

    • Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report no. 14. The Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987;27(4):239-53.

    • Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no. 3. The Early Treatment Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987;27(4):254-64.

    • Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1987;94(7):761-74.

    • Chew E, Strauber S, Beck R, Aiello LP, Antoszyk A, Bressler N, et al. Randomized trial of peribulbar triamcinolone acetonide with and without focal photocoagulation for mild diabetic macular edema: a pilot study. Ophthalmology. 2007;114(6):1190-6.

    • A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115(9):1447-9, 9.e1-10.

    • Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, et al. Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol. 2009;127(3):245-51.

    • Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010;117(6):1064-77.e35.

    • Mehta H, Hennings C, Gillies MC, Nguyen V, Campain A, Fraser-Bell S. Anti-vascular endothelial growth factor combined with intravitreal steroids for diabetic macular oedema. Cochrane Database Syst Rev. 2018;4(4):Cd011599.

    • Maturi RK, Glassman AR, Liu D, Beck RW, Bhavsar AR, Bressler NM, et al. Effect of Adding Dexamethasone to Continued Ranibizumab Treatment in Patients With Persistent Diabetic Macular Edema: A DRCR Network Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. 2018;136(1):29-38.

    • Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991;98(5 Suppl):766-85.

    • Sato Y, Kojimahara N, Kitano S, Kato S, Ando N, Yamaguchi N, et al. Multicenter randomized clinical trial of retinal photocoagulation for preproliferative diabetic retinopathy. Jpn J Ophthalmol. 2012;56(1):52-9.

    • Brown DM, Wykoff CC, Boyer D, Heier JS, Clark WL, Emanuelli A, et al. Evaluation of Intravitreal Afl ibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy: Results From the PANORAMA Randomized Clinical Trial. JAMA Ophthalmol. 2021;139(9):946-55.

    • Gross JG, Glassman AR, Jampol LM, Inusah S, Aiello LP, Antoszyk AN, et al. Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. Jama. 2015;314(20):2137-46.

    • Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study fi ndings. Ophthalmology. 1978;85(1):82-106.

    • Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) fi ndings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology. 1981;88(7):583-600.

    • Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol. 1990;108(7):958-64.

    • Ushida H, Kachi S, Asami T, Ishikawa K, Kondo M, Terasaki H. Infl uence of preoperative intravitreal bevacizumab on visual function in eyes with proliferative diabetic retinopathy. Ophthalmic Res. 2013;49(1):30- 6.

    • Antoszyk AN, Glassman AR, Beaulieu WT, Jampol LM, Jhaveri CD, Punjabi OS, et al. Effect of Intravitreous Afl ibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. Jama. 2020;324(23):2383-95.

    • Javitt JC, Aiello LP, Chiang Y, Ferris FL, 3rd, Canner JK, Greenfi eld S. Preventive eye care in people with diabetes is cost-saving to the federal government. Implications for health-care reform. Diabetes Care. 1994;17(8):909-17.

    • Javitt JC, Canner JK, Frank RG, Steinwachs DM, Sommer A. Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model. Ophthalmology. 1990;97(4):483-94; discussion 94-5.

    onix_3.0::thothThoth ONIX 3.0
    onix_3.0::project_museProject MUSE ONIX 3.0
    onix_3.0::oapenOAPEN ONIX 3.0
    onix_3.0::jstorJSTOR ONIX 3.0
    onix_3.0::google_booksGoogle Books ONIX 3.0
    onix_3.0::overdriveOverDrive ONIX 3.0
    onix_2.1::ebsco_hostEBSCO Host ONIX 2.1
    csv::thothThoth CSV
    json::thothThoth JSON
    kbart::oclcOCLC KBART
    bibtex::thothThoth BibTeX
    doideposit::crossrefCrossRef DOI deposit
    onix_2.1::proquest_ebraryProQuest Ebrary ONIX 2.1
    marc21record::thothThoth MARC 21 Record
    marc21markup::thothThoth MARC 21 Markup
    marc21xml::thothThoth MARC 21 XML

    Share This Chapter!