Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Aug 25, 2016; 7(16): 333-341
Published online Aug 25, 2016. doi: 10.4239/wjd.v7.i16.333
Treatment of diabetic retinopathy: Recent advances and unresolved challenges
Michael W Stewart
Michael W Stewart, Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Author contributions: The author solely contributed to this paper.
Conflict-of-interest statement: Allergan: Advisory Board, Institutional research support; Boehringer-Ingelheim: Consultant; Momenta Pharmaceuticals: Consultant; Regeneron: Advisory Board, Institutional research support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Michael W Stewart, MD, Department of Ophthalmology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, United States.
Telephone: +1-904-9532232 Fax: +1-904-9537040
Received: February 16, 2016
Peer-review started: February 17, 2016
First decision: April 15, 2016
Revised: May 8, 2016
Accepted: July 11, 2016
Article in press: July 13, 2016
Published online: August 25, 2016

Diabetic retinopathy (DR) is the leading cause of blindness in industrialized countries. Remarkable advances in the diagnosis and treatment of DR have been made during the past 30 years, but several important management questions and treatment deficiencies remain unanswered. The global diabetes epidemic threatens to overwhelm resources and increase the incidence of blindness, necessitating the development of innovative programs to diagnose and treat patients. The introduction and rapid adoption of intravitreal pharmacologic agents, particularly drugs that block the actions of vascular endothelial growth factor (VEGF) and corticosteroids, have changed the goal of DR treatment from stabilization of vision to improvement. Anti-VEGF injections improve visual acuity in patients with diabetic macular edema (DME) from 8-12 letters and improvements with corticosteroids are only slightly less. Unfortunately, a third of patients have an incomplete response to anti-VEGF therapy, but the best second-line therapy remains unknown. Current first-line therapy requires monthly visits and injections; longer acting therapies are needed to free up healthcare resources and improve patient compliance. VEGF suppression may be as effective as panretinal photocoagulation (PRP) for proliferative diabetic retinopathy, but more studies are needed before PRP is abandoned. For over 30 years laser was the mainstay for the treatment of DME, but recent studies question its role in the pharmacologic era. Aggressive treatment improves vision in most patients, but many still do not achieve reading and driving vision. New drugs are needed to add to gains achieved with available therapies.

Keywords: Aflibercept, Bevacizumab, Dexamethasone delivery system, Diabetic macular edema, Ranibizumab, Macular photocoagulation, Panretinal photocoagulation, Proliferative diabetic retinopathy, Diabetic retinopathy, Fluocinolone acetonide insert

Core tip: Newly introduced pharmacotherapies have contributed significantly to the treatment of diabetic retinopathy over the past 10 years and have become first-line therapy. Several questions regarding the best management of certain diabetic conditions remain and new therapies are needed to improve outcomes. Ongoing research and development should address many of these issues over the next 10 years.