Fourth annual ophthalmic drug development and delivery summit and third annual onmark national payor/provider forum.

tissues in the eye may also be affected. Diabetic retinopathy can be nonproliferative or proliferative. The nonproliferative type is associated with micro aneurysms, hemorrhages, diabetic macular edema (DME), and hard exudates. The proliferative type is characterized by new blood vessel formation and fibrous tractional bands that are formed from the optic disc. Conventional treatment targets glycemic control. Some evidence suggests a risk of worsening retinopathy with antihyperglycemic agents (along with the threat of hypoglycemic episodes and diabetic ketoacidosis), but glycemic control is the one approach with proven benefit. A reduction in retinal microaneurysms has also been observed with aspirin in combination with dipyridamole (Aggrenox, Boehringer Ingelheim) or ticlopidine (Ticlid, Roche). Clinical research has confirmed the efficacy of laser treatments and surgical vitrectomy. Vitrectomy is indicated for vitreous hemorrhage and proliferative diabetic retinopathy. For some patients, vitrectomy can improve vision; it has also been effective for some individuals with DME that has been refractory to laser treatments. Steady advances in surgical techniques are widening the number of indications. For patients with severe nonproliferative or proliferative retinopathy, pan-retinal photocoagulation has become the standard of care. Treating the associated DME with 1,500 laser burns preserves vision for many, but the method is not without hazards. Among potential risks of adverse events are constriction of the visual field, night blindness, changes in color vision, misplaced laser burns that exacerbate DME, acute glaucoma, and traction retina detachment. Dr. Edelman said, however, “Despite all these risks, it is still the benchmark.” The list of pharmacological agents that have been tested in diabetic retinopathy is extensive. Aldose reductase inhibitors showed no significant effects on endpoints or progression. The protein kinase C inhibitor ruboxistaurin (Eli Lilly) reduced the risk of vision loss, but the benefit was modest. Insulin-like growth factor (IGF)–inhibiting microspheres Mr. Alexander is a freelance medical writer living in New York City. Fourth Annual Ophthalmic Drug Development and Delivery Summit