The Clinical Management of Diabetic Retinopathy

The diagnosis of diabetic retinopathy carries several negative implications. The disease may lead to loss of visual acuity and blindness and is often associated with the systemic complications of diabetes (eg, nephropathy and neuropathy), in addition to hypertension and hyperlipidemia. Individually, each of these conditions is detrimental to the patient’s health, but they can also worsen retinopathy. Therefore, not only is it important to screen, diagnose, and treat diabetic retinopathy, it is also important to screen, diagnose, and treat the comorbid conditions. The complexity of dealing with these comorbid conditions has led to recommendations for routine, multidisciplinary, team-based diabetes care. Landmark studies have demonstrated the benefit of blood glucose management in preventing and treating diabetic retinopathy. Clinical studies also support the benefit of treating hypertension and hyperlipidemia in reducing progression of the disease. Evidence from the Diabetic Retinopathy Study, the Early Treatment Diabetic Retinopathy Study, and the Diabetic Retinopathy Vitrectomy Study has provided insight into how best to use effective interventions, such as photocoagulation and vitrectomy, in patients with significant diabetic retinopathy, diabetic macular edema, vitreous hemorrhage, and diabetic traction retinal detachments. Meanwhile, research continues for pharmacologic interventions that prevent or interfere with the pathogenesis of diabetic retinopathy, including vascular endothelial growth factor inhibitors (eg, pegaptanib), protein kinase C-β inhibitors (eg, ruboxistaurin), intravitreal triamcinolone acetonide, pigment-epithelium–derived factor, and growth hormone release inhibition. (Adv Stud Med. 2004;4(9A):S702-S713)