Dr. Diva Kant Misra

Diabetic retinopathy is the most frequently occurring complication of diabetes mellitus and remains a leading cause of vision loss globally. Its aetiology and pathology have been extensively studied for half a century, yet there are disappointingly few therapeutic options. Although some new treatments have been introduced for diabetic macular oedema (DMO) (e.g. intravitreal vascular endothelial growth factor inhibitors (‘anti-VEGFs’) and new steroids), up to 50% of patients fail to respond. Furthermore, for people with proliferative diabetic retinopathy (PDR), laser photocoagulation remains a mainstay therapy, even though it is an inherently destructive procedure.

This review summarises the clinical features of diabetic retinopathy and its risk factors. It describes details of retinal pathology and how advances in our understanding of pathogenesis have led to identification of new therapeutic targets. We emphasise that although there have been significant advances, there is still a pressing need for a better understanding basic mechanisms enable development of reliable and robust means to identify patients at highest risk, and to intervene effectively before vision loss occurs.

Treatment

Treatment, which depends largely on the type of diabetic retinopathy you have and how severe it is, is geared to slowing or stopping the progression.

Early diabetic retinopathy

If you have mild or moderate nonproliferative diabetic retinopathy, you might not need treatment right away. However, your eye doctor will closely monitor your eyes to determine when you might need treatment.

Work with your diabetes doctor (endocrinologist) to determine if there are ways to improve your diabetes management. When diabetic retinopathy is mild or moderate, good blood sugar control can usually slow the progression.

Advanced diabetic retinopathy

If you have proliferative diabetic retinopathy or macular edema, you’ll need prompt treatment. Depending on the specific problems with your retina, options might include:

• Injecting medications into the eye.
• Photocoagulation.
• Panretinal photocoagulation. 
• Vitrectomy.

While treatment can slow or stop the progression of diabetic retinopathy, it’s not a cure. Because diabetes is a lifelong condition, future retinal damage and vision loss are still possible.