Advances in the treatment of diabetic retinopathy

As the diabetes epidemic in the United States continues to worsen, so too does the prevalence of diabetic retinopathy (DR). DR is divided broadly into nonproliferative and proliferative stages, with or without vision-threatening macular edema. Progression to proliferative DR is associated with visio...

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Bibliographic Details
Published in:Journal of diabetes and its complications Vol. 33; no. 12; p. 107417
Main Authors: Singh, Rishi P., Elman, Michael J., Singh, Simran K., Fung, Anne E., Stoilov, Ivaylo
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01.12.2019
Elsevier Limited
Subjects:
Angiogenesis Inhibitors - administration & dosage
Angiogenesis Inhibitors - adverse effects
Anti-VEGF therapy
Clinical medicine
Clinical trials
Clinical Trials, Phase III as Topic - methods
Clinical Trials, Phase III as Topic - statistics & numerical data
Collaboration
Diabetes
Diabetic macular edema
Diabetic retinopathy
Diabetic Retinopathy - drug therapy
Diabetic Retinopathy - epidemiology
Disease Progression
Edema
Endocrinology - methods
Endocrinology - trends
FDA approval
Hispanic Americans
Humans
Immunotherapy
Intravitreal Injections
Lasers
Macular Edema - drug therapy
Macular Edema - epidemiology
Macular Edema - etiology
Medical personnel
Mental health
Monoclonal antibodies
Ophthalmology - methods
Ophthalmology - trends
Patients
Quality of life
Quality standards
Ranibizumab
Ranibizumab - administration & dosage
Ranibizumab - adverse effects
Receptors, Vascular Endothelial Growth Factor - administration & dosage
Recombinant Fusion Proteins - administration & dosage
Recombinant Fusion Proteins - adverse effects
Severity of Illness Index
Vascular endothelial growth factor
Vascular endothelial growth factor A
Visual Acuity
United States > US
Diabetic retinopathy
Vascular endothelial growth factor A
Anti-VEGF therapy
Diabetic macular edema
Ranibizumab
ISSN:1056-8727, 1873-460X, 1873-460X
Online Access:Get full text
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Summary:As the diabetes epidemic in the United States continues to worsen, so too does the prevalence of diabetic retinopathy (DR). DR is divided broadly into nonproliferative and proliferative stages, with or without vision-threatening macular edema. Progression to proliferative DR is associated with vision loss that is often irreparable, and a rapid decline in health-related quality of life. Vascular endothelial growth factor (VEGF)-A is upregulated in the diabetic eye, and has been identified as a key driver of DR pathogenesis. With this perspective, we review the published phase III clinical trial data of anti-VEGF therapies approved for the treatment of DR in the United States. Using the Early Treatment Diabetic Retinopathy Study Diabetic Retinopathy Severity Scale, in which an improvement of ≥2 steps is considered clinically significant, approximately one-third of patients with DR and macular edema experience this level of improvement after 1 year of treatment with either ranibizumab or aflibercept. The rates of clinically significant DR improvement with ranibizumab could be twice that in the subgroup of patients with moderately severe or severe nonproliferative DR and macular edema. These clinical trial data indicate that intraocular inhibition of VEGF is a rational approach for the management of DR.
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ISSN:1056-8727
1873-460X
1873-460X
DOI:10.1016/j.jdiacomp.2019.107417