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Diabetic Retinopathy: Changing Treatment Paradigms

Is there a role for the medical management of NPDR?

Part Two of Two.

The Goal and Key questions

Using anti-VEGF therapy as the cornerstone of treatment for diabetic retinopathy (DR) itself is a relatively new concept, and as such, engenders many questions about who to treat, how to treat, and when to treat. In the context of concurrent diabetic macular edema (DME), a multitude of well-designed, prospective studies can guide our management decisions.1,2 There is also sound rationale for offering medical therapy for eyes with proliferative diabetic retinopathy (PDR), even when DME is not present, based on evidence from controlled clinical trials.3,4 More recently, prospective studies are investigating the role of anti-VEGF agents in treating eyes with high-risk nonproliferative DR (NPDR), without DME. Similar to slowing a moving train, the use of anti-VEGF injections over time appears to be able to slow, stop, and, in some provocative cases, even reverse the progressive nature of the disease and thus avoid damage to the eye that may result in permanent loss of vision.5

This roundtable from AAO 2018 gathered a panel of leading retina specialists to discuss the important nuances in treating eyes with NPDR using anti-VEGF agents. Naturally, this proposed paradigm raises several questions:

  • Early intervention necessitates prompt recognition and diagnosis. How can the eye care community improve on the ability to identify treatment-warranting DR?
  • What is the role of imaging in managing DR?
  • What is the threshold for initiating treatment in eyes with NPDR? Is it sufficient to wait for DME to appear or should we offer treatment even earlier?
  • Once the decision is made to offer treatment, what is the optimal timing for the treatment and follow-up intervals?

—Charles C. Wykoff, MD, PhD, Moderator

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