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Diabetic retinal disease: an update on the use of anti‐VEGF agents
Author(s) -
Davies Nigel,
Shotliff Kevin
Publication year - 2013
Publication title -
practical diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.205
H-Index - 24
eISSN - 2047-2900
pISSN - 2047-2897
DOI - 10.1002/pdi.1742
Subject(s) - medicine , diabetic retinopathy , maculopathy , retinopathy , ophthalmology , diabetes mellitus , retinal , surgery , endocrinology
agents in diabetic retinal disease. Here we provide an update on the change in practice that these agents have brought to the management of sight-threatening disease. The UK National Screening Programme offers every person with diabetes annual screening to detect potential sight-threatening retinopathy. Patients with proliferative retinopathy and with diabetic maculopathy are referred to the hospital eye service for further assessment. Control of risk factors for progression is vital. The DCCT and UKPDS2,3 have clearly shown that tight control of blood glucose and blood pressure is beneficial in the long term. The use of lipid-lowering agents, particularly the statin group is highly recommended and the FIELD study showed reduction in the need for laser therapy in the group of patients treated with fenofibrate.4 The instigation of tighter control, however, can lead to a transient worsening of retinopathy for a year or thereabouts but in the longer term reduces the risk of progression.5 While the initial treatment for proliferative retinopathy is urgent pan-retinal photocoagulation (PRP) with laser, diabetic maculopathy is the most frequent cause of central visual loss with sight-threatening maculopathy characterised by oedema within 500 microns of the fovea, with or without exudate or a larger area of oedema and exudate greater in extent than one disc diameter and any part of which encroaches within 1000 microns of the fovea. Patients with these findings should have an optical coherence tomography (OCT) scan to document oedema and fluorescein angiography to identify areas of leakage and areas of ischaemia. Areas of leakage are treated with focal or grid pattern laser burns. The laser energy is reduced in comparison with that used in PRP, to reduce the chance of damage to retinal pigment epithelium (RPE) cells and photoreceptors in the macula area. This form of laser treatment has been shown to reduce the rate of vision loss.6 The use of laser is limited, however, when oedema begins to collect at the fovea which itself cannot be treated. The fovea provides essentially all of our fine detailed vision and is only 0.5mm in diameter. A 6/60 letter has a retinal extent of around 0.3mm and a 6/6 letter 0.03mm. The fovea is the only part of the retina with the neuroanatomy to resolve at a level of 6/12 or better. Consequently, saving this tiny area of tissue is paramount for each individual.