DIABETIC RETINOPATHY - RECENT DEVELOPMENTS AND CHALLENGES

Abstract

Diabetic Retinopathy is the leading cause of new blindness in working population. Over 135 million individuals are afflicted with diabetes across the world. Prevalence of diabetic retinopathy is increasing worldwide due to increasing number and prolonged survival of diabetic patients. The prevalence of diabetes is approximately 2% in U.K population although prevalence among Asian groups can be as high as 16% [1]. Increasing survival of patients with diabetic retinopathy, resulting in higher incidence severe, sight-threatening complications, compounds the problem. The 5 year survival rate for patients with proliferative disease 50 years ago was 30% compared with today’s figure of 90% for patients of early onset diabetes and 60% for patients with late onset diabetes[2]. There is evidence that retinopathy begins to develop at least 7 years before the clinical diagnosis of type 2 diabetes [3]. Successful management of diabetic retinopathy via a combina­tion of glucose control, laser therapy, and vitrectomy represents one of the most striking achievements of modern ophthalmol­ogy. Diabetic macular edema is a manifestation of diabetic retinopathy that produces loss of central vision. The prevalence of diabetic macular edema is 20% in diabetic patients [4]. Currently, the only demonstrated means to reduce the risk of visual loss from diabetic macular edema are intensive glycemic control and laser photocoagulation [5-7]. If fundus examinations are initiated prior to the develop­ment of significant retinopathy and repeated periodically, and if the recommendations of the Early Treatment Diabetic Retinopathy Study (ETDRS) are followed with respect to the management of subsequent diabetic macular edema or neovas­cularization, the risk of severe visual loss is less than 5%. The current review will discuss the pathophysiology, screening, medical treatment, and future research for diabetic Retinopathy.