Why Is Continued Vision Loss Still a Problem in Some Patients With Diabetic Retinopathy, Despite Treatment?

Evidence suggests that most patients with diabetic retinopathy (DR) who lose vision do so because of complications of proliferative diabetic retinopathy (PDR) or diabetic macular edema (DME). Diligent screening of patients for PDR and DME followed by administration of laser treatment, anti–vascular endothelial growth factor (VEGF) therapy, or surgery can greatly reduce the risk of vision loss from these conditions.1 However, some patients with DR continue to lose vision despite treatments that ameliorate DME or PDR. Even in the best of circumstances, such as those in the DRCR Retina Network Protocol T trial,2 4% of patients receiving aflibercept, 6% of patients receiving bevacizumab, and 2% of patients receiving ranibizumab had lost at least 10 letters (approximately 2 lines) of visual acuity at 2 years. In the same trial,2 among patients with a baseline visual acuity of 20/50 to 20/320, 9% of patients receiving aflibercept, 16% of patients receiving bevacizumab, and 15% of patients receiving ranibizumab had visual acuity of 20/80 or less at 2 years, while among patients with a baseline visual acuity of 20/32 to 20/40 at baseline, 6% of patients receiving aflibercept, 6% of patients receiving bevacizumab, and 3% of patients receiving ranibizumab had a visual acuity of 20/50 or less at 2 years.2 The precise incidence and reasons underlying progressive vision loss in eyes that have been treated for either PDR or DME remain unclear and may be confounded by non–DR-related pathology such as cataracts, glaucoma, or age-related macular degeneration.

Citation

Bressler, S. B., Scanlon, P. H., & Pearce, E. (2022). Why Is Continued Vision Loss Still a Problem in Some Patients With Diabetic Retinopathy, Despite Treatment?. JAMA ophthalmology, 140(4), 308–309. https://doi.org/10.1001/jamaophthalmol.2022.0135

DOI

10.1001/jamaophthalmol.2022.0135

URI

https://hdl.handle.net/20.500.14709/546