Diabetic retinopathyCommentary: Treatment of diabetic retinopathy

doi:10.1136/bmj.326.7397.1023

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Diabetic retinopathy

Simon Harding, consultant ophthalmologist

St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8XP
St Thomas's Hospital, London SE1 7EH

Definition Diabetic retinopathy is characterised by varying degrees of microaneurysms, haemorrhages, exudates (known as hard exudates in the United States), venous changes, new vessel formation, and retinal thickening. It can involve the peripheral retina or the macula, or both. The range of severity of retinopathy includes background (mild non-proliferative), preproliferative (moderate or severe non-proliferative), proliferative, and advanced retinopathy. Involvement of the macula can be focal, diffuse, ischaemic, or mixed.

What are the effects of treatments for diabetic retinopathy?

Beneficial

Macular photocoagulation

In people with clinically significant macular oedema, one large randomised controlled trial (RCT) has found that laser photocoagulation to the macula versus no treatment significantly reduces visual loss at three years in eyes with macular oedema and mild to moderate diabetic retinopathy, with some evidence of greater benefit in eyes with better vision. Subgroup analysis found that focal laser treatment was significantly more effective in reducing visual loss in eyes with clinically significant macular oedema, particularly in people in whom the centre of the macula was involved or imminently threatened.

Peripheral retinal laser photocoagulation

In people with preproliferative (moderate or severe non-proliferative) retinopathy and maculopathy, RCTs involving eyes with preproliferative retinopathy and maculopathy have found that peripheral retinal photocoagulation versus no treatment significantly reduces the risk of severe visual loss at five years.

Eye with diabetic maculopathy

(Credit: SUE FORD/SPL)

Peripheral retinal laser photocoagulation

In people with proliferative retinopathy, RCTs have found that peripheral retinal photocoagulation versus no treatment significantly reduces the risk of severe visual loss at …