Treatment of diabetic retinopathy

The present treatment for diabetic retinopathy encompasses a number of modalities. Good diabetic control may be helpful in retarding the onset of retinopathy The present mainstay of ocular treatment of diabetic retinopathy is photocoagulation. A controlled clinical trial, the Diabetic Retinopathy Study, has shown that photocoagulation is effective in reducing the incidence of blindness by one-half to two-thirds for patients with moderate to severe proliferative diabetic retinopathy. A new collaborative trial for photocoagulation combined with aspirin, the Early Treatment Diabetic Retinopathy Study, began enrolling patients with background and mild proliferative diabetic retinopathy in January 1980. Pituitary ablation is reserved for a special form of severe diabetic retinopathy when the diabetic patient is otherwise in reasonable health. For the most part, pituitary ablation has been replaced by photocoagulation and vitrectomy. Vitrectomy is a new form of intraocular surgery to remove vitreous hemorrhages associated with severe diabetic retinopathy. Although it has a high rate of complications, vitrectomy is effective for approximately one-half of carefully selected patients. It is also used for the treatment of progressive, diabetic, tractional, retinal detachments. This therapeutic modality is also undergoing a controlled collaborative clinical trial, the Diabetic Retinopathy Vitrectomy Study. Because diabetic retinopathy is a slowly progressive, often symptomless disease in its early stages, it is important for each diabetic patient to have periodic eye examinations by an ophthalmologist. In juvenile diabetics, these should begin within 3-5 yr after diagnosis or at puberty. Adult-onset diabetics should be examined within 1-3 mo after their systemic therapy has been stabilized. Any diabetic patient with ocular symptoms should have an ophthalmic evaluation forthwith.