ADA: Diabetic Retinopathy Management Guidelines Issued

The American Diabetes Association (ADA) has issued updated guidelines on the prevention, assessment, and treatment of diabetic retinopathy.  The recommendations, an update to the 2002 ADA position statement, will be published in the March 2017 issue of Diabetes Care.

“Over the past decade, new research and significant improvements in technology have aided our ability to diagnose and treat diabetic retinopathy, and advances in medications are giving people with diabetes the opportunity to improve glucose management and potentially avoid or delay the progression of complications such as retinopathy,” said Thomas W. Gardner, MD, MS, corresponding author of the article and professor of ophthalmology and visual sciences at the Kellogg Eye Center at the University of Michigan.

To reduce the risk or slow the progression of of diabetic retinopathy, the guidelines recommend optimizing glycemic control, as well as lowering blood pressure and serum lipids. For adults with type 1 diabetes, a comprehensive eye exam should be conducted within five years of the onset of diabetes; for patients with type 2 diabetes, the exam should be done at the time of diagnosis.

With regards to treatment, the ADA recommends the following:

• Patients with macular edema, severe nonproliferative diabetic retinopathy or any proliferative diabetic retinopathy should be promptly referred to an ophthalmologist with experience in managing diabetic retinopathy (Grade A)
• In patients with high-risk proliferative diabetic retinopathy (and sometimes in severe nonproliferative diabetic retinopathy), laser photocoagulation therapy can reduce the risk of vision loss (Grade A)
• For central-involved diabetic macular edema, intravitreous injections of anti-vascular endothelial growth factor may be used (Grade A)
• Since aspirin does not increase the risk of retinal hemorrhage, the presence of retinopathy is not a contraindication to aspirin therapy (Grade A)

Both ranibizumab (Lucentis; Genentech) and aflibercept (Eylea, Regeneron) are FDA-approved for the treatment of diabetic retinopathy in patients with diabetic macular edema. Bevacizumab has also been used to treat diabetes-related retinal diseases however the drug is not currently approved for this indication. Compounding pharmacies have often repackaged bevacizumab into smaller doses more appropriate for the eyes. In 2015, the Food and Drug Administration (FDA) announced the restriction of bevacizumab’s ophthalmic use to the five-day period following the repackaging of the drug by a compound pharmacy.

To read the complete position statement visit care.diabetesjournals.org.