Panel discusses treatment options for diabetic eye diseases

Lloyd Paul Aiello, MD, moderated a panel at the American Academy of Ophthalmology’s 2022 annual meeting in Chicago that focused on diabetic retinopathy. He shares some of the highlights of this session.

Video transcript

Note: This transcript has been lightly edited for clarity.

David Hutton, Ophthalmology Times: I'm David Hutton of Ophthalmology Times. At the American Academy of Ophthalmology 2022 annual meeting in Chicago, Dr. Lloyd Paul Aiello moderated a panel on diabetic retinopathy. Dr. Aiello, thanks for joining us today to discuss this panel. Tell us some of the key points and takeaways from this session.

Lloyd Paul Aiello, MD: Well, thank you very much for this opportunity. It was actually a very exciting session because, as many folks know, the evolution of the care in diabetic retinopathy has been changing dramatically over the last several years. And with recent advances now, we are continuing to have very important questions answered that help us refine that care.

In this session, one of the aspects that was covered was with our recent ability to document the far periphery of the retina now quite easily, we have to understand whether or not findings out there are important in our understanding of the future progression, retinopathy. And the risk factors included with that. And so that was covered by Dr. (Jennifer) Sun, where many of the aspects of the findings in the peripheral retina now are having implications with regard to the progression rates.

Certain findings, particularly with regard to the sourcing angiogram and ultra-widefield imaging, allow us to determine folks that are at higher risk of progression than others in a way that can't be detected with standard photography. We also have some evaluation of different anti-VEGF treatments and other inhibitor treatments that are being done by Dr. Michael Ip. In addition to anti and two outcomes, now showing the prolonged effect of these treatments for diabetic macular edema that was presented by Jennifer Lim.

Dr. (Neil) Bressler addressed a very important and timely question now with regard to using anti-VEGF for the prevention of severe nonproliferative diabetic retinopathy. More specifically preventing severe proliferative retinopathy from moving on to sight-threating complications, such as proliferative diabetic retinopathy. It has been shown that anti-VEGFs can be at least as effective as panretinal photocoagulation in terms of preventing the complications down the road, and in fact, they have some benefits early on, although the outcomes are similar after treatment. But we have the issue with regard to whether or not patients get lost to treatment since with the anti-VEGF they may rebound as opposed to with a diabetic retinopathy where oftentimes they can be quiescent for years too decades.

With regard to whether diabetic patients are being lost to follow up, which is an important follow-on question, this was addressed that with real world data from the group.

And finally, as we started to look into where we are going in the future with additional aspects, the role of inflammation and diabetic macular edema was covered by Dr. Barry Kupperman, because now many targets are addressing suppressing this inflammation to try to have further beneficial effects. And the drugs in the pipeline that are coming down the way a variety of them were covered by Dr. David Boyer to give us some idea of what exciting advances we may be seeing in coming years.

David Hutton: Ultimately, what can this mean for ophthalmologists and the patients they treat who are diagnosed with diabetic retinopathy?

Lloyd Paul Aiello, MD: Well, this has many implications. And it's very important because our total number of diabetic patients continue to grow a great deal. But what we're finding now is we can further refine who is at risk of progression compared to those that aren't, and furthermore, we are now having additional therapeutic options for those people who may not be responding as well as we would like to some of the early anti-VEGF inhibitor therapies.