Q&A: Stela Vujosevic shares why the staging system for diabetic eye conditions should be updated

Photo of Stela Vujosevic at the 2025 EURETINA meeting in Paris, France

Stela Vujosevic, Md, PhD, FEBO, presented the need for a new staging system for diabetic retinopathy and diabetic macular edema at the 2025 EURETINA meeting in Paris, France. In her interview with the Eye Care Network, she highlighted advancements in imaging technologies like OCT and OCTA that enable more comprehensive retinal evaluation. The current system was deemed obsolete, failing to fully capture the neurovascular unit's status. She emphasized integrating multiple parameters, including retinal inflammation, neurodegeneration, and patient-reported outcomes to create a more holistic approach to disease staging and treatment.

Note: The following conversation has been lightly edited for clarity.

Ophthalmology Times: You are presenting here at the 2025 EURETINA meeting on the staging system for diabetic eye conditions. Can you share why a new staging system is needed?

Stela Vujosevic, MD, PhD, FEBO: My presentation is on, do we need a new staging system for diabetic retinopathy and diabetic macular edema? And my answer is, yes. Why do we need it? We need it because the current staging system actually is obsolete, because we have a huge advancement in the digitalization, in the imaging modalities, in the omics research, and that's why we definitely need novel and more, I would say, inclusive staging system for both DR and DME. The current staging system does not completely reflect what is the status of the neurovascular unit in the retina.

And also, how can we monitor the progression of the disease and the treatment outcomes? And we also have novel imaging modalities that evaluate more in detail and in a non-invasive way, different aspects of diabetic retinal disease. Let's just think of OCT and OCT-A, or also on the ultrawidefield imaging which covers a far periphery of the retina and which can help in better staging of the disease. So when we integrate all of these imaging modalities, we can definitely look into more parameters in the retina to better characterize the disease stage.

OT: How does this compare to the current staging system?

Vujosevic: Currently, we usually use only the central retinal thickness for the evaluation of the diabetic macular edema. However, we know that there are many more aspects and many more parameters in the retina that we can evaluate. For example, if we think of the characteristics of the retinal cyst of the intraretinal and subretinal fluid, and quantify the volume of the fluid. If we think of the signs of inflammation in the retina, such as, for example, the hyperreflective foci, the sign of the activation of the microglial cells, or the sign, very important sign, of the neurodegeneration in the retina that we can evaluate with the OCT so the deep disorganization of the inner retinal layers. Also going more deeper in the retina to the outer retinal layers, and especially to the integrity of the for example, EZ of the photoreceptors. So the health status of the photoreceptors is definitely something very important for the visual prognosis. Integrating all these parameters with also the non-perfusion areas in the retina that we can also evaluate non-invasively with the OCT-A, gives us a much more comprehensive view of the possibility that we can have in improving the vision of these patients when they are treated. So that's why we definitely need to think to integrate all of these imaging modalities in the staging system, and obviously not to forget the patient's point of view. So the quality of life of the patients and the patients reported outcome measures, which are also very important to understand better how and when to treat these patients.

OT: What do you think is coming in the future for retinal care and treatments?

Vujosevic: So I would say that we are in a very exciting period of the research and also of the clinical possibilities of the patients and of the treatment landscape. That is definitely something that should guide us toward the validation of novel biomarkers at surrogate endpoints, and also endpoints that can enhance the research of novel treatments and also the treatments at the earlier stages of the disease, and lead to the easier, let's say, acceptance by the regulatory entities and for the improvement of all the community and especially for the patients.