New discoveries in diabetes- and thyroid-related eye disease

Although reports from Europe indicate a reduction in the incidence of diabetes-related visual loss, diabetic retinopathy continues to be the leading cause of blindness. One agent, vascular endothelial growth factor (VEGF), has been found to stimulate angiogenesis and may be the cause of diabetic neovascularization and visual loss. New research implies that the manipulation of the VEGF pathway may be able to prevent diabetic visual loss. Type I (insulin-dependent) and type II (non-insulin-dependent) diabetes mellitus are different disease processes. There have been few attempts in the past to differentiate the retinopathy associated with these two distinct disorders. Recent reports indicate that these disorders have different responses to ocular therapy. Thyroid orbitopathy combined with ocular hypertension can produce true glaucoma. Nevertheless, this requires a prolonged duration of orbitopathy and most patients who have this combination will improve and not develop permanent glaucomatous changes. Similarly, the majority of Graves' disease patients develop improved function over time; however, the psychologic sequelae continue after the disease process is in remission, which warrants further studies.