New approaches to the treatment of diabetic retinopathy

Diabetic retinopathy (DR) is a leading cause of visual impairment in working age in industrialized countries. It is classified as non-proliferative (mild, moderate or severe) and proliferative, with diabetic macular oedema potentially developing at any of these stages. The prevalence and incidence of DR increase with diabetes duration and worsening of metabolic and blood pressure control. Current approaches to prevent and/or treat DR include optimized control of blood glucose and blood pressure and screening for early identification of high-risk, although still asymptomatic, retinal lesions. Results from recent clinical trials suggest a role for blockers of the renin-angiotensin system (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers) and for fenofibrate in reducing progression and/or inducing regression of mild-to-moderate non-proliferative DR. Intravitreal administration of anti-vascular endothelial growth factor (VEGF) agents was shown to reduce visual loss in more advanced stages of DR, especially in macular oedema.