Diabetic Retinopathy: Which Treatment is Best?

A 2015 study in JAMA sponsored by the U.S. National Eye Institute (NEI) reports the first major advancement in nearly four decades for treating proliferative diabetic retinopathy—the advanced stage of the diabetes-related eye disease.

Diabetic retinopathy occurs when high blood glucose levels damage small blood levels in the retina. Proliferative retinopathy, the most dangerous form of the disease, is caused by the growth of these new abnormal blood vessels that originate from the retina and that can rupture and bleed into the eye’s center. The blood vessels can also cause the retina to detach from the back of the eye. In both cases, acute vision loss can result.

The gold standard of therapy is a laser treatment called panretinal, or scatter, photocoagulation, which cuts the risk of blindness by more than 50 percent. Potential side effects of laser therapy, though, include a significant loss of side, or peripheral, vision and decreased night vision.

In the NEI study, researchers compared the effects of laser therapy (one or more treatments) with three monthly intraocular injections, and as needed thereafter, of the drug ranibizumab (Lucentis). Patients ages 44 to 59 were evaluated two years after their treatment.

Researchers found that Lucentis improved vision better than laser therapy and carried little risk of peripheral vision loss. The researchers also noted that Lucentis might help prevent a complication of diabetic retinopathy called diabetic macular edema. Lucentis is already FDA-approved to treat macular edema. The study found that 28 percent of patients in the laser therapy group developed macular edema, compared with only 9 percent in the Lucentis group.

The researchers concluded that Lucentis might eventually be a viable alternative to laser therapy for patients with proliferative diabetic retinopathy. They’ll continue following the patients in this study for a total of five years to assess longer-term outcomes.