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Dr candela eye center9/6/2023 ![]() The widespread availability and use of non-invasive imaging such as optical coherence tomography (OCT), together with the introduction of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatments have revolutionized the assessment and treatment of diabetic macular edema (DME), and dramatically improved visual outcomes for this complication of DR ( 11– 13). Panretinal laser photocoagulation (PRP) helps to prevent severe vision loss due to proliferative DR (PDR), and the introduction of pattern scan laser (PASCAL) has made the procedure quicker, easier to perform, and more comfortable for patients ( 8– 10). For example, the universal adoption of DR classification systems such as the Early Treatment of Diabetic Retinopathy Study (ETDRS) and International Classification of Diabetic Retinopathy (ICDR) severity scales that effectively prognosticate the risk of disease progression, coupled with large-scale DR screening programs around the world, have allowed for appropriate surveillance and early intervention to prevent the onset of vision-threatening complications ( 5– 7). Such improvements in visual outcomes for DR are multifactorial, and are due in large part to a combination of better systemic risk factor control, coupled with advances in ocular disease assessment, screening, imaging and treatment in recent years. Fortunately, much of the visual loss from DR is preventable, and the rates of vision loss from diabetes and DR have steadily declined over the past few decades ( 4, 5). Globally, more than 100 million individuals are living with DR, and DR is a leading cause of blindness and visual impairment, especially among the working-age adult population ( 1, 3). In this article, we discuss these major trends in DR that we expect to see in 2030 and beyond.ĭiabetic retinopathy (DR) is the major ocular complication of diabetes mellitus, and occurs in about 30 to 40% of diabetic individuals ( 1, 2). Finally, the classification system for diabetic retinal disease will need to be continually updated to keep pace with new developments. Fifth, new pharmacologic agents targeting other non-VEGF-driven pathways, and novel therapeutic strategies such as gene therapy are being developed for DR. Fourth, artificial intelligence for screening, diagnosis and prognostication of DR will become increasingly accessible and important. Third, a wealth of information is becoming available from newer imaging modalities such as widefield imaging systems and optical coherence tomography angiography. Second, better understanding of disease pathophysiology is placing greater emphasis on retinal neural dysfunction and non-vascular aspects of diabetic retinal disease. First, epidemiologic projections show that the global burden of DR is not only increasing, but also shifting from high-income countries towards middle- and low-income areas. Looking forward to 2030, many of these ongoing developments are likely to further transform the field. Yet, there are still more exciting advances being made. ![]() For example, the accessibility of imaging with optical coherence tomography, and the development of anti-vascular endothelial growth factor (VEGF) treatment are just some of the landmark developments that have shaped the DR landscape over the last few decades. Major advances in diagnostics, technology and treatment have already revolutionized how we manage DR in the early part of the 21 st century. Diabetic retinopathy (DR) is the major ocular complication of diabetes mellitus, and is a problem with significant global health impact. ![]()
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