#NEJMEReview: Evaluation and Care of Patients with Diabetic
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Vascular complications of diabetes mellitus, including the evolution of the retinal damage known as diabetic retinopathy, have been recognized for centuries. Over the past decade, advances in technology such as retinal imaging and the development of new therapies have dramatically improved the evaluation, treatment, and visual outcomes of patients with diabetic retinopathy. Nonetheless, diabetic macular edema and proliferative diabetic retinopathy remain the leading causes of both moderate and severe vision loss in most developed countries. This article reviews the worldwide effect of diabetic retinopathy and recent changes in the evaluation and treatment of affected patients.

In most patients, retinopathy develops 10 to 15 years after diabetes has been diagnosed. With the increasing prevalence of diabetes, more people are at risk for retinopathy, and greater resources are required to identify and treat this condition. Globally, 629 million persons are expected to have diabetes by 2045.

The duration of diabetes and the level of glycemic control have a major effect on the development of complications of diabetes. However, known risk factors are relatively poor predictors of retinopathy development or progression, and genetic association studies have proved disappointing. Vision-threatening complications generally arise from increased retinal vascular permeability, complications of retinal or anterior-chamber neovascularization, or extensive vascular loss in the central retina. A variety of mechanisms underlying diabetic retinopathy have been postulated

Advances in retinal imaging and new treatments are changing care for patients with diabetic retinopathy. With the current unprecedented ability to noninvasively observe retinal structures, detect retinopathy, and identify patients at greatest risk for vision loss, the ocular care of persons with diabetes can now be performed faster, with greater precision, and in a manner that is easier for both physician and patient. With the concurrent introduction of intraocular VEGF-inhibitor therapy, which can prevent vision loss and induce visual improvement, the treatment of diabetic macular edema and diabetic retinopathy has changed dramatically for the better, and the evolution of effective treatment should continue for years to come.

Source: https://www.nejm.org/doi/full/10.1056/NEJMra1909637?rss=searchAndBrowse
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