Restricted accessResearch articleFirst published online 2020-3
American Society of Retina Specialists Clinical Practice Guidelines: Management of Nonproliferative and Proliferative Diabetic Retinopathy Without Diabetic Macular Edema
MazharKVarmaRChoudhuryFMcKean-CowdinRShtirCJAzenSP; Los Angeles Latino Eye Study Group. Severity of diabetic retinopathy and health-related quality of life: the Los Angeles Latino Eye Study. Ophthalmology. 2011;118(4):649–655. doi:10.1016/j.ophtha.2010.08.003
2.
WillisJRDoanQVGleesonM, et al.Vision-related functional burden of diabetic retinopathy across severity levels in the United States. JAMA Ophthalmol. 2017;135(9):926–932. doi:10.1001/jamaophthalmol.2017.2553
3.
Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.
LeCaireTJPaltaMKleinRKleinBECruickshanksKJ. Assessing progress in retinopathy outcomes in type 1 diabetes: comparing findings from the Wisconsin Diabetes Registry Study and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Diabetes Care. 2013;36(3):631–637. doi:10.2337/dc12-0863
6.
BakriSJWolfeJDRegilloCDFlynnHWJrWykoffCC. Evidence-based guidelines for management of diabetic macular edema. J Vitreoretin Dis. 2019;3(3):145–152. doi:10.1177/2474126419834711
7.
American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):S55–S64. doi:10.2337/dc18-S006
8.
American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S103–S123. doi:10.2337/dc19-S010
9.
SolomonSDChewEDuhEJ, et al.Diabetic retinopathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(3):412–418. doi:10.2337/dc16-2641
10.
Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Ophthalmology. 1995;102(4):647–661. doi:10.1016/s0161-6420(95)30973-6
11.
HainsworthDPBebuIAielloLP, et al.Risk factors for retinopathy in type 1 diabetes: the DCCT/EDIC study. Diabetes Care. 2019;42(5):875–882. doi:10.2337/dc18-2308
12.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):P837–P853. doi:10.1016/S0140-6736(98)07019-6
13.
ACCORD Study Group, ACCORD Eye Study Group, ChewEY, et al.Effects of medical therapies on retinopathy progression in type 2 diabetes. N Engl J Med. 2010;363(3):233–244. doi:10.1056/NEJMoa1001288
14.
ChewEYDavisMDDanisRP; et al.Action to Control Cardiovascular Risk in Diabetes Eye Study Research Group. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology. 2014;121(12):2443–2451. doi:10.1016/j.ophtha.2014.07.019
15.
GaedePVedelPLarsenNJensenGVParvingHHPedersenO. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383–393. doi:10.1056/NEJMoa021778
16.
American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes—2019. Diabetes Care. 2019;42(suppl 1):S61–S70. doi:10.2337/dc19-S006
17.
de BoerIHBangaloreSBenetosA, et al.Diabetes and hypertension: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(9):1273–1284. doi:10.2337/dci17-0026
18.
ChaturvediNPortaMKleinR; et al.DIRECT Programme Study Group. Effect of candesartan on prevention (DIRECT-Prevent 1) and progression (DIRECT-Protect 1) of retinopathy in type 1 diabetes: randomised, placebo-controlled trials. Lancet. 2008;372(9647):1394–1402. doi:10.1016/S0140-6736(08)61412-9
19.
SchrierRWEstacioROEslerAMehlerP. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int. 2002;61(3):1086–1097. doi:10.1046/j.1523-1755.2002.00213.x
20.
RuggenentiPLauriaGIlievIP; et al.DEMAND Study Investigators. Effects of manidipine and delapril in hypertensive patients with type 2 diabetes mellitus: the delapril and manidipine for nephroprotection in diabetes (DEMAND) randomized clinical trial. Hypertension. 2011;58(5):776–783. doi:10.1161/HYPERTENSIONAHA.111.174474
21.
MatthewsDRStrattonIMAldingtonSJHolmanRRKohnerEM; UK Prospective Diabetes Study Group. Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol. 2004;122(11):1631–1640. doi:10.1001/archopht.122.11.1631
22.
DoDVWangXVedulaSS, et al.Blood pressure control for diabetic retinopathy. Cochrane Database Syst Rev. 2015;1:CD006127. doi:10.1002/14651858.CD006127.pub2
23.
LeskeMCWuSYHennisA; et al.Barbados Eye Study Group. Hyperglycemia, blood pressure, and the 9-year incidence of diabetic retinopathy: the Barbados Eye Studies. Ophthalmology. 2005;112(5):799–805. doi:10.1016/j.ophtha.2004.11.054
24.
SacksFMHermansMPFiorettoP, et al.Association between plasma triglycerides and high-density lipoprotein cholesterol and microvascular kidney disease and retinopathy in type 2 diabetes mellitus: a global case-control study in 13 countries. Circulation. 2014;129(9):999–1008. doi:10.1161/CIRCULATIONAHA.113.002529
25.
KleinBEMyersCEHowardKPKleinR. Serum lipids and proliferative diabetic retinopathy and macular edema in persons with long-term type 1 diabetes mellitus: the Wisconsin Epidemiologic Study of Diabetic Retinopathy. JAMA Ophthalmol. 2015;133(5):503–510. doi:10.1001/jamaophthalmol.2014.5108
26.
KleinBEMossSEKleinRSurawiczTS. The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XIII. Relationship of serum cholesterol to retinopathy and hard exudate. Ophthalmology. 1991;98(8):1261–1265. doi:10.1016/s0161-6420(91)32145-6
27.
ChewEYKleinMLFerrisFLIII, et al.Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy. Early Treatment Diabetic Retinopathy Study (ETDRS) report 22. Arch Ophthalmol. 1996;114(9):1079–1084. doi:10.1001/archopht.1996.01100140281004
28.
KeechACMitchellPSummanenPA; et al.FIELD Study Investigators. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD study): a randomised controlled trial. Lancet. 2007;370(9600):1687–1697. doi:10.1016/S0140-6736(07)61607-9
29.
GoldbergMFJampolLM. Knowledge of diabetic retinopathy before and 18 years after the Airlie House Symposium on Treatment of Diabetic Retinopathy. Ophthalmology. 1987;94(7):741–746. doi:10.1016/s0161-6420(87)33524-9
30.
Diabetic Retinopathy Study. Report number 6. Design, methods, and baseline results. Report number 7. A modification of the Airlie house classification of diabetic retinopathy. Prepared by the Diabetic Retinopathy. Invest Ophthalmol Vis Sci. 1981;21(1 pt 2):1–226.
31.
Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic retinopathy from stereoscopic color fundus photographs—an extension of the modified Airlie House classification. ETDRS report number 10. Ophthalmology. 1991;98(5 suppl):786–806. doi:10.1016/S0161-6420(13)38012-9
32.
Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 suppl):823–833. doi:10.1016/S0161-6420(13)38014-2
33.
DavisMDFisherMRGangnonRE, et al.Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: early treatment diabetic retinopathy study report #18. Invest Ophthalmol Vis Sci. 1998;39(2):233–252.
34.
Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991;98(5 suppl):766–785. doi:10.1016/S0161-6420(13)38011-7
35.
WilkinsonCPFerrisFL IIIKleinRE; et al.Global Diabetic Retinopathy Project Group. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677–1682. doi:10.1016/S0161-6420(03)00475-5
36.
Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology. 1981;88(7):583–600.
37.
Diabetic Retinopathy Clinical Research Network; Googe J, Brucker AJ, Bressler NM, et al. Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation. Retina. 2011;31(6):1009–1027. doi:10.1097/IAE.0b013e318217d739
38.
ChappelowAVTanKWaheedNKKaiserPK. Panretinal photocoagulation for proliferative diabetic retinopathy: pattern scan laser versus argon laser. Am J Ophthalmol. 2012;153(1):137–142.e2. doi:10.1016/j.ajo.2011.05.035
39.
NagpalMMarlechaSNagpalK. Comparison of laser photocoagulation for diabetic retinopathy using 532-nm standard laser versus multispot pattern scan laser. Retina. 2010;30(3):452–458. doi:10.1097/IAE.0b013e3181c70127
40.
MoutrayTEvansJRLoisNArmstrongDJPetoTAzuara-BlancoA. Different lasers and techniques for proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2018;3:CD012314. doi:10.1002/14651858.CD012314.pub2
41.
BresslerSBBeaulieuWTGlassmanAR; et al.Diabetic Retinopathy Clinical Research Network. Factors associated with worsening proliferative diabetic retinopathy in eyes treated with panretinal photocoagulation or ranibizumab. Ophthalmology. 2017;124(4):431–439. doi:10.1016/j.ophtha.2016.12.005
42.
PalankerDLavinskyDBlumenkranzMSMarcellinoG. The impact of pulse duration and burn grade on size of retinal photocoagulation lesion: implications for pattern density. Retina. 2011;31(8):1664–1669. doi:10.1097/IAE.0b013e3182115679
43.
DoftBHBlankenshipGW. Single versus multiple treatment sessions of argon laser panretinal photocoagulation for proliferative diabetic retinopathy. Ophthalmology. 1982;89(7):772–779. doi:10.1016/s0161-6420(82)34734-x
44.
MuqitMMKMarcellinoGRHensonDB, et al.Single-session vs multiple-session pattern scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: the Manchester Pascal Study. Arch Ophthalmol. 2010;128(5):525–533. doi:10.1001/archophthalmol.2010.60
45.
Diabetic Retinopathy Clinical Research Network, BruckerAJQinH, et al.Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol. 2009;127(2):132–140. doi:10.1001/archophthalmol.2008.565
46.
Writing Committee for the Diabetic Retinopathy Clinical Research Network; GrossJGGlassmanARJampolLM, et al.Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA. 2015;314(20):2137–2146. doi:10.1001/jama.2015.15217
47.
GrossJGGlassmanARLiuD; et al.Diabetic Retinopathy Clinical Research Network. Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol. 2018;136(10):1138–1148. doi:10.1001/jamaophthalmol.2018.3255
48.
SivaprasadSPrevostATVasconcelosJC; et al.CLARITY Study Group. Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial. Lancet. 2017;389(10085):2193–2203. doi:10.1016/S0140-6736(17)31193-5
49.
LinJChangJSSmiddyWE. Cost evaluation of panretinal photocoagulation versus intravitreal ranibizumab for proliferative diabetic retinopathy. Ophthalmology. 2016;123(9):1912–1918. doi:10.1016/j.ophtha.2016.05.037
50.
ObeidAGaoXAliFS, et al.Loss to follow-up in patients with proliferative diabetic retinopathy after panretinal photocoagulation or intravitreal anti-VEGF injections. Ophthalmology. 2018;125(9):1386–1392. doi:10.1016/j.ophtha.2018.02.034
51.
ObeidASuDPatelSN, et al.Outcomes of eyes lost to follow-up with proliferative diabetic retinopathy that received panretinal photocoagulation versus intravitreal anti-vascular endothelial growth factor. Ophthalmology. 2019;126(3):407–413. doi:10.1016/j.ophtha.2018.07.027
52.
Indications for photocoagulation treatment of diabetic retinopathy: Diabetic Retinopathy Study Report No. 14. The Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987;27(4):239–253. doi:10.1097/00004397-198702740-00004
53.
ChewEYFerrisFL IIICsakyKG, et al.The long-term effects of laser photocoagulation treatment in patients with diabetic retinopathy: the Early Treatment Diabetic Retinopathy follow-up study. Ophthalmology. 2003;110(9):1683–1689. doi:10.1016/S0161-6420(03)00579-7
54.
IpMSDomalpallyAHopkinsJJWongPEhrlichJS. Long-term effects of ranibizumab on diabetic retinopathy severity and progression. Arch Ophthalmol. 2012;130(9):1145–1152. doi:10.1001/archophthalmol.2012.1043
55.
WykoffCCEichenbaumDARothDBHillLFungAEHaskovaZ. Ranibizumab induces regression of diabetic retinopathy in most patients at high risk of progression to proliferative diabetic retinopathy. Ophthalmol Retina. 2018;2(10):997–1009. doi:10.1016/j.oret.2018.06.005
56.
DhootDSBakerKSarojN, et al.Baseline factors affecting changes in diabetic retinopathy severity scale score after intravitreal aflibercept or laser for diabetic macular edema: post hoc analyses from VISTA and VIVID. Ophthalmology. 2018;125(1):51–56. doi:10.1016/j.ophtha.2017.06.029
57.
BresslerSBLiuDGlassmanAR; et al.Diabetic Retinopathy Clinical Research Network. Change in diabetic retinopathy through 2 years: secondary analysis of a randomized clinical trial comparing aflibercept, bevacizumab, and ranibizumab. JAMA Ophthalmol. 2017;135(6):558–568. doi:10.1001/jamaophthalmol.2017.0821
58.
Study of the Efficacy and Safety of Intravitreal (IVT) Aflibercept for the Improvement of Moderately Severe to Severe Nonproliferative Diabetic Retinopathy (NPDR)–Full Text View–ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02718326. Published November 21, 2019. Accessed December 28, 2019.
59.
BoyerDS.Treatment of moderately severe to severe nonproliferative diabetic retinopathy with intravitreal aflibercept injection: 52-week results from the phase 3 PANORAMA Study. Paper presented at: Association for Research in Vision and Ophthalmology Annual Meeting; April 29, 2019; Vancouver, BC, Canada.
60.
WykoffCCChakravarthyUCampochiaroPABaileyCGreenKCunha-VazJ. Long-term effects of intravitreal 0.19 mg fluocinolone acetonide implant on progression and regression of diabetic retinopathy. Ophthalmology. 2017;124(4):440–449. doi:10.1016/j.ophtha.2016.11.034
BrownDMNguyenQDMarcusDM; et al.RIDE and RISE Research Group. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013;120(10):2013–2022. doi:10.1016/j.ophtha.2013.02.034
63.
WykoffCCMarcusDMMidenaE, et al.Intravitreal aflibercept injection in eyes with substantial vision loss after laser photocoagulation for diabetic macular edema: subanalysis of the VISTA and VIVID randomized clinical trials. JAMA Ophthalmol. 2017;135(2):107–114. doi:10.1001/jamaophthalmol.2016.4912
64.
HoACAlbiniTABrownDMBoyerDSRegilloCDHeierJS. The potential importance of detection of neovascular age-related macular degeneration when visual acuity is relatively good. JAMA Ophthalmol. 2017;135(3):268–273. doi:10.1001/jamaophthalmol.2016.5314
65.
CampochiaroPAWykoffCCShapiroHRubioRGEhrlichJS. Neutralization of vascular endothelial growth factor slows progression of retinal nonperfusion in patients with diabetic macular edema. Ophthalmology. 2014;121(9):1783–1789. doi:10.1016/j.ophtha.2014.03.021
66.
WykoffCCShahCDhootD, et al.Longitudinal retinal perfusion status in eyes with diabetic macular edema receiving intravitreal aflibercept or laser in VISTA study. Ophthalmology. 2019;126(8):1171–1180. doi:10.1016/j.ophtha.2019.03.040
67.
GuptaPLiang GanATKidd ManRE, et al.Impact of incidence and progression of diabetic retinopathy on vision-specific functioning. Ophthalmology. 2018;125(9):1401–1409. doi:10.1016/j.ophtha.2018.02.011
68.
RayessNRahimyEStoreyP, et al.Postinjection endophthalmitis rates and characteristics following intravitreal bevacizumab, ranibizumab, and aflibercept. Am J Ophthalmol. 2016;165:88–93. doi:10.1016/j.ajo.2016.02.028
69.
BakerCWGlassmanARBeaulieuWT; et al.DRCR Retina Network. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):1880–1894. doi:10.1001/jama.2019.5790
70.
LuAJChenAJHwangVLawPYStewartJMChaoDL. Analysis of patient-reported barriers to diabetic retinopathy follow-up. Ophthalmic Surg Lasers Imaging Retina. 2019;50(2):99–105. doi:10.3928/23258160-20190129-06
71.
KeenumZMcGwinGJrWitherspoonCDHallerJAClarkMEOwsleyC. Patients’ adherence to recommended follow-up eye care after diabetic retinopathy screening in a publicly funded county clinic and factors associated with follow-up eye care use. JAMA Ophthalmol. 2016;134(11):1221–1228. doi:10.1001/jamaophthalmol.2016.3081