Anti-VEGFs considered in cases of severe diabetic retinopathy
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KOLOA, Hawaii — When deciding which patients with diabetic retinopathy to treat with anti-VEGFs, ophthalmologists should consider severity of disease, according to a speaker here.
During a presentation at Retina 2023, Roger A. Goldberg, MD, said that regression of DR induced by anti-VEGF treatment is unique in mild or moderate nonproliferative DR (NPDR).
“It's really regression in name only. It turns out that induced mild or moderate NPDR doesn't really behave like native, untreated mild or moderate NPDR,” Goldberg said. “The induced, improved DR is much more volatile and likely to worsen.”
Patients with severe NPDR and retinal nonperfusion or macular leakage on fluorescein angiography can be considered for anti-VEGF treatment, as can patients with concurrent diabetic macular edema, he said.
“It's not always an either/or. I think there is a role for anti-VEGF agents in conjunction with [panretinal photocoagulation] in our PDR patients,” he said.
Patients with “Protocol V-DME” are also worth considering for anti-VEGF therapy, he said.
“They've got DME, maybe their vision is OK, Protocol V said you can watch them, but you're seeing their peripheral diabetic retinopathy worsen,” he said. “I think in conjunction with other factors, like some DME, you might say, ‘Hey, I'm treating both of those things,’ but you're really treating the diabetic retinopathy as well.”
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Goldberg RA. Should we “do DR” and use anti-VEGFs for the treatment of diabetic retinopathy? Presented at: Retina 2023; Jan. 15-20, 2023; Koloa, Hawaii.
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