Diabetic Retinopathy: Assessing the Armamentarium for Improved Detection and Treatment


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Question 1
Which of the following statements is incorrect regarding OCT angiography (OCTA) for evaluation of diabetic eyes?
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The correct answer is C.

Rationale: OCT angiography (OCTA) detects typical diabetic changes before they are visible clinically. OCTA is an emerging modality for vascular structure assessment and nonperfusion evaluation that;

  • Reconstructs vascular flow patterns
  • Combines structural and functional feedback
  • Provides novel information compared to both conventional OCT and fluorescein angiography
  • But does not provide leakage information

Question 2
In Protocol S, 5-year outcomes of panretinal photocoagulation (PRP) versus intravitreal ranibizumab for proliferative diabetic retinopathy showed which of the following?
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The correct answer is A.

Rationale: In Protocol S, visual acuity in most study eyes that completed follow-up was very good at 5 years and was similar in both groups. Severe vision loss or serious PDR complications were uncommon with PRP or ranibizumab. However, the ranibizumab group had lower rates of developing vision-impairing diabetic macular edema and less visual field loss. Patient-specific factors, including anticipated visit compliance, cost, and frequency of visits, should be considered when choosing treatment for patients with PDR. These findings support either anti-vascular endothelial growth factor therapy or PRP as viable treatments for patients with PDR.

Reference: Gross JG, et al. JAMA Ophthalmol. 2018;136(10):1138-48.

Question 3
A 47-year-old white man presents for his annual examination. He is monocular due to a previous right eye injury. He has no complaints but wants new glasses, despite having 20/20 VA. The patient has type 2 diabetes mellitus for 10 years, with good glycemic control. Examination reveals some dot-blot hemorrhages on fundus photography, with normal OCT, consistent with mild proliferative DR. No treatment is rendered. He returns in 6 months and more hemorrhages and DME are observed on fundus photography. What is the best treatment approach to initiate at this time?
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The correct answer is B.

Rationale: Despite the significant reduction in DR in patients with good glycemic control, DR develops even in that setting and is independently associated with disease duration. Anti-VEGF therapy would be the most prudent approach in this patient with proliferative retinopathy.