Madridge
Journal of Ophthalmology

ISSN: 2638-2040

Editorial Article

Diabetic Retinopathy - "There is Life beyond Anti-VEGF"

Abdul Waris*

Assistant Professor, Institute of Ophthalmology, JNMCH, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

*Corresponding author: Abdul Waris, Assistant Professor, Institute of Ophthalmology, JNMCH, Aligarh Muslim University, Aligarh-202002, Uttar Pradesh, India, Tel: 0091-8755461186, E-mail: waris_eye@yahoo.co.in

Received: April 16, 2016 Accepted: April 19, 2016 Published: April 25, 2016

Citation: Waris A. Diabetic Retinopathy - "There is Life beyond Anti-VEGF". Madridge J Ophthalmol. 2016; 1(1): 5-6. doi: 10.18689/mjop-1000102

Copyright: © 2016 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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The world is bracing up for a Diabetic Epidemic. With over 400 million diabetics at present and the number to reach 600 million by 2030 a catastrophe is waiting. We as ophthalmologists are concerned because Diabetic Retinopathy (DR) is slowly riding up the ladder as the leading cause of blindness in the world.

Pharmacotherapies in the form of anti-VEGFs and steroid implants have come in a big way in confronting this menace. But mind it they are costly, require repeated injections, there is a dirth of VR facilities in poor nations and despite all it is not yet a cure for the disease process. In this era of anti-VEGFs we forget a world beyond i.e. medical management of DR, which is cost effective and an adjuvant in the fight against DR related blindness [1,2].

The golden rule we suggest is the rule of '5'. Before looking at the fundus verify the glycosylated hemoglobin, RFT, lipid profile, Hb & BP of the patient. DCCT, UK prospective diabetes study, Role of statins [3], Role of Anemia [4], Role of Nephropathy [5] all have conclusive evidence based support.

Pregnancy, Obesity, smoking, exercise all has a bearing on DR and has to be taken into account [6]. In my practice I use calcium dobesilate, vitamin C, antioxidants, micronutrients with good results, though based on limited research. Please look at the Internist's prescription, if they have prescribed rosiglitazone or Losartan expect intractable macular edema.

Yes, Anti Vegf's have been a panacea but if you also become a part time physician it will definitely reduce over dependence on anti-VEGFs with a cost effective [7,8] and broader cure of the disease.

References

  1. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. BMJ. 1998; 317(7160): 703-713. doi: 10.1136/bmj.317.7160.703   
  2. Sen K, Misra A, Kumar A, Pandey RM. Simvastatin retards progression of retinopathy in diabetic patients with hypercholesterolemia. Diabetes Res Clin Pract. 2002; 56(1): 1-1. doi: 10.1016/S0168-8227(01)00341-2   
  3. Ranil PK, Raman R, Rachepalli SR, et al. Anemia and diabetic retinopathy in type 2 diabetes mellitus. J Assoc physicians India. 2010; 58: 91-94.   
  4. Knudsen ST, Bek T, Poulsen PL, Hove MN, Rehling M, Mogensen CE. Effects of losartan on diabetic maculopathy in type 2 diabetic patients: a randomized, double-masked study. J Intern Med. 2003; 254(2): 147-158. doi: 10.1046/j.1365-2796.2003.01192.x   
  5. Garay RP, Hannaert P, Chiavaroli C. Calcium Dobesilate in the treatment of DR. Treat Endocrinol. 2005; 4(4): 221-232. doi: 10.2165/00024677-200504040-00003   
  6. Shaw JE, Sicree RA, Zimmet PX. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010; 87: 4-14. doi: 10.1016/j.diabres.2009.10.007   
  7. Francisco J Sepúlveda, Patricia Pérez, Martha G Medinilla, Carmen A Aboytes. Anemia as a factor related to the progression of proliferative diabetic retinopathy after photocoagulation. Journal of Diabetes and its Complications. 2012; 26(5): 454-457. doi: 10.1016/j.jdiacomp.2012.04.013