Diabetic retinopathy: history, modern approaches to management, prospective views of prevention and treatment

Abstract

Diabetic retinopathy (DR) is a serious complication of diabetes mellitus (DM). As DR progresses, it could be complicated with a significant decrease or complete loss of vision. It is the leading cause of blindness in the working-age population and, according to global estimates, occurs in one in every three patients with diabetes. DR has been studied for more than 160 years, and the implementation of retinal laser coagulation into clinical practice in the 20th century, and then vascular endothelial growth factor (VEGF) inhibitors in the 21th century, allowed us to influence vascular proliferation in DR and reduce the risk of vision loss from diabetic macular oedema (DME). However, these tools can only stop the progression of DR at the stages with risk of complications with vision loss, and prevention screenings and the impact on risk factors (hyperglycaemia, arterial hypertension, and dyslipidemia) remains as the main method of management of DR. Possible new risk factors (hypodynamy, obesity, body weight deficiency, and obstructive sleep apnoea syndrome) attract a lot of attention, and there is ongoing research for early markers of DR in the fundus, which could allow more active influence on the pathological process in its early stages. This review focuses on epidemiology, history of research, proven and possible risk factors, and current and promising approaches to the prevention and treatment of DR, including accurate, less traumatic laser techniques (PASCAL, NAVILAS, and D-MPL), and intravitreal antiangiogenic drugs in studies.