ETDRS study
PRP safe to defer until severe NPDR or PDR
Focal laser reduced risk of moderate visual loss 50% and severe by 4-10%
Defined CSMO
Aspirin no effect on DR and VH
What is high risk PDR
NVD - greater than 1/4 to 1/3 disc area in size located on or within 1DD of disc
Any size NVD with VH or pre-retinal haem
NVE - over 1/2 disc area associated with vitreous or preretinal haemorrahge
Vitreous or pre-retinal haem associated with NVD/NVE
Focal laser reduced risk of moderate visual loss by
505
Reduction in severe visual loss by focal laser?
4-10%
ACCORD study
Intensive glycaemia control - targeted HbA1c<6% vs standard therpy
Intensive lipid control - combination therapy with statin + fibrate vs statin monotherapy
Intensive BP control - targetting SBP of <120 vs <140
T2DM
High risk - 40-79, CVS disease, 55-79 with atherosclerosis, LVH, albuminuria
ACCORD findings
Slowing down of progression of retinopathy was observed in patients treated intensively for glycaemia and those who were treated with fenofibrate in addition to statin but NO effect was observed in those treated with intensive BP control
Non-ocular related arms
The addition of fenofibrate to simvastatin did NOT reduce rate of fatal CVS events
Intensive glycaemic control did not significantly reduce major CVS events
Targeting a SBP <120 compared with <140 did not reduce rate of composite outcome of fatal and nonfatal major CVS events
Wet AMD studies
IVAN
ANCHOR
VIEW1
ANCHOR
Monthly ranubizumab is better than PDT for classic CNV
IVAN
Inconclusive evidence that bevacizumab was non-inferior to ranibizumab
VIEW 1 and 2
Aflibercept was non-inferior to ranibizumab
RISE
Studied ranibizumab treating DMO
DRS
Showed that PRP safe and effective at preventing the risk of visual loss and blindness in patients with advanced DR
PRP reduced incidence of severe visual loss by 50% at 5 years
(5/200 or worse)
UKPDS
Demonstrated the importance of blood sugar control in T2DM
Progression of DR was reduced by 21% and the need for PRP by 29% in the intensive control group
Pts with a tight BP control had 34% reduction in progression of DR
DCCT
Demonstrated importance of good blood glucose control in T1DM
Intensive control reduced incidence of DR by 74%, and reduced of progression of DR by 54%
AREDS
Vitamin C
Vitamin E
Beta carotene
Zinc
Copper Oxide
AREDS
Category 1 - No or few small drusen
Category 2 - Many small drusen or a few medium sized drusen
Category 3 (intermediate AMD) - Many medium sized drusen or on or more large drusen in one or both eyes
Category 4 (advanced AMD): in only one eye - geographic atrophy or wet AMD
Randomised to
1. Antioxidant + zinc + copper
2. Zinc + copper
3 Antioxdiant
4 Placebo
AREDS Results
Category 2 - antioxidants and zine did not slow rate of progression
Category3/4 - risk of developing advanced AMD reduced by 25%
Use in intermediate AMD in either eye or advanced AMD in one eye
AREDS2
+ lutein and xeaxanthin
+ omega fatty acids
Eliminating beta-carotene (increased lung cancer in smokers)
Lowering zinc doses
AREDS2 findings
Adding omega-3 fatty acids or lutein + xeaxanthin had no additional effect on the risk of advanced AMD
Eliminating beta-carotene or reducing zine and no significant effect in effectiveness
Lutein + xeaxanthin coudl be appopriate beta carotene substitute in smokers
