Changing times for the management of diabetic retinopathy.

Laser photocoagulation has led a revolution in the management of diabetic retinopathy. Scatter photocoagulation and focal photocoagulation has been shown to be effective in reducing vision loss. Just as dramatic as laser photocoagulation, medical treatment has led another revolution in the treatment of diabetic retinopathy. Good glycemic, blood pressure, and lipid control have contributed to further reduce vision loss and laser photocoagulation. In the very near future, there will be significant advances in pharmacologic treatment of diabetic retinopathy. Treatment with antioxidants, agents inhibiting hyperglycemia-induced protein kinase activity, and other agents will likely prevent the development/progression of retinopathy. Because pharmacologic agents are aimed at the prevention of retinopathy, patients with retinopathy will need to be examined earlier to diagnose retinopathy at earlier stages. To maximize the opportunity for earlier diagnosis, ophthalmologist may need to adopt screening strategies to identify patients most likely to benefit from these new treatments.