Roles for VEGF Inhibitors in the Management of Retinal Diseases - Episode 12

Future of Non-Proliferative Diabetic Retinopathy Treatment

December 13, 2021

A panel of retinal disease experts provide some advice for physicians and comment on the future of treating nonproliferative diabetic retinopathy.

W. Lloyd Clark, MD: We’re going to wrap things up. First of all, I’d like to thank our expert panel today. What a great discussion, very informative. Really a comprehensive discussion on anti-VEGF therapy, diabetic retinopathy, and the management of diabetic retinopathy with our most effective agents. Before we conclude, I’d like to get your parting thoughts from the panel. First, let’s start with Joe Coney.

Joseph M. Coney, MD: One thing that we didn’t hit on, I just want to leave this as a note because we’re all trialists on this call here; it’s that if we’re going to continue to make an impact, particularly in diabetes, we also need to make sure that our clinical trials are representative of the people that we treat. And that means increasing the number of minorities in our clinical trials. It was very disheartening for me to see when I look back at VISTA and VIVID, and see how many Black patients were randomized in those trials; it really bothers me. We need to make sure that the efficacy is good across all ethnic groups, and the only way we do that is that it’s our responsibility to have that discussion with patients. It also may be important to increase the number of minority PIs [primary investigators]. As we are teaching our residents in how to get involved with clinical trials, these are some of the discussions that we may be able to have with them. One of the problems with this community is that we have a hard time recruiting patients because of their trust of the system, the communication with the physician. And sometimes they resonate more with people who look like them.

This also helps with consumer education and also health literacy. There are pockets in this country where they don’t even understand that diabetes affects the eye. Once they get into our office, we do a fairly good job with them. Obviously, we diagnose them early, they get good treatment, we stabilize their vision. But the problem is getting them to see us early, and part of that is just getting used to being seen. And then hopefully, at some point, with the data that we get from trials, we can make sure that the efficacy is the same. At some point, we can get to a point where we are getting a personalized approach. That’s what we’re really talking about here, personalizing treatments based on a person’s eye disease. But in order to do that, we need to make sure that all are represented.

W. Lloyd Clark, MD: Diana Do, first, a great discussion today. Give us your last thoughts on this topic.

Diana V. Do, MD: The key impact that I’d like to leave our colleagues is that we do have effective and safe treatments now for diabetic eye disease, specifically severe nonproliferative diabetic retinopathy. And engaging our patients in this discussion and allowing them to know that they can have an improvement and a reduction in the risk of vision-threatening complications if we start proactive treatment would be a beneficial, educational conversation to have. There are millions of Americans out there who are at risk of progression of their diabetic eye disease, and if we try to proactively treat them, we really can make a big impact on their lives.

W. Lloyd Clark, MD: And finally, Ehsan Rahimy, you get the final word.

Ehsan Rahimy, MD: It was honestly a great discussion with great colleagues here today. My final parting words would be this battle we’re waging against diabetic eye disease is obviously a multidisciplinary approach. And at least the 2 take-home points for me would be, one, engaging with educating our colleagues who are responsible for, oftentimes, being the first entry point into the care system for some of these patients with diabetes to get them in, get them referred to see us, engage with their optometrists or ophthalmologists, PCPs [primary care physicians], endocrinologists, and encouraging early referrals when they’re uncomfortable, making sure patients are getting their screenings done. But then also, as Diana alluded to, we need to make sure they understand that there is safe, efficacious treatment available now. And whether we’re turning back the hands of time, or potentially just resetting the clock, it remains to be seen how permanent some of these effects are. But knowing that we can turn back at least the disease severity a little bit and offering this treatment to our patients and allowing them to partake in these treatment decisions is key.

W. Lloyd Clark, MD: To our audience, thank you very much for watching this HCPLive® Peer Exchange. If you enjoyed this content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your inbox.

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