Diabetic Retinopathy

5 Questions With Dr Theodore Leng: Diabetic Retinopathy, Anti-VEGF, and Laser Treatments

Diabetic retinopathy is a serious complication of diabetes that can lead to vision loss if left untreated, according to the American Academy of Ophthalmology (AAO).1

The 2 stages of diabetic retinopathy, non-proliferative and proliferative diabetic retinopathy, each affect vision differently and require specific treatment. Several treatment options for diabetic retinopathy exist and are administered to patients based on the nature and severity of their condition.

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Theodore Leng, MD, FACS, who is a board-certified ophthalmologist and assistant professor of ophthalmology at Stanford University Medical Center in California, recently presented “Update on Diabetic Retinopathy: The Role of Anti-VEGF and Laser”2 at the AAO 2017 Annual Meeting. Consultant360 spoke with Dr Leng, who shed some light on treatment options for diabetic retinopathy.

Note: Zachary Bodnar, MD, also contributed to the content of this article.

Consultant360: What is diabetic retinopathy, and how common is it among patients with diabetes?

Theodore Leng: Diabetic retinopathy is an injury to the small capillaries of the retina caused by poorly controlled blood sugar. This results in a reduction in the oxygen supply to the retina, which, in turn, causes the formation of new, abnormal blood vessels that may leak, bleed, or cause a retinal detachment.

The prevalence of diabetic retinopathy is approximately 20% to 40% of individuals with diabetes and is more common in those who have had diabetes for many years.

C360: Of all patients with diabetes, which patients have the highest risk for diabetic retinopathy?

TL: Diabetic retinopathy is more common in patients with type 1 diabetes vs those with type 2 diabetes. The risk of diabetic retinopathy increases the longer a person has lived with diabetes. However, good control of blood sugar can reduce this risk.

C360: What are anti-VEGF therapy and laser treatment? Are they considered the standard of care for diabetic retinopathy?

TL: Vascular endothelial growth factor (VEGF) is a molecule produced by the body in response to a chronic lack of oxygen that stimulates the growth of new blood vessels. Anti-VEGF medications can be injected into the eye to block this signal and are very effective at treating diabetic retinopathy. They are the standard of care for macular edema caused by diabetic retinopathy.

Laser treatments are used to treat portions of the retina that have a poor supply of oxygen.  This reduces the production of VEGF and is the standard of care for the treatment of proliferative diabetic retinopathy (the growth of new, abnormal blood vessels).

C360: Are there alternative treatments if anti-VEGF therapy and laser treatment cannot be used?

TL: Steroid injections into the eye are very effective treatments for macular edema associated with diabetic retinopathy, but they are associated with complications including increased rate of cataract formation and high pressure in the eye that can lead to glaucoma. Some patients with very severe diabetic retinopathy, bleeding inside the eye, and retinal detachments may need vitrectomy surgery to prevent further vision loss.

C360: What are you hoping practitioners take away from your session?

TL: I hope that the ophthalmologists attending my session will come away with the most recent treatment strategies for their patients with diabetic retinopathy through an engaging group discussion.

—Christina Vogt


1. Diabetic retinopathy. American Academy of Ophthalmology. Accessed on November 8, 2017.

2. Leng T. Update on diabetic retinopathy: the role of anti-VEGF and laser. Presented at: American Academy of Ophthalmology (AAO) 2017 Annual Meeting; November 11-14, 2017; New Orleans, LA.