I never thought I would be able to say that we can reverse diabetic retinopathy during the course of my career. Yet today, we are doing exactly that. Not only are we preventing blindness, but we are improving vision, and that’s really remarkable. Despite this good news, however, we are faced with some familiar challenges.
Patients with diabetic retinopathy are about to embark on a journey that demands a huge commitment. It requires impeccable compliance to be successful with the current treatment regimen. It requires very hard work on the part of both patients and physicians, who must be consistent and persistent to achieve the best results. It’s not easy, and no one can slack off.
We often hear people talk about the burden of managing diabetic retinopathy, but the burden of vision loss is much greater. If you want to compare burdens, blindness always wins.
What I see helping people on this journey is this: Every medical professional who touches patients who have diabetes — primary eye care providers, primary care physicians, endocrinologists, nephrologists, podiatrists, pharmacists — must emphasize the critical importance of managing this disease. The staff in the retina specialist’s office has to be encouraging. Patients’ employers have to be understanding about the need for frequent time off. Family members have to be engaged and supportive.
This is not an individual’s journey. It’s a multifaceted, multi-person journey. But, the journey is worthwhile. The prize at the end? Patients get to keep their vision.
We see the very best results with DME and diabetic retinopathy in clinical trials. What is it about clinical trials that makes them unique and makes the results better?
The hallmarks of a clinical trial include consistency in treatment and follow-up, compliance, good communication, teamwork, and best management practices. It takes motivated patients to participate in clinical trials. They must adhere to a monthly schedule, not only for possible treatments but to be monitored and have data collected. The study team reminds patients to keep their appointments and calls them if they miss appointments. Everything we do to ensure the success of a clinical trial helps to make each patient’s journey successful. Thus, I propose that we treat all of our patients as if they’re in a clinical trial.
Is this a realistic goal? I believe it is. I have many very compliant patients in my practice who are not in clinical trials, and they achieve equally good results.
Early in the anti-VEGF era, the clinical trials required monthly injections, and most clinicians predicted that regimen would be unsustainable. Yet, today, many of us administer monthly injections for 3 to 6 months at a time, and even those who follow a treat-and-extend regimen typically administer 10 injections in the first year. So we can do that; there’s precedent. Whatever regimen we follow, we — as individuals who take care of patients with diabetes — must be committed to this journey, and so must our patients.
In the articles that follow, clinicians share insights on this journey and the tools and processes they employ to help navigate their patients toward successful outcomes. ■