At the Retina 2025 conference in Koloa, Hawaii, leading experts highlighted how 20 years of DRCR Retina Network clinical trials have revolutionized the treatment approach for diabetic eye diseases, establishing new paradigms that directly impact patient care.
"We cannot overstate some of these fundamental contributions to clinical care," emphasized John W. Kitchens, MD, during his comprehensive review of the network's landmark studies and their clinical implications.
Anti-VEGF Therapy and Treatment Strategies
The trials have definitively established anti-VEGF therapy as the standard of care for diabetic macular edema (DME). Research demonstrates that combination therapy, utilizing intravitreal dexamethasone implants alongside anti-VEGF agents such as ranibizumab, provides enhanced retinal drying effects. This finding has practical implications for clinical practice, as Dr. Kitchens noted, "The way I treat in my clinic is I look at OCT, and I want to see the dryest possible OCT."
Cost Considerations and Treatment Alternatives
A significant finding from the research reveals substantial cost variations among anti-VEGF therapies, an important consideration for healthcare providers and patients. The studies also demonstrated that panretinal photocoagulation (PRP) is noninferior to anti-VEGF treatment for proliferative diabetic retinopathy (PDR), offering a viable alternative treatment pathway.
Challenging Traditional Approaches
The research has challenged several conventional treatment approaches. Notable findings include:
- Topical antibiotics do not reduce endophthalmitis risk
- Pattern scan PRP may be less effective than single-spot PRP for limiting PDR progression
- Not all DME cases require immediate intervention
Watchful Waiting Versus Early Intervention
A particularly significant finding relates to treatment timing. "For patients with good visual acuity and center-involved DME, you don't need to treat right away," Dr. Kitchens explained. This observation is supported by data showing that not all subclinical, non-center involved DME progresses to center involvement.
Protocol W, focusing on nonproliferative retinopathy, demonstrated that while anti-VEGF therapy could reduce progression to proliferative disease, a watchful waiting approach might be more appropriate. As Dr. Kitchens elaborated, "We have treatment for these things. If they occur and PDR or DME develops, anti-VEGF and anti-VEGF with PRP laser treatment are effective, so why not wait and watch those patients then treat them when it occurs?"
