DIAGNOSING AND TREATING A PATIENT LIKE KEVIN

Fundoscopic appearance of moderately severe NPDR, bilateral OD/OS
Fundoscopic appearance of moderately severe NPDR, bilateral OD/OS
Fundoscopic appearance of moderately severe NPDR, bilateral OD/OS.

For a patient with nonproliferative diabetic retinopathy (NPDR), the overarching goal is to reduce disease severity and reduce progression to proliferative DR (PDR). You can help drive patient outcomes through early detection, monitoring, and timely referral.1-3 A severity scale can help identify and standardize the clinical features of diabetic retinopathy (DR) at various stages and allow for early detection and timely intervention.1,4-6

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Moderately Severe NPDR Example

Kevin

Male

58 years of age

Right eye (OD), Left eye (OS)

Moderately severe NPDR, bilateral OD/OS

Onset 5 years ago

No previous treatment

Clinical Findings

Retinal:
  • OD—Microaneurysms, small intraretinal hemorrhages in 4 fields, venous beading definite in 1 field; intraretinal microvascular abnormalities definite in 1 field
  • OS (not pictured)—Microaneurysms, small intraretinal hemorrhages in 4 fields, venous beading in 1 field, intraretinal microvascular abnormalities definite in 1 field, diffuse hard and soft exudates

ETDRS-DRSS Score: 47, bilateral

CRT: OS—247 μm, OD—253 μm

IOP: OS—15 mm Hg, OD—16 mm Hg

ETDRS Letters: OD—81, OS—80

Snellen Equivalent: 20/25, bilateral

HbA1c: 9.3

BMI: 31

Medical History

Comorbidities: Type 2 diabetes (13 years), treated with insulin; diabetic neuropathy treated with pregabalin; obesity

Familial: None known

Note: This is a representative case example that you may encounter in clinical practice.

BMI = body mass index; CRT = central retinal thickness; ETDRS-DRSS = Early Treatment Diabetic Retinopathy Study–Diabetic Retinopathy Severity Scale; HbA1c = glycated hemoglobin; IOP = intraocular pressure.

Insurance

Commercial, no restrictions

Timely Refer Appropriate Patients to a Retina Specialist Who Can Treat DR2,3

See More Important Safety Information and Indications
  • CONTRAINDICATIONS: EYLEA® (aflibercept) Injection is contraindicated in patients with ocular or periocular infections, active intraocular inflammation, or known hypersensitivity to aflibercept or to any of the excipients in EYLEA.
Important Safety Information and Indications INDICATIONS

EYLEA® (aflibercept) Injection 2 mg (0.05 mL) is indicated for the treatment of patients with Neovascular (Wet) Age-related Macular Degeneration (AMD), Macular Edema following Retinal Vein Occlusion (RVO), Diabetic Macular Edema (DME), and Diabetic Retinopathy (DR).

Please see the full Prescribing Information for EYLEA.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

The information provided in this site is intended for U.S. Doctors of Optometry.

References:

  1. Early Treatment Diabetic Retinopathy Study Research Group. Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Ophthalmology. 1991;98(5 suppl):823-833.
  2. Care of the Patient With Diabetes Mellitus: Quick Reference Guide. American Optometric Association website. http://bit.ly/2M22OUJ. Accessed January 14, 2020.
  3. Ferrucci S, Yeh B. Diabetic retinopathy by the numbers. Rev Optom. June 15, 2016. http://bit.ly/2KNNJ4E. Accessed January 14, 2020.
  4. Davis MD, Fisher MR, Gangnon RE, et al; for the Early Treatment Diabetic Retinopathy Study Research Group. Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss: Early Treatment Diabetic Retinopathy Study report #18. Invest Ophthalmol Vis Sci. 1998;39(2):233-252.
  5. Staurenghi G, Feltgen N, Arnold JJ, et al. Impact of baseline Diabetic Retinopathy Severity Scale scores on visual outcomes in the VIVID-DME and VISTA-DME studies. Br J Ophthalmol. 2018;102(7):954-958.
  6. American Academy of Ophthalmology. Preferred Practice Pattern®: Diabetic Retinopathy. http://bit.ly/2SX3H2D. Accessed January 14, 2020.