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Review
. 2020 Jun;34(Suppl 1):1-51.
doi: 10.1038/s41433-020-0961-6.

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Winfried M Amoaku  1 , Faruque Ghanchi  2 , Clare Bailey  3 , Sanjiv Banerjee  4 , Somnath Banerjee  5 , Louise Downey  6 , Richard Gale  7 , Robin Hamilton  8 , Kamlesh Khunti  9 , Esther Posner  10 , Fahd Quhill  11 , Stephen Robinson  12 , Roopa Setty  2 , Dawn Sim  8 , Deepali Varma  13 , Hemal Mehta  14
Affiliations
Review

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Winfried M Amoaku et al. Eye (Lond). 2020 Jun.

Erratum in

Abstract

The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

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Conflict of interest statement

WMA has received honoraria for advisory board memberships from AbbVie, Alcon, Alimera, Allergan, Bayer, Bausch and Lomb, Novartis and Pfizer, speaker Fees from Alimera, Allergan, Bayer, Novartis and Pfizer, and Educational travel grants from Alimera, Allergan, Bayer, Novartis and Pfizer. He has undertaken clinical research sponsored by Allergan, Bayer, Gyroscope, and Novartis. His institution has received research funding from Allergan, Bayer, Boehringer Ingelheim, CenterVue, Novartis, and Optos plc. CB attended advisory boards of, and received lecture fees from Novartis, Bayer, Roche, Allergan, Alimera Sciences. Her employer Bristol Eye Hospital has received research funding from Boehringer Ingelheim, Roche, Bayer, Novartis, and Allergan. Sanjiv Banerjee has received speaker fees and travel grants from Novartis, and honoraria for advisory board memberships and travel grants from Allergan. Somnath Banerjee has received honoraria for Advisory Boards from Bayer and Alimera, and Educational Travel Grants from Allergan, Alimera, and DORC. LD has received honoraria for advisory board memberships from Alimera, Allergan, Bayer, Novartis and Thrombogenics, speaker fees from Alimera, Bausch and Lomb, Bayer and Novartis and educational travel grants from Allergan, Bayer and Novartis. Her institution has undertaken clinical research sponsored by Alimera, Allergan, Bayer, Novartis and Roche. RG has received travel grants from Allergan, Bayer and Novartis and research grants from Novartis and Bayer. He has received honoraria for advisory board memberships from Bayer, Novartis, Allergan, Alimera, and Roche. FG has received honorarium for consultancy-advisory boards from Alimera, Allergan, Bayer, Novartis, Oxford BioElectronics, Roche; educational travel grants from Allergan, Bayer, Novartis and departmental research grants from Allergan, Bayer, Boehringer Ingelheim, Chengdu Pharma, Novartis, PanOptica. RH has received educational travel awards from Allergan, Bayer, and Novartis. He has served on advisory boards of Allergan, Bayer, Novartis, and Roche. His institution has received research funding from Allergan, Novartis, Roche, Bayer, Thea, and Thrombogenics. KK has received honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Berlin-Chemie AG/Menarini Group, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi, Takeda, Servier and Pfizer, research support from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Sanofi and Pfizer. HM has received research grants, educational travel grants and honoraria for advisory board memberships from Allergan, Bayer, Novartis and Roche. EP has received honoraria for advisory board memberships from Alimera, Allergan, Educational sponsorships from Alimera, Allergan, and Bayer, and speaker fees from Allergan, Novartis. Her institution has received research funding from Bayer. FQ has received honoraria for advisory board memberships and speaker fees from Alimera Sciences, Allergan, Heidelberg Engineering, SIFI, Meagate and Novartis. He has received educational travel grants from Alimera Sciences, Allergan, Heidelberg Engineering, SIFI, Meagate and Novartis. SR has no declarations. RS has received educational travel grants and speaker fees from Allergan, Bayer, and Novartis. DS has received speaker fees and travel grants from Allergan, Bayer, Novartis, and Roche, and honoraria for advisory board memberships from Allergan and Big Picture Medical UK. DV has received honoraria for advisory board meetings and speaker fees from Allergan, Bayer and Novartis; travel sponsorships from Alimera, Allergan, Bayer and Novartis. Her institution has undertaken clinical research sponsored by Allergan, Alimera, Bayer, Roche, Boehringer Ingelheim, Chengdu Kanghong Biotechnology Co Ltd and Novartis.

Figures

Fig. 1
Fig. 1. Existing UK DMO pathway.
Pathway based on CRT and lens status. CFT central foveal thickness; CNV choroidal nevoascular membrane; DMO diabetic macular oedema; VEGF vascular endothelial growth factor.
Fig. 2
Fig. 2. Existing UK DMO ‘anti-VEGF first-line’ pathway: based on NICE TAs for eyes with CFT > 400 μm.
NICE The National Institute for Health and Care Excellence; VEGF vascular endothelial growth factor.
Fig. 3
Fig. 3. Summary of recommended pathway for non-centre involving DMO: consensus recommendation.
DMO diabetic macular oedema.
Fig. 4
Fig. 4. Consensus Recommended Pathway for Management of Centre-involving DMO.
CFT central foveal thickness; DMO diabetic macular oedema; VEGF vascular endothelial growth factor.
See this image and copyright information in PMC

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