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Effect of systemic medications on onset and progression of diabetic retinopathy

Nature Reviews Endocrinology volume 6, pages 494–508 (2010)Cite this article

Subjects

Abstract

Diabetic retinopathy remains a leading cause of visual loss worldwide. Patients with diabetes mellitus commonly have multiple comorbidities treated with a wide variety of medications. Systemic medications that target glycemic control and coexisting conditions may have beneficial or deleterious effects on the onset or progression of diabetic retinopathy. In addition, data is accumulating to suggest that the use of systemic therapy primarily to address ocular complications of diabetic retinopathy may be a promising therapeutic approach. This article reviews our current understanding of the ocular-specific effects of systemic medications commonly used by patients with diabetes mellitus, including those directed at control of hyperglycemia, dyslipidemia, hypertension, cardiac disease, anemia, inflammation and cancer. Current clinical evidence is strongest for the use of angiotensin-converting enzyme inhibitors and angiotensin-2 receptor blockers in preventing the onset or slowing the progression of early diabetic retinopathy. To a more limited extent, evidence of a benefit of fibrates for diabetic macular edema exists. Numerous other agents hold considerable promise or potential risk. Thus, these compounds must undergo further rigorous study to determine the actual clinical efficacy and adverse effects before definitive therapeutic care recommendations can be offered.

Key Points

  • Individuals with diabetes mellitus are at risk of multiple systemic comorbidities, as well as numerous microvascular and macrovascular complications

  • An extensive and diverse array of medications, acting through multiple mechanisms, is available for managing the systemic comorbidities of diabetes mellitus

  • Systemic medications may have independent beneficial or deleterious effects on the onset or progression of diabetic retinopathy that are unrelated to the primary therapeutic intent

  • The ocular effects of systemic medications must be appreciated and considered when determining treatment regimens and suggesting ophthalmic follow-up

  • Accumulating data suggest that the use of systemic therapy to primarily address ocular complications of diabetic retinopathy could be a promising approach

  • As our understanding of the interactions between ocular status and systemic medications improves, close communication between all medical and eye-care providers will become increasingly important

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Acknowledgements

Laurie Barclay, freelance writer and reviewer, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, 02215, MA, USA

    Paolo S. Silva, Jerry D. Cavallerano, Jennifer K. Sun, Lloyd M. Aiello & Lloyd Paul Aiello

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  1. Paolo S. Silva
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Contributions

P. S. Silva, J. D. Cavallerano, J. K. Sun and L. P. Aiello researched the data for the article. P. S. Silva, J. D. Cavallerano, J. K. Sun, L. M. Aiello and L. P. Aiello provided a substantial contribution to discussions of the content. P. S. Silva, J. D. Cavallerano, J. K. Sun, L. M. Aiello and L. P. Aiello contributed equally to writing the article and to review and/or editing of the manuscript before submission.

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Correspondence to Lloyd Paul Aiello.

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Competing interests

L. P. Aiello is a Data Monitoring Board Member for Genentech and a consultant for Eli Lilly, GlaxoSmithKline, Merck, Novartis and Pfizer. The other authors declare no competing interests.

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Silva, P., Cavallerano, J., Sun, J. et al. Effect of systemic medications on onset and progression of diabetic retinopathy. Nat Rev Endocrinol 6, 494–508 (2010). https://doi.org/10.1038/nrendo.2010.122

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