Preface

Diabetic retinopathy is the most common microvascular complication of diabetes and remains a major cause of new-onset visual loss in the United States and other industrialized nations. In addition to the morbidity and suffering caused by visual loss, the economic impact from diabetic retinopathy is tremendous. Despite significant advances in scientific understanding of diabetic retinopathy, the major treatments for this condition have largely remained the same for many years. Indeed, laser photocoagulation for proliferative diabetic retinopathy emerged in the late 1960’s, and the Early Treatment Diabetic Retinopathy Study (ETDRS) guidelines for laser treatment of macular edema were formulated around the mid-1980’s. Guidelines for vitrectomy for vitreous hemorrhage and retinal detachment were also formulated in the 1980’s.

However, new therapeutic strategies are being advanced, which raise the prospect that the years ahead will see very significant additions to the options for treatment of diabetic retinopathy. Both corticosteroids and anti-VEGF treatments are serving as additional options in the clinical management of DR. The emergence of anti-VEGF treatments strongly highlights the advent of rational drug therapy based on the identification of causative mechanisms and molecular targets. There is ample reason to anticipate additional significant therapeutic advances in the not too distant future, made possible by the great progress that has been made in identifying new molecules, pathways, and processes that promote diabetic retinopathy, all of which serve as potential therapeutic targets.

For these reasons, this is a very appropriate time to assess the current state of knowledge regarding the clinical management of DR as well as its underlying mechanisms. This book is intended to depict the current clinical understanding of DR as well as the many scientific advances in understanding this condition. The first section encompasses the current understanding of diabetic retinopathy from a clinical standpoint, including current clinical practice. The second section serves as a description of the current understanding of the pathophysiology of DR from the standpoint of biomedical research. Many of these advances may serve as the basis for the development of additional therapeutic strategies. The pathogenesis of DR is certainly multi-factorial, and there is clearly interplay between many of these factors. Although a wide array of topics is covered, this section certainly does not encompass the entire gamut of pathogenic mechanisms of this complex disease, and it is anticipated that further important molecules and processes will emerge in the years ahead. The third and final section discusses new and more recent concepts relating to management and treatment of DR.

I am grateful to the many authors who contributed the chapters in this text. These individuals are internationally recognized leaders in diabetic retinopathy, and their prominence and expertise in their respective fields are invaluable to this discussion. Indeed, I have every expectation that they will continue to be among the leaders in advancing

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