Preventing diabetic retinopathy through control of systemic factors.

PURPOSE OF REVIEW: Diabetic retinopathy (DR), the leading cause of vision loss in working-age adults, is associated with many systemic factors that contribute to the severity and progression of this disease. Intensive glycemic and blood pressure control has been shown to delay both the onset and progression of diabetic retinopathy.

RECENT FINDINGS: Studies involving angiotensin-converting enzyme inhibitors are currently underway to elucidate the efficacy of these drugs in further reducing the progression of diabetic retinopathy by means other than just hypertensive control. Dyslipidemia is associated with macular exudates and vision loss. Anticoagulation with aspirin is neither contraindicated in diabetics nor associated with prevention or progression of diabetic retinopathy. The effects of smoking on diabetic retinopathy are equivocal. Pregnancy may be associated with the progression of diabetic retinopathy in the absence of long-term effects if serum glucose levels are well monitored and controlled prior to and during pregnancy.

SUMMARY: Genetic research is providing more insight into the pathogenesis and mechanisms of diabetic retinopathy, allowing possible identification of those at higher risk for developing diabetic retinopathy.