Diabetic eye disease is the most common microvascular complication in the diabetic population and remains a leading cause of blindness among working-age adults in the developed world. The recent introduction of therapies targeting the vascular permeability factor and angiogenic mediator vascular endothelial growth factor (VEGF) has had a profound impact on the treatment of patients with diabetic eye disease. Clinical trials assessing the efficacy of anti-VEGF therapies have demonstrated a response to treatment in most patients with diabetic macular edema (DME). However, whether or not patients respond to anti-VEGF therapy, they require multiple (monthly) treatments, and most will have persistent DME despite aggressive therapy.1 A major improvement in visual acuity (ie, a gain of at least 15 letters—or 3 lines—on the Early Treatment Diabetic Retinopathy Study visual acuity chart) is observed in only a minority (approximately 40%) of treated patients with DME.1 While vision improvement in these clinical trials may be limited by a ceiling effect in those patients who have a relatively modest reduction of baseline (pretreatment) visual acuity, these results suggest that anti-VEGF therapy alone may not be sufficient to adequately treat DME in some diabetic patients.
Sodhi A, Montaner S. Angiopoietin-like 4 as an Emerging Therapeutic Target for Diabetic Eye Disease. JAMA Ophthalmol. 2015;133(12):1375-1376. doi:10.1001/jamaophthalmol.2015.3723