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Invited Commentary
March 30, 2021

Practicality of Prophylactic Aflibercept to Reduce Diabetic Retinopathy Progression

Author Affiliations
  • 1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
JAMA Ophthalmol. 2021;139(7):713-714. doi:10.1001/jamaophthalmol.2021.0624

Anti–vascular endothelial growth factor (VEGF) therapy has revolutionized the treatment of diabetic retinopathy, including diabetic macular edema and proliferative diabetic retinopathy (PDR). Diabetic Retinopathy Clinical Research (DRCR) Retina Network Protocol S1 and the Clinical Efficacy of Intravitreal Aflibercept Versus Panretinal Photocoagulation for Best Corrected Visual Acuity in Patients With Proliferative Diabetic Retinopathy at 52 Weeks (CLARITY)2 trials demonstrated superior visual acuity outcomes with anti-VEGF treatment compared with panretinal photocoagulation (PRP). DRCR Retina Network Protocol T showed that visual acuity improved in anti-VEGF–treated eyes with center-involved diabetic macular edema (CI-DME) accompanied by vision loss.3 However, the role of prophylactic anti-VEGF treatment in eyes with moderate or severe nonproliferative diabetic retinopathy (NPDR) and good vision to reduce the risk of progression to PDR or CI-DME with vision loss has not been defined. DRCR Retina Network Protocol W addresses this question.

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