The focus on retinal vascular disease in this issue brings to the fore a striking dichotomy in current treatment options. Thermal laser photocoagulation has continued to be a standard of care and mainstay of treatment for retinal vascular diseases in recent years, while at the same time pharmacologic therapies have eclipsed the use of laser for treatment of neovascular age-related macular degeneration (AMD).

Consider, for example, of the Diabetic Retinopathy Clinical Research Network (DRCR.net) trial of triamcinolone vs laser in diabetic macular edema, or the SCORE-BRVO trial in patients with branch retinal vein occlusion. In both of these randomized controlled trials, intravitreal injection of triamcinolone showed no significant treatment benefit over macular grid laser photocoagulation over time. Meanwhile, vascular endothelial growth factor (VEGF) inhibitors have revolutionized the care of patients with choroidal neovascularization secondary to AMD.

This may soon change, however. Pharmacologic therapies for retinal vascular diseases may be catching up with the advances in neovascular AMD treatment. In this issue, for example, we have an update from David M. Brown (page 38) on the results of the BRAVO and CRUISE studies of ranibizumab (Lucentis, Genentech, Inc.) in the treatment of BRVO and CRVO, respectively. Both of those trials showed a significant treatment benefit for intravitreal ranibizumab injection over the standard of care.

Sustained-delivery strategies are also showing potential promise of advantages over intravitreal injection of steroids. The Ozurdex dexamethasone implant (Allergan, Inc.) was reasonably well tolerated and produced substantial improvements in visual acuity in patients with BRVO in 12-month results presented at the Macula Society meeting (page 56). The Iluvien fluocinolone acetonide implant (Alimera Sciences) significantly improved visual acuity in patients with diabetic macular edema in 2-year results presented at Angiogenesis 2010 (Retina News, March issue of Retina Today). And the Verisome triamcinolone delivery system (Icon Biosciences) showed evidence of efficacy in a phase 1 trial, as Anne E. Fung details in this issue (page 51).

We will soon have more important information regarding anti-VEGF or corticosteroid therapy in combination with macular laser photocoagulation for diabetic macular edema from the DRCR network. It is likely that laser photocoagulation will remain a treatment tool for this retinal vascular disease, in sharp contrast to the scenario in exudative AMD.