This summer has been a hotbed of activity in the retina space, and geographic atrophy (GA) has taken center stage. We know that this is the diabetes issue, and we will get to that, but we would be remiss if we didn’t spend a few minutes discussing the new kids on the block. We now have two therapies, pegcetacoplan (Syfovre, Apellis) and avacincaptad pegol (Izervay, Iveric Bio/Astellas), for the treatment of GA, a condition that previously had no therapeutic options. These approvals mean that we have important—and careful—conversations ahead of us with our patients with GA.

A show of hands at the annual American Society of Retina Specialists (ASRS) meeting revealed that nearly a third of a packed conference room had already started treating patients with GA. However, it’s been a rocky start to the era of GA therapy, considering that, at the time of the meeting, there were seven cases of occlusive retinal vasculitis after the injection of pegcetacoplan presented by the Research and Safety in Therapeutics committee of the ASRS. Of those ASRS attendees who said they had already treated patients, at least half, if not more, also indicated that they planned to ease off treatment until more safety information becomes available. With avacincaptad pegol entering the market in August, the clinical decisions have only gotten more challenging.

It’s exciting, for sure. Our field is abuzz with excitement, speculation, conversations, and concerns.

Amid the hubbub, some of our other bread-and-butter clinical scenarios, like diabetic eye disease, seem to have taken a back seat in our conversations. Treating diabetic retinopathy (DR) isn’t as novel or controversial as GA therapy, but it’s a critical topic that deserves our attention. We also have a few advances to spice up our DR treatment paradigm, including the newly FDA-approved 8 mg aflibercept (Eylea HD, Regeneron), which may extend therapy for some patients out to 16 weeks.1

Just a few months ago, authors published updated DR prevalence numbers in JAMA Ophthalmology, and the statistics are daunting.2 As of 2021, an estimated 9.6 million people in the United States have DR—a whopping 26.43% of patients with diabetes. Of those patients with DR, nearly 2 million (5.06%) already have vision-threatening disease.2 The study authors note that these numbers have skyrocketed since we last checked the prevalence in 2004. Back then, researchers estimated that 10.2 million US adults at least 40 years of age had diabetes—now, we have almost as many with DR alone.3 In addition, just shy of 900,000 patients had vision-threatening DR in 2004, and that number is now approaching 2 million.3 Scary stuff.

What can we—the clinicians who see these patients after the damage has already been done—do to help? The first is awareness. The author of the JAMA Ophthalmology invited commentary, Xiangrong Kong, MD, at Wilmer Eye Insitute, uses the appropriate term pandemic to describe what we are dealing with.4 However, after the COVID-19 pandemic, the term has lost much of its oomph, even though COVID-19 affected more than 700 million people globally and led to nearly 7 million deaths.5 We do wonder what would happen if we started telling our patients with diabetes that they are part of a long-standing pandemic. Maybe that type of language would help them better understand the seriousness of their diagnosis and the importance of adhering to treatment.

We probably aren’t going to start tossing around the term pandemic every time we see a patient with DR, but there are many simple way to affect change in our clinics. In one of this issue’s featured articles, Brittany Long, BS, and Allison Menezes, MD, suggest that retina specialists can spend 2 minutes discussing healthy eating habits and help more than 20% of patients improve their diets and glycemic control. Other authors share pearls for improved diagnostics with ultra-widefield imaging, approaches for medical and surgical treatment, and tips for identifying rare cases of maturity-onset diabetes of the young.

Taken together, these articles are designed to help refocus our attention on the pandemic that has plagued our offices for decades. An estimated 1.49 million people have late-stage AMD (wet AMD or GA).6 We know that this is a gross underrepresentation of the population at large, and it is an essential population to serve and treat, but it’s still a far cry from the 9.6 million patients with DR.2 We must remain diligent and work hard to screen, educate, and treat patients with diabetes—to get the pandemic under control, once and for all.

1. FDA Approves Regeneron’s High-Dose Aflibercept, Eylea HD [press release]. Eyewire+. August 19, 2023. Accessed August 21, 2023. eyewire.news/news/fda-approves-regenerons-high-dose-aflibercept-eylea-hd

2. Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of diabetic retinopathy in the US in 2021 [published online ahead of print June 15, 2023]. JAMA Ophthalmol.

3. The Eye Diseases Prevalence Research Group. The prevalence of diabetic retinopathy among adults in the United States. Arch Ophthalmol. 2004;122(4):552-563.

4. Kong X. Diabetic retinopathy in the US—Where we are now and what is next [published online ahead of print June 15, 2023]. JAMA Ophthalmol.

5. WHO Coronavirus (COVID-19) Dashboard. Updated August 13,2023. Accessed August 21, 2023. covid19.who.int

6. Rein DB, Wittenborn JS, Burke-Conte Z, et al. Prevalence of age-related macular degeneration in the US in 2019. JAMA Ophthalmol. 2022;140(12):1202-1208.