Letters to the Editor

Diabetic retinopathy: Screening, prevention, and treatment

Ashley Lim
Cleveland Clinic Journal of Medicine December 2024, 91 (12) 723; DOI: https://doi.org/10.3949/ccjm.91c.12001

To the Editor: I read with great interest the review on diabetic retinopathy by Dr. Chong and colleagues1 published in the August 2024 issue of the Journal. The article rightly emphasizes the pivotal role of primary care physicians in managing diabetic retinopathy through early detection and referrals. However, there are additional facets of diabetes care that deserve attention to further reduce the growing burden of this disease.

The authors emphasize the importance of glycemic control in preventing diabetic retinopathy. The article, however, could further explore the impact of new therapies, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, which have shown promise in managing diabetes but have complex interactions with diabetic retinopathy.2 Recent studies have highlighted potential early worsening of retinopathy when rapid glycemic control is achieved using these agents.3 Further discussion of this phenomenon could provide clinicians with a more nuanced understanding of the risks and benefits of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists.

The section on artificial intelligence in diabetic retinopathy screening could be expanded regarding the limitations of artificial intelligence tools. While systems that use artificial intelligence to identify diabetic retinopathy are promising, concerns about lower specificity and inappropriate referrals are noted in other reviews.4 A broader discussion of these limitations, as well as practical solutions, would aid in implementing such systems in clinical practice.

In summary, the authors have skillfully compiled important information on diabetic retinopathy, providing valuable guidance for clinicians treating patients with diabetes. Their thorough coverage of screening, prevention, and treatment offers critical insights. I commend their work and look forward to future updates and discussions on advancing management strategies and applying these insights in everyday clinical practice.

REFERENCES

    1. Chong DD,
    2. Das N,
    3. Singh RP
    . Diabetic retinopathy: screening, prevention, and treatment. Clev Clin J Med 2024; 91(8):503–510. doi:10.3949/ccjm.91a.24028
    1. Wai KM,
    2. Mishra K,
    3. Koo E, et al
    . Impact of GLP-1 agonists and SGLT-2 inhibitors on diabetic retinopathy progression: an aggregated electronic health record data study. Am J Ophthalmol 2024; 265:39–47. doi:10.1016/j.ajo.2024.04.010
    1. Jingi AM,
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    4. Noubiap JJ
    . Mechanism of worsening diabetic retinopathy with rapid lowering of blood glucose: the synergistic hypothesis. BMC Endocr Disord 2017; 17(1):63. doi:10.1186/s12902-017-0213-3
    1. Lim JI,
    2. Regillo CD,
    3. Sadda SR, et al
    . Artificial intelligence detection of diabetic retinopathy: subgroup comparison of the EyeArt system with ophthalmologists’ dilated examinations. Ophthalmol Sci 2022; 3(1):100228. doi:10.1016/j.xops.2022.100228