Upfront
Diabetic Eye Care: Past, Present, Future

In this issue of Retinal Physician, we tackle the problem of diabetic retinopathy. Retinal complications from diabetes mellitus remain the leading cause of vision loss for people under 50. Landmark laser trials performed in the 1970s and 1980s gave us clear guidelines on how to use photocoagulation to control proliferative and nonproliferative forms of this disease. However, despite the successful treatment, patients continued to experience vision loss or even blindness due to chronic macular edema, retinal ischemia, proliferative fibrovascular growth with retinal detachment, and vitreous hemorrhage.

In an attempt to improve the patient outcome, advances in surgical technique and instrumentation were the main focus from the 1980s to early in this decade. Additionally, the ability to better identify patients with disease or with high-risk characteristics has improved, allowing for earlier intervention and reduction in vision loss.

More recently, treatment has begun to turn toward a pharmacological approach for management of diabetic complications. Although successful, laser photocoagulation does induce damage to retinal tissue in order to achieve its success. The possibility of controlling both the exudative and proliferative manifestations of this retinal vascular disease offers an opportunity to provide better visual function and perhaps longer-term stability for individuals with diabetes.

As you will see, we've come a long way from the 1960s where the only management for diabetic retinopathy involved a neurosurgical approach with pituitary ablation. As frightening a thought as that may be today, it is likely that 10 to 15 years from now we will look back on therapies used now with equal shock and amazement.

This issue also contains information on coding and reimbursement, imaging, lasers for AMD, expanding use of ambulatory surgery centers for vitreoretinal procedures, and the controversial topic of specialty accreditation.

As Retinal Physician moves forward, we welcome your feedback, and encourage you to take advantage of this new forum to express your views and share your experience and research. We are now accepting original research papers for peer review publication as well as case reports and "Op-Ed" pieces that provide your colleagues with insight into patient and practice management issues.