Prognosis

Diabetic retinopathy is a chronic, progressive disease.

Patients treated with macular laser therapy alone for diabetic macular edema may show recurrence in the same or other eye. Treatment is usually limited to areas of retinal thickening, and untreated areas may develop edema. Visual loss may develop despite treatment.[80] By contrast, patients treated for center-involving diabetic macular edema with ranibizumab and either deferred or prompt laser gained 9.8 or 7.2 letters over a 5 year period.[131]

Patients treated with panretinal photocoagulation alone for proliferative diabetic retinopathy (PDR) are less likely to lose vision through vitreous hemorrhage than those who are untreated. Although hemorrhage can occur despite treatment, many patients reach a steady state in which fibrovascular proliferation ceases.[74] It is possible, given the superior visual acuity results obtained with aflibercept monotherapy compared with panretinal photocoagulation in the treatment of proliferative diabetic retinopathy, that prognosis for this condition may improve in the future.[123]

Eyes that have undergone vitrectomy commonly show little postoperative progression of retinopathy.

In higher resource countries in which effective primary care, screening, and secondary care resources are available, good visual outcomes can be achieved.[35]​[122]​

However, even in high-resource countries, visual prognosis for some may be poor. The 5-year loss to follow-up excluding deaths in the studies above was around 40%, and loss to follow-up is associated with visual loss.[132]​[133]​[134]​[135]​ In addition, some individuals and communities within high-resource countries may have poorer prognosis.

In many lower- and middle-income countries, and in newly affluent countries, primary care, screening programs, and secondary care may not be sufficient to identify patients with sight-threatening retinopathy and permit timely and appropriate treatment. In such contexts, the visual prognosis of diabetic retinopathy may be poor.

A meta-analysis found that the presence of any retinopathy increased all-cause mortality/major cardiovascular events in both type 1 (odds ratio 1.58) and type 2 diabetes (odds ratio 2.34). This effect was more pronounced in patients with advanced retinopathy, both in type 1 (odds ratio 7.00), and type 2 (odds ratio 4.22). Not all additional mortality could be explained on the basis of cardiovascular events.[136]​

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