FDA Approves New Treatment for Diabetic Eye Condition
Written by Ginger Vieira on May 28, 2019
The drug Eyela can be used to treat the early stages of diabetic retinopathy, reducing the chances of serious vision loss.
Diabetic retinopathy is the leading cause of blindness in adults across the globe, according to the American Journal of Managed Care.
The most challenging aspect of retinopathy is that it often goes undetected until too much damage has been done and the person affected is already losing their vision.
As a result, this nearly silent assault on the eyes leaves people living with diabetes with few treatment options as the severity of the condition and vision loss worsens.
However, a new treatment option — Eylea, from Regeneron Pharmaceuticals — has just been approved by the Food and Drug Administration (FDA) to treat all stages of diabetic retinopathy.
Eylea is a “vascular endothelial growth factor (VEGF)” inhibitor, which means it works by blocking the growth of potentially abnormal blood vessels. It reduces swelling and reduces the leakage and bleeding that’s responsible for increasing vision loss.
First created to treat diabetic macular edema, Eylea’s recent FDA approval will give people struggling with the threat of vision loss a greater chance of preserving their sight.
Regeneron’s press release reported that during a recently published clinical trial, Eylea reduced a patient’s risk of early signs of retinopathy from progressing into “proliferative diabetic eye disease” by 85 to 88 percent.
“Eylea is the only drug that has been approved for the early treatment of diabetic retinopathy to attempt to prevent the progression of serious retinal complications,” Dr. Mark Fromer, an ophthalmologist at Fromer Eye Centers in New York City, told Healthline.
While there are treatments for retinopathy that work similarly, experts say Eylea presents the best opportunity for a patient whose retinopathy is detected early to preserve as much vision and overall eye health as possible.
How diabetes threatens eyesight
While a person with diabetes can develop retinopathy even with well-managed blood sugar levels, the condition is generally rare.
Most cases of retinopathy are the result of chronically high blood sugar levels that gradually damage blood vessels in the retina of a person’s eye.
As the excessive amount of glucose in a person’s bloodstream damages and destroys those blood vessels, they will eventually begin to bleed or leak and impair vision, according to the National Eye Institute (NEI).
In addition to diligent diabetes management, one of the only ways to prevent severe vision loss from retinopathy is by stopping it early in its tracks — before symptoms develop — through annual eye exams with an optometrist.
Further developed retinopathy can reveal these signs and symptoms, according to the American Optometric Association:
Seemingly sudden or double vision
Difficulty reading text close up
Pain or pressure in your eyes
A dark ring or aura around lights or glowing signs
Dark spots in your vision
Images of flashing lights in your vision
What usually follows retinopathy in a person with diabetes is diabetic macular edema (DME).
DME is characterized by the swelling of the macula in a person’s eye, which also severely threatens vision.
Following DME, people can be diagnosed with proliferative diabetic retinopathy (PDR), which is characterized by significant vision loss.
Existing treatments to save eyesight
“There are essentially three different types of treatment for diabetic retinopathy,” explained Dr. Fromer. “These include laser therapy or injections of two different classes of drugs — steroids or anti-VEGFs like Eylea.”
Avastin and Lucentis are the most commonly known treatments for diabetic retinopathy and are delivered via injection.
However, Lucentis is only approved and intended to treat the later stages of retinopathy and DME.
One of the biggest challenges to these injection treatments is getting a patient onboard with the idea.
While annual eye exams can be difficult for some people to schedule consistently, the fear that might result from being told you’ll need an injection in your eye could prevent someone from receiving treatment altogether.
“Although the concept of injections sounds frightening to most patients, the injections are not painful, as a topical anesthetic is provided prior to the injection,” said Dr. Fromer.
“While they do put a lot of numbing drops into your eye beforehand,” Stacey Divone told Healthline last year, “the moment you see that needle come up to your eye and the liquid is actually flowing into your eyeball, it’s a very unpleasant feeling.”
Divone has lived with type 1 diabetes for 20 years and was diagnosed with quickly progressing DME and retinopathy. She was treated with one injection of Lucentis last year.
In the near future, noninvasive treatments such as a “glowing contact lens” may be available, dramatically simplifying how retinopathy and DME are treated.
Choose your treatment wisely
Injections of Lucentis and Eylea don’t come cheap. Avastin is actually more affordable than both.
All three are covered by Medicare.
While Eylea proved to be just as effective as Lucentis, both cost approximately $2,000 per injection per eye.
Avastin, on the other hand, costs $50 per injection. Why? The Chicago Tribune’s research attributed it to the increasingly complex money game within today’s health insurance and reimbursement design.
For example, doctors could prescribe a more expensive treatment if the patient is covered by Medicare and then receive nearly four times as much in reimbursement versus prescribing the more affordable option.
Regardless, if a patient’s retinopathy is in the earliest stages, Eylea is their only effective option to preserve their eyesight.
Dr. Fromer emphasizes, however, to be sure to discuss all your options with your eye care team.
“Your doctor must be familiar with all treatment options when it comes to treating patients with diabetic retinopathy as all patients do not respond the same to each treatment,” he explained.
“Complications are rare with injections,” he added. “The risk of visual loss if not treated is much greater. The benefits of stabilization of diabetic retinopathy with treatment far outweigh the risks.”
Preservation of eyesight is simple
The American Diabetes Association’s HbA1c guidelines suggest people strive for an HbA1c at or below 7 percent for the best possible prevention of diabetes-related eye complications.
Research has also shown that, even for adolescents with type 1 diabetes, an A1c below 7.5 percent significantly reduces the risk of retinopathy.
While taking vitamins A, E, C, and lutein can help improve eye health, nothing can compensate for persistently high blood sugar levels.
And everyone with diabetes should have their eyes examined every year.
The NEI also reported that early detection through annual eye exams can reduce your risk of vision loss by 95 percent.
“The most important information for the patient to have is they must be involved with their care. This means careful vigilance with diet, exercise, and blood sugar control along with regular monitoring with their retinal specialist,” added Dr. Fromer. “This is their greatest chance to save their vision.”