The purpose of this study is to assess the prevalence of diabetic retinopathy (DR) worldwide from articles published since 2015 where the assessment of the presence and severity of DR was based on retinal images. Methods: A total of 4 databases were searched for the MESH terms diabetic retinopathy and prevalence. Of 112 publications 32 studies were included and individual data pooled for analysis. The presence of any DR or diabetic macular edema (DME) was recorded and severity as mild, moderate or severe non-proliferative DR (NPDR), proliferative DR (PDR) and DME and/or clinically significant macular edema (CSME). The level of severity of DR reported refer to persons with diabetes and not individual eyes.

Syncope during coughing is a result of hypotension, rather than bradycardia. Coughing during HUT is a useful test in patients suspected to have cough syncope but in whom the history is not conclusive.

New clinical trials for diabetic macular oedema (DMO) are being designed to prove superiority over aflibercept when this agent is already very effective in improving visual acuity (VA) and DMO. The aim of this study was to determine the optimal inclusion–exclusion criteria for trials to aim for superiority in visual outcomes with newer agents. As Phase 1 studies are short duration, we aimed to evaluate the early response of aflibercept in a real-world cohort initiated on monthly aflibercept for 3 consecutive injections and observed the effects at 4 months. The sub-optimal responders were pre-defined based on different cut-offs for VA and central sub-field thickness (CST). 200 patients with treatment naïve DMO treated with 3 loading doses of aflibercept were included in the study. We found that those presenting with baseline VA of 35–54 ETDRS letters (n = 43) had higher proportion of sub-optimal responders compared to other categories (p < 0.001). Patients with baseline CST of less than 400 µm (n = 96) responded less well functionally and anatomically to loading dose than eyes with baseline CST of 400 µm or more (n = 104, p = 0.02), indicating that eyes with CST ≥ 400 µm is another inclusion criteria. There was minimal correlation between change in CST and change in VA at 4 months (r = − 0.27), suggesting that both these inclusion criteria are non-exclusive. However, for maximal efficacy, patients that meet both these inclusion criteria are more likely to show benefit from an alternative intervention. New trials should aim to include patients with treatment naïve DMO with VA between 35–54 letters and CST of 400 µm or more when aflibercept is used as the comparator.

Key Points Question What is the topographic distribution of retinal neovascularization in patients with proliferative diabetic retinopathy, and is there an association between response to treatment and the retinal location of the neovascularization? Findings In this post hoc unmasked analysis of the Clinical Efficacy and Mechanistic Evaluation of Aflibercept for Proliferative Diabetic Retinopathy (CLARITY) randomized clinical trial, treatment-naive retinal neovascularization elsewhere (NVE) had a predilection for the nasal quadrant. By 52 weeks, the aflibercept group was more likely to have regression of NVE; neither treatment was likely to be associated with complete regression of disc neovascularization (NVD). Meaning This study further elaborates on the outcomes of the CLARITY trial in that, anatomically, despite the superior outcomes among patients within NVE who received aflibercept, regression was seen more in NVE than in NVD.

This cross-sectional study investigates the use of circulating serum biomarkers to distinguish individuals without diabetic retinopathy from those with sight-threatening diabetic retinopathy.

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