Objective: To evaluate the impact of current and emerging biologic therapies on the treatment of diabetic eye diseases, specifically diabetic retinopathy and diabetic macular edema, and to examine how integrating these therapies with early detection, multidisciplinary collaboration, and patient-centered care improves long-term visual outcomes in patients with diabetes. Background: Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the most common and vision-threatening complications of diabetes mellitus. As global diabetes prevalence continues to rise, so does the burden of diabetic eye disease. Many patients face barriers to care, and substantial gaps remain in treatment accessibility and long-term adherence. Although treatments such as anti-vascular endothelial growth factor (anti-VEGF) agents and corticosteroids have transformed the management of DR and DME, novel therapies may pose challenges, including increased costs or complexity associated with injection administration. A comprehensive, multidisciplinary strategy that integrates biologic therapies with early screening and coordinated care may further improve clinical outcomes and reduce the risk of vision loss in this high-risk population. Methods: This review synthesizes evidence from controlled trials, observational studies, and treatment guidelines published between 2010 and 2025. It evaluates pharmacologic interventions, including anti-VEGF agents and corticosteroids, analyzing their efficacy, dosing strategies, and adverse effects. Various interdisciplinary care models and public health factors, such as screening adherence and access disparities, were examined and summarized. Results: Biologic agents targeting VEGF and inflammatory pathways demonstrate strong efficacy in preserving or improving visual acuity in patients with DME and DR, particularly when administered at individualized intervals. However, high treatment burden, limited adherence, and disparities in access present ongoing challenges. Studies show that early ophthalmologic screening, routine HbA1c monitoring, and collaborative care among healthcare professionals lead to significantly better disease management and reduced progression to vision-threatening stages. Conclusions: The management of diabetic eye disease is undergoing a paradigm shift with the advent of biologic therapies. When coupled with routine screening, patient education, and a multidisciplinary care model, these interventions can substantially improve visual and systemic
References
[1]
Gonzalez-Cortes, J.H., Martinez-Pacheco, V.A., Gonzalez-Cantu, J.E., Bilgic, A., de Ribot, F.M., Sudhalkar, A., et al. (2022) Current Treatments and Innovations in Diabetic Retinopathy and Diabetic Macular Edema. Pharmaceutics, 15, Article No. 122. https://doi.org/10.3390/pharmaceutics15010122
Mouri, M. and Badireddy, M. (2025) Hyperglycemia. StatPearls Publishing.
[5]
Alvarez, S., Coffey, R., Mathias, P.M. and Algotar, A.M. (2025) Prediabetes. StatPearls Publishing.
[6]
Blood Glucose Control Studies for Type 1 Diabetes: DCCT & EDIC-NIDDK. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/blood-glucose-control-studies-type-1-diabetes-dcct-edic
[7]
Wong, T.Y., Cheung, C.M.G., Larsen, M., Sharma, S. and Simó, R. (2016) Diabetic Retinopathy. NatureReviewsDiseasePrimers, 2, Article No. 16012. https://doi.org/10.1038/nrdp.2016.12
[8]
Khalid, M., Petroianu, G. and Adem, A. (2022) Advanced Glycation End Products and Diabetes Mellitus: Mechanisms and Perspectives. Biomolecules, 12, 542. https://pmc.ncbi.nlm.nih.gov/articles/PMC9030615/
[9]
Wang, W. and Lo, A.C.Y. (2018) Diabetic Retinopathy: Pathophysiology and Treatments. InternationalJournalofMolecularSciences, 19, Article No. 1816. https://doi.org/10.3390/ijms19061816
Shukla, U.V. and Tripathy, K. (2025) Diabetic Retinopathy. StatPearls Publishing.
[12]
Campbell, M. and Humphries, P. (2013) The Blood-Retina Barrier: Tight Junctions and Barrier Modulation. In: Cheng, C.Y., Ed., Biology and Regulation of Blood‑Tissue Barriers, Springer, 70-84. https://doi.org/10.1007/978-1-4614-4711-5_3
[13]
Lin, K., Hsih, W., Lin, Y., Wen, C. and Chang, T. (2021) Update in the Epidemiology, Risk Factors, Screening, and Treatment of Diabetic Retinopathy. JournalofDiabetesInvestigation, 12, 1322-1325. https://doi.org/10.1111/jdi.13480
[14]
Skarbez, K., Priestley, Y., Hoepf, M. and Koevary, S.B. (2010) Comprehensive Review of the Effects of Diabetes on Ocular Health. ExpertReviewofOphthalmology, 5, 557-577. https://doi.org/10.1586/eop.10.44
[15]
Zhang, X., Zeng, H., Bao, S., Wang, N. and Gillies, M.C. (2014) Diabetic Macular Edema: New Concepts in Patho-Physiology and Treatment. Cell&Bioscience, 4, Article No. 27. https://doi.org/10.1186/2045-3701-4-27
[16]
Upadhyay, T., Prasad, R. and Mathurkar, S. (2024) A Narrative Review of the Advances in Screening Methods for Diabetic Retinopathy: Enhancing Early Detection and Vision Preservation. Cureus, 16, e53586. https://doi.org/10.7759/cureus.53586
[17]
Liberski, S., Wichrowska, M. and Kocięcki, J. (2022) Aflibercept versus Faricimab in the Treatment of Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: A Review. InternationalJournalofMolecularSciences, 23, Article No. 9424. https://doi.org/10.3390/ijms23169424
[18]
Fogli, S., Del Re, M., Rofi, E., Posarelli, C., Figus, M. and Danesi, R. (2018) Clinical Pharmacology of Intravitreal Anti-VEGF Drugs. Eye, 32, 1010-1020. https://doi.org/10.1038/s41433-018-0021-7
[19]
Virgili, G., Parravano, M., Evans, J.R., Gordon, I. and Lucenteforte, E. (2018) Anti-vascular Endothelial Growth Factor for Diabetic Macular Oedema: A Network Meta-analysis. CochraneDatabaseofSystematicReviews, 2018, CD007419. https://doi.org/10.1002/14651858.cd007419.pub6
[20]
Wykoff, C.C., Abreu, F., Adamis, A.P., Basu, K., Eichenbaum, D.A., Haskova, Z., et al. (2022) Efficacy, Durability, and Safety of Intravitreal Faricimab with Extended Dosing up to Every 16 Weeks in Patients with Diabetic Macular Oedema (YOSEMITE and RHINE): Two Randomised, Double-Masked, Phase 3 Trials. TheLancet, 399, 741-755. https://doi.org/10.1016/s0140-6736(22)00018-6
Hendrick, A.M., Gibson, M.V. and Kulshreshtha, A. (2015) Diabetic Retinopathy. PrimaryCare: ClinicsinOfficePractice, 42, 451-464. https://doi.org/10.1016/j.pop.2015.05.005
[24]
Behar-Cohen, F. and Zhao, M. (2016) Corticosteroids and the Retina: A Role for the Mineralocorticoid Receptor. CurrentOpinioninNeurology, 29, 49-54. https://doi.org/10.1097/wco.0000000000000284
[25]
Munk, M.R., Somfai, G.M., de Smet, M.D., Donati, G., Menke, M.N., Garweg, J.G., et al. (2022) The Role of Intravitreal Corticosteroids in the Treatment of DME: Predictive OCT Biomarkers. InternationalJournalofMolecularSciences, 23, Article No. 7585. https://doi.org/10.3390/ijms23147585
[26]
D’Amico, D.J. and Shah, A.R. (2025) Diabetic Retinopathy: Prevention and Treatment. UpToDate. https://www.uptodate.com/contents/diabetic-retinopathy-prevention-and-treatment#H2490278836
[27]
Whitcup, S.M., Cidlowski, J.A., Csaky, K.G. and Ambati, J. (2018) Pharmacology of Corticosteroids for Diabetic Macular Edema. InvestigativeOpthalmology&VisualScience, 59, 1-12. https://doi.org/10.1167/iovs.17-22259
[28]
Schwartz, S., Scott, I., Stewart, M. and Flynn Jr., H. (2016) Update on Corticosteroids for Diabetic Macular Edema. ClinicalOphthalmology, 10, 1723-1730. https://doi.org/10.2147/opth.s115546
[29]
Therini Bio Pty Ltd (2024) A Phase 1b Open-Label, Multiple Ascending Dose Study of the Safety, Tolerability, and Biological Activity of Intravitreal THN391 in Diabetic Macular Oedema Secondary to Non-Proliferative Diabetic Retinopathy.
[30]
Boehringer Ingelheim (2024) A First-In Human Trial to Study Safety and Tolerability of Single Rising Intravitreal Doses (Open Label, Non-Randomized, Uncontrolled) and in Addition the Early Biological Response of Multiple Intravitreal Dosing (Single-Masked, Randomized, Sham-Controlled) of BI 764524 in Panretinal Photocoagulation (PRP) Treated Proliferative Diabetic Retinopathy (PDR) Patients with Diabetic Macular Ischemia (DMI)—The HORNBILL Study.
OD BJT OD, and Carolyn Majcher Diabetic Eye Disease: A Comprehensive Look at the Optometrist’s Role. https://www.reviewofoptometry.com/article/diabetic-eye-disease-a-comprehensive-look-at-the-optometrists-role
[33]
Vashist, P., Singh, S., Gupta, N. and Saxena, R. (2011) Role of Early Screening for Diabetic Retinopathy in Patients with Diabetes Mellitus: An Overview. IndianJournalofCommunityMedicine, 36, 247-252. https://doi.org/10.4103/0970-0218.91324
[34]
Chong, D.D., Das, N. and Singh, R.P. (2024) Diabetic Retinopathy: Screening, Prevention, and Treatment. ClevelandClinicJournalofMedicine, 91, 503-510. https://doi.org/10.3949/ccjm.91a.24028
[35]
Alali, N.M., Albazei, A., Alotaibi, H.M., Almohammadi, A.M., Alsirhani, E.K., Alanazi, T.S., et al. (2022) Diabetic Retinopathy and Eye Screening: Diabetic Patients Standpoint, Their Practice, and Barriers; a Cross-Sectional Study. JournalofClinicalMedicine, 11, Article No. 6351. https://doi.org/10.3390/jcm11216351
[36]
van Eijk, K.N.D., Blom, J.W., Gussekloo, J., Polak, B.C.P. and Groeneveld, Y. (2012) Diabetic Retinopathy Screening in Patients with Diabetes Mellitus in Primary Care: Incentives and Barriers to Screening Attendance. Diabetes Research and Clinical Practice, 96, 10-16. https://doi.org/10.1016/j.diabres.2011.11.003
[37]
Bryl, A., Mrugacz, M., Falkowski, M. and Zorena, K. (2022) The Effect of Hyperlipidemia on the Course of Diabetic Retinopathy—Literature Review. JournalofClinicalMedicine, 11, Article No. 2761. https://doi.org/10.3390/jcm11102761
[38]
Park, S.J. and Park, D.H. (2020) Revisiting Lipids in Retinal Diseases: A Focused Review on Age-Related Macular Degeneration and Diabetic Retinopathy. JournalofLipidandAtherosclerosis, 9, 406-418. https://doi.org/10.12997/jla.2020.9.3.406
[39]
Flaxel, C.J., Adelman, R.A., Bailey, S.T., Fawzi, A., Lim, J.I., Vemulakonda, G.A., et al. (2020) Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology, 127, P66-P145. https://doi.org/10.1016/j.ophtha.2019.09.025
[40]
Weber, Z.A., Kaur, P., Hundal, A., Ibriga, S.H. and Bhatwadekar, A.D. (2019) Effect of the Pharmacist-Managed Cardiovascular Risk Reduction Services on Diabetic Retinopathy Outcome Measures. PharmacyPractice, 17, Article No. 1319. https://doi.org/10.18549/pharmpract.2019.1.1319
[41]
Hughes, J., Wibowo, Y., Sunderland, B. and Hoti, K. (2017) The Role of the Pharmacist in the Management of Type 2 Diabetes: Current Insights and Future Directions. IntegratedPharmacyResearchandPractice, 6, 15-27. https://doi.org/10.2147/iprp.s103783
[42]
Hadia, R., Trivedi, R., Kardani, S., Baile, S., Sajan, C., Saggu, V., et al. (2025) Managing Age-Related Macular Degeneration and Diabetic Macular Edema: A Comprehensive Update for Clinical Pharmacists. InternationalJournalofPharmaceuticalInvestigation, 15, 858-863. https://doi.org/10.5530/ijpi.20250310
[43]
Falavarjani, K.G. and Nguyen, Q.D. (2013) Adverse Events and Complications Associated with Intravitreal Injection of Anti-VEGF Agents: A Review of Literature. Eye, 27, 787-794. https://doi.org/10.1038/eye.2013.107