Table 1 Epidemiology, screening, treatments, and 20-year outlook for diabetic retinopathy, glaucoma, and age-related macular degeneration.

Epidemiology and Demographics most affected

An estimated 1 in 29 persons aged 40 or older in the US have diabetic retinopathy⁸⁶. Diabetic retinopathy typically causes blindness during working-age years, resulting in substantial economic costs.

An estimated 70 million people worldwide have glaucoma, and it is the leading cause of irreversible blindness²⁸. Risk factors include old age, family history of glaucoma, use of corticosteroids, elevated IOP, and African American ethnicity.

Estimated to account for 9% of all cases of blindness worldwide⁸⁷.

The main risk factors for AMD are genetic predisposition, age, and nicotine consumption.

Screening modalities and effectiveness

Ophthalmoscopy is the standard method to screen for diabetic retinopathy, with the earliest clinical sign being microaneurysms in the posterior pole. Fluorescein angiography is an invasive method to detect vascular changes in established diabetic retinopathy. OCT may provide additional information on the retinal layers⁸⁸

Early diagnosis can be challenging due to insidious nature of disease progression.

Recommended examination consists of a clinical history, tonometry, stereoscopic examination, and slit-lamp examination. Visual fields should also be examined a minimum of three times within the first year a diagnosis is made.

Initial symptoms of AMD often consist of central visual field loss or distorted vision. Diagnosis of AMD typically includes visual acuity, ophthalmic examination, examination of the macular layer with OCT, funduscopic evaluation with dilated pupils, and fluorescein angiography, if necessary⁸⁷

Current treatments

Lifestyle modifications

Anti-VEGF Intravitreal Injections

Laser Photocoagulation

Eye drops, Trabeculectomy, Laser Trabeculoplasty, Minimally Invasive Glaucoma Surgery²⁸

Depending on Wet/Dry Classification. Laser Photocoagulation. Anti-VEGF Intravitreal Injections

10–20 year outlook

The number of people with diabetic retinopathy worldwide is expected to reach 224 million by 2040⁶³

In 2040, the number of people with glaucoma is expected to reach 111.8 million⁶⁴

By 2040, 288 million people are expected to develop AMD⁷⁵