EURETINA 2025: Why the current staging for diabetic eye disease is obsolete

As imaging modalities improve, so do clinicians' understanding of disease. But some parts of the clinical landscape need to keep better pace with innovation in technology and technique. This argument was key to a lecture from Stela Vujosevic, MD, PhD, FEBO, who is the head of medical retina at IRCCS MultiMedica in Milan, Italy. She presented during the European Society of Retina Specialists (EURETINA) as part of the symposium on diabetes and vascular disease." Her presentation title posed a question: "Do we need a new staging for diabetic retinopathy and macular edema?"

Prof. Vujosevic answered in the affirmative. The staging system for diabetic retinopathy (DR) and diabetic macular edema (DME) has not caught up with advancements in imaging or image analysis, Prof. Vujosevic said.

"The current staging system does not completely reflect the status of the neovascular unit in the retina," she said. "We need a novel and, I would say, more inclusive staging system for both DR and DME." Prof. Vujosevic provided the example of hyperreflective foci, a sign of inflammation and activation of microglial cells. These biomarkers can be assessed with optical coherence tomography (OCT), and provide an idea of the prognosis of a patient's diabetic eye disease. Advanced biomarkers, now detectable with OCT and high-res OCT, should be a foundational aspect of the next generation of staging for DME and DR.

The revisions to current staging models do not end with imaging—they include patient-reported qualitative data as well. "We definitely need to integrate all of these imaging modalities into the staging system, and obviously not forget the patient's point of view," Prof. Vujosevic continued. "Quality of life and patient-reported outcome measures are also very important to understand better how and when to treat these patients."

Watch the video to hear Prof. Vujosevic delineate the benefits of staging, including earlier diagnosis and the potential for support from regulatory bodies to help patients access earlier treatment.