Diabetic retinopathy remains the most frequent cause of new cases of blindness among adults aged 20–74 years. A number of large clinical trials have validated treatment methods now considered standard. However, the disease continues to progress in approximately 50% of the eyes treated by photocoagulation. Other forms of therapy targeted at the earliest stages of retinal disease are needed. The difficulties in defining and accepting surrogate outcomes appropriate to evaluate the earlier stages of retinopathy are discussed. Special attention is given to trial design and the most likely possibilities for surrogate outcomes: mean difference on the Early Treatment Diabetic Retinopathy Study retinopathy scale of at least 2 steps per eye, reduction in macular thickening and reduction in fluorescein leakage.

1.
Aiello LP, Gardner TW, King GL, Blankenship G, Cavallerano JD, Ferris FL, Klain R: Diabetic retinopathy (technical review). Diabetes Care 1998;21:143–156.
2.
Diabetes Control and Complications Trial: The effect of intensive diabetes treatment on the progression of diabetic retinopathy in insulin dependent diabetes mellitus. Arch Ophthalmol 1995;113:36–51.
3.
UK Prospective Diabetes Study (UKPDS) Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998;352:837–853.
4.
Diabetic Retinopathy Study Research Group: Report 8: Photocoagulation treatment of proliferative diabetic retinopathy: Clinical applications of Diabetic Retinopathy Study (DRS) findings. Ophthalmology 1981;88:583–600.
5.
Early Treatment Diabetic Retinopathy Study Research Group: Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number One. Arch Ophthalmol 1985;103:1796–1806.
6.
Cunha-Vaz JG: Perspectives in the treatment of diabetic retinopathy. Diab/Metabol Rev 1992;8:105–116.
7.
Ferris F, Davis M: Treating 20/20 eyes with diabetic macula edema. Arch Ophthalmol 1990;117:675–676.
8.
Cunha-Vaz JG: Vitreous fluorometry; in Osborne MN, Ghader (eds): Progress in Retinal Research. Oxford, Pergamon Press, 1985, pp 90–114.
9.
Chambers W: Introductory remarks. Transcripts of the joint Meeting of the Ophthalmic Drugs Subcommittee of the Dermatologic and Ophthalmic Drugs Advisory Committee and the Endocrine and Metabolic Drugs Advisory Committee. Food and Drug Administration, Gaithersburg, Maryland, March 1998.
10.
Shahidi M, Ogura Y, Blair NP, Zeimer R: Retinal thickness change after focal laser treatment of diabetic macular edema. Br J Ophthalmol 1994;78:827–830.
11.
Hee MR, Puliafito CA, Wong C, Duker JS, Reichek E, Rutlege B, Schuman JS, Sotanson EA, Fujimoto JG: Quantitative assessment of macular edema with optical coherence tomography. Arch Ophthalmol 1995;113:1019–1029.
12.
Cunha-Vaz JG, Lobo C, Castro Sousa JP, Leite E, Faria de Abreu JR: Progression of retinopathy and alteration of the blood-retinal barrier in patients with type 2 diabetes. A seven-years prospective follow-up study. Graefes Arch Exp Ophthalmol 1998;236:264–268.
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