Walia S, Morya AK, Khullar S, Aggarwal S, Kaur R. Role of alternative oral therapy for the management of wet age-related macular degeneration and proliferative diabetic retinopathy. World J Diabetes 2025; 16(8): 109231 [DOI: 10.4239/wjd.v16.i8.109231]
Corresponding Author of This Article
Arvind Kumar Morya, MD, Professor, Senior Researcher, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shweta Walia, Department of Ophthalmology, MGM Medical College, Indore 452001, Madhya Pradesh, India
Arvind Kumar Morya, Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
Srishti Khullar, Department of Ophthalmology, Military Hospital, Agra 282001, Uttar Pradesh, India
Sarita Aggarwal, Department of Ophthalmology, Santosh Deemed to be University, Ghaziabad, Ghaziabad 201009, Uttar Pradesh, India
Rajwinder Kaur, Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda 151101, Punjab, India
Author contributions: Morya AK conceptualized the research; Walia S searched various search engines; Walia S, Morya AK, and Khullar S wrote the manuscript; Walia S, Morya AK, Aggarwal S, and Kaur R edited the manuscript; Walia S and Morya AK prepared all the documents; and Morya AK submitted the final edited manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other coauthors who contributed their efforts to this manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Arvind Kumar Morya, MD, Professor, Senior Researcher, Department of Ophthalmology, All India Institute of Medical Sciences, Bibi Nagar, Hyderabad 508126, Telangana, India. bulbul.morya@gmail.com
Received: May 6, 2025 Revised: May 20, 2025 Accepted: July 18, 2025 Published online: August 15, 2025 Processing time: 102 Days and 15.7 Hours
Abstract
Proliferative diabetic retinopathy (PDR) affects approximately 6% of diabetic patients globally. The overall prevalence of diabetic retinopathy is around 22%. Wet age-related macular degeneration (ARMD), the sight-threatening type of ARMD, affects approximately 1.2%-1.3% of the general population and represents 15% of total ARMD cases. While intravitreal anti-vascular endothelial growth factor injections are still the mainstay therapy, there are a few challenges, such as frequent administration, cost burden, and compliance barriers that prompt the need for exploration into systemic oral alternative drugs like fenofibrate, candesartan, and vorolanib. These oral therapies have the advantage of being non-invasive and systemically accessible with few logistical burdens. This review highlights current evidence supporting the use of oral therapies in PDR and wet ARMD management, along with practical limitations and future prospects.
Core Tip: Anti-vascular endothelial growth factor injections are effective for proliferative diabetic retinopathy (PDR) and wet age-related macular degeneration (ARMD), but patient compliance and healthcare strain limit their utility. This review explores the role of oral drugs such as fenofibrate, candesartan, and vorolanib in the management of PDR and wet ARMD. These agents offer ease of administration and may serve as adjuncts or substitutes for injection-averse patients. Further multicenter randomized controlled trials are warranted to confirm long-term safety and efficacy.
