The prevalence of diabetes mellitus (DM) is projected to approach 600 million people worldwide by 2035 and there are concerns about a potential diabetes epidemic in Asia. 1 Diabetic retinopathy (DR), a complication of DM, afflicts a third of diabetics and is the principal cause of vision loss among the working age group in developed countries 2 and remains a leading cause of preventable blindness. 3 The proportion of visual impairment worldwide caused by DR has increased. 4 Diabetic macular edema (DME), characterized by increased vascular permeability and the deposition of hard exudates at the central retina, can develop at any stages of DR and afflicts 21 million people globally. 5Through regular eye examinations and adequate DM management, the diabetes-related vision loss can be prevented in 98% of cases. 6,7 Primary interventions, such as intensive glycemic and blood pressure control, can reduce the incidence and progression of DR and DME, while secondary interventions, such as laser photocoagulation and injections of anti-vascular endothelial growth factor drugs, may prevent development and progression of vision loss. [8][9][10][11][12][13] Therefore, early detection of DR and DME through screening programs and appropriate referral for therapy are essential to preserving vision in individuals with diabetes. DR screening has been shown to be a cost-effective method of preventing diabetes-related vision loss.14,15 Since blindness from DR and DME is preventable from both public health screening and clinical management perspectives, it is important to precisely identify persons who have DR/DME for early intervention before they progress to severe visionthreatening stages. 16Current DR screening programs typically employ retinal fundus photography and manual assessment of DR, 17 but this approach requires highly skilled readers which is labor-intensive and costly. Moreover, fundus photography as a technique Abstract Due to the increasing prevalence of diabetes mellitus, demand for diabetic retinopathy (DR) screening platforms is steeply increasing. Early detection and treatment of DR are key public health interventions that can greatly reduce the likelihood of vision loss. Current DR screening programs typically employ retinal fundus photography, which relies on skilled readers for manual DR assessment. However, this is labor-intensive and suffers from inconsistency across sites. Hence, there has been a recent proliferation of automated retinal image analysis software that may potentially alleviate this burden cost-effectively. Furthermore, current screening programs based on 2-dimensional fundus photography do not effectively screen for diabetic macular edema (DME). Optical coherence tomography is becoming increasingly recognized as the reference standard for DME assessment and can potentially provide a cost-effective solution for improving DME detection in large-scale DR screening programs. Current screening techniques are also unable to image the peripheral retina and require pharmacological pupil dilation; ul...

Purpose: The COVID-19 pandemic has put strain on healthcare systems and the availability and allocation of healthcare manpower, resources and infrastructure. With immediate priorities to protect the health and safety of both patients and healthcare service providers, ophthalmologists globally were advised to defer nonurgent cases, while at the same time managing sight-threatening conditions such as neovascular Age-related Macular Degeneration (AMD). The management of AMD patients both from a monitoring and treatment perspective presents a particular challenge for ophthalmologists. This review looks at how these pressures have encouraged the acceptance and speed of adoption of digitalization. Design and methods: A literature review was conducted on the use of digital technology during COVID-19 pandemic, and on the transformation of medicine, ophthalmology and AMD screening through digitalization. Results: In the management of AMD, the implementation of artificial intelligence and “virtual clinics” have provided assistance in screening, diagnosis, monitoring of the progression and the treatment of AMD. In addition, hardware and software developments in home monitoring devices has assisted in self-monitoring approaches. Conclusions: Digitalization strategies and developments are currently ongoing and underway to ensure early detection, stability and visual improvement in patients suffering from AMD in this COVID-19 era. This may set a precedence for the post COVID-19 new normal where digital platforms may be routine, standard and expected in healthcare delivery.

Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular AMD (nAMD) that accounts for a significant proportion of nAMD cases worldwide, and particularly in Asia. Contemporary PCV treatment strategies have closely followed those used in typical nAMD, though there are significant gaps in knowledge on PCV management and it remains unclear if these strategies are appropriate. Current clinical trial data suggest intravitreal anti-vascular endothelial growth factor (VEGF) therapy alone or in combination with photodynamic therapy is effective in managing haemorrhage and exudation in PCV, although the optimal treatment interval, including as-needed and treat-and-extend approaches, is unclear. Newer imaging modalities, including OCT angiography and high-resolution spectral domain OCT have enabled characterisation of unique PCV biomarkers that may provide guidance on how and when treatment and re-treatment should be initiated. Treatment burden for PCV is a major focus of future therapeutic research and several newly developed anti-VEGF agents, including brolucizumab, faricimab, and new modes of drug delivery like the port delivery system, offer hope for dramatically reduced treatment burden for PCV patients. Beyond anti-VEGF therapy, recent developments in our understanding of PCV pathophysiology, in particular the role of choroidal anatomy and lipid mediators in PCV pathogenesis, offer new treatment avenues that may become clinically relevant in the future. This article explores the current management of PCV and more recent approaches to PCV treatment based on an improved understanding of this unique disease process.