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Diabetic retinopathy (DR) is the most common complication of diabetes. It causes vision loss, and the incidence is increasing with the growth of the diabetes epidemic worldwide. Over the past few decades a number of clinical trials have confirmed that careful control of glycemia and blood pressure can reduce the risk of developing DR and control its progression. In recent years, many treatment options have been developed for clinical management of the complications of DR (e.g., proliferative DR and macular edema) using laser-based therapies, intravitreal corticosteroids and anti-vascular endothelial growth factors, and vitrectomy to remove scarring and hemorrhage, but all these have limited benefits. In this review, we highlight and discuss potential molecular targets and new approaches that have shown great promise for the treatment of DR. New drugs and strategies are based on targeting a number of hyperglycemia-induced metabolic stress pathways, oxidative stress and inflammatory pathways, the renin-angiotensin system, and neurodegeneration, in addition to the use of stem cells and ribonucleic acid interference (RNAi) technologies. At present, clinical trials of some of these newer drugs in humans are yet to begin or are in early stages. Together, the new therapeutic drugs and approaches discussed may control the incidence and progression of DR with greater efficacy and safety.

In early summer, 1990, 3590 schoolboys from the Al-Baha region of Saudi Arabia were assessed for their ocular status. Children from 15 schools were randomly selected to assess eye problems and visual defects. Of the boys examined 3521 (89.7%) had visual acuity of 20/30 or better and 3443 (95.9%) achieved 20/30 or better after correction. The main causes of visual impairment were refractive error in 260 (7.2%) and amblyopia in 58 (1.6%). Seventeen (0.5%) boys had strabismus. Vernal keratoconjunctivitis was found in 204 (5.7%). Four hundred and forty-nine (26.4%) had nonspecific conjunctivitis, 173 (4.8%) had bacterial conjunctivitis, and 28 (0.8%) had blepharitis. Of the five geographical areas surveyed, trachoma was only found in the Aqeek area among 49 (1.4%) schoolboys. Earlier detection and treatment of visual impairment is of paramount importance in decreasing the rate of visual loss among schoolchildren.

We investigated the efficacy of cyclocryotherapy, a procedure which destroys the ciliary epithelium, thereby decreasing the production of aqueous humor, by retrospectively studying 109 eyes with advanced primary congenital glaucoma that had undergone the procedure. The eyes were divided into two groups: group I comprised 75 eyes (69%) that had undergone conventional surgical procedures for congenital glaucoma prior to cyclocryotherapy; group II, 34 eyes (31%) that had not undergone any such previous procedures. All eyes were followed for at least 12 months after the last cyclocryotherapy. With "success" defined as "having an IOP greater than or equal to 8 mmHg, greater than or equal to 19 mmHg with or without medication," the success rate in all eyes was 30%, with no significant difference between the success rates in groups I and II (P greater than .05). Chronic hypotony (IOP less than 8 mmHg) was found in seven eyes (6%). Six eyes (6%) developed cataract during the course of treatment with cyclocryotherapy. Cyclocryotherapy appears to be a reasonable addition to the treatment of eyes with advanced, uncontrolled, primary congenital glaucoma.

Trachoma remains one of the world's leading causes of blindness. A population based survey of the prevalence of trachoma was conducted in the South Western part of Saudi Arabia in the period of between July and November 1991. Overall, 7126 people were examined. Of these, 19 (0.26%) persons had active trachoma and 35 (0.5%) people had inactive trachoma. Sequelae of trachoma included conjunctival scarring, trichiasis and corneal scarring. Among 635 subjects with visual impairment, 6 (0.95%) patients had visual impairment due to trachoma. Trachoma does not seem to be a major ophthalmic problem in this area and proper management of the complications of trachoma will exclude it from the causes of blindness and visual impairment in this part of Saudi Arabia.

The authors studied 1,681 consecutive patients who attended their ophthalmic outpatient clinics over a period of 12 months to determine the patients' visual acuity status and the causes of any visual loss. Using the World Health Organization criteria for definition of visual acuity status, 1004 (59.7%) patients had normal vision. Four hundred and thirty-one (25.6%) patients had low vision or visual impairment and 246 (14.6%) patients were blind. Twenty-eight (1.9%) patients had no light perception in both eyes. Cataract, both in isolation and co-existing with other ocular pathology, was the major cause of both low vision and blindness (58.5% and 81.7%, respectively). A concerted attack on cataract alone will markedly reduce blindness and low vision in this region.