This article outlines efforts to modernise clinically meaningful staging systems and endpoints for diabetic retinal disease (DRD). During a workshop involving over 100 international experts, participants emphasised the need for validated structural and functional endpoints based on the retinal neurovascular unit. Key biomarkers identified included retinal nonperfusion, inner retinal thinning and retinal layer disorganisation, while functional measures such as contrast sensitivity, electrophysiology and mobility performance were prioritised. The proposed framework supports precision phenotyping to identify disease-driving molecular pathways and guide targeted therapies. Future priorities include multi-centre studies, standardised protocols, and AI-ready endpoints to improve DRD diagnosis, treatment and patient outcomes worldwide.
The evolving landscape of diabetic retinopathy
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