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<p>Retinal ischemia remains a leading cause of irreversible blindness worldwide and underlies major conditions such as diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome, retinopathy of prematurity, and retinal vasculitis. Current management strategies are often fragmented and reactive, with panretinal photocoagulation (PRP), intravitreal anti–vascular endothelial growth factor (VEGF) therapy, and pars plana vitrectomy (PPV) commonly initiated only after sight-threatening neovascular complications have developed. This narrative review synthesizes evidence from landmark clinical trials, meta-analyses, and multimodal imaging studies identified through PubMed, Scopus, Web of Science, and Google Scholar (1980–2025). We propose the Corrective Action and Preventive Action (CAPA) framework as a stage-specific conceptual model that integrates corrective interventions—such as anti-VEGF therapy, focal laser, and PPV—with preventive strategies, including PRP and targeted ischemic bed ablation, guided by widefield fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. By reframing timing and sequencing of treatment, the CAPA model aims to shift practice toward proactive and structured disease modification, with the goal of preserving vision earlier and reducing long-term sequelae. Prospective studies are needed to determine the safety, cost-effectiveness, and feasibility of implementing CAPA across diverse healthcare settings.</p>

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The CAPA framework: a conceptual model integrating corrective and preventive strategies for retinal ischemia and neovascularization

  • 期刊论文

  • 发表日期：

    2026年2月21日

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  • Ramesh Venkatesh,
  • Vishma Prabhu,
  • Pratibha Hande,
  • Chaitra Jayadev,
  • Rupak Roy,
  • Rohit Shetty,
  • Soema Tebhla,
  • Pragati Raj,
  • Madhav Pai,
  • Karishma Tendulkar,
  • Jay Chhablani

摘要

Retinal ischemia remains a leading cause of irreversible blindness worldwide and underlies major conditions such as diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome, retinopathy of prematurity, and retinal vasculitis. Current management strategies are often fragmented and reactive, with panretinal photocoagulation (PRP), intravitreal anti–vascular endothelial growth factor (VEGF) therapy, and pars plana vitrectomy (PPV) commonly initiated only after sight-threatening neovascular complications have developed. This narrative review synthesizes evidence from landmark clinical trials, meta-analyses, and multimodal imaging studies identified through PubMed, Scopus, Web of Science, and Google Scholar (1980–2025). We propose the Corrective Action and Preventive Action (CAPA) framework as a stage-specific conceptual model that integrates corrective interventions—such as anti-VEGF therapy, focal laser, and PPV—with preventive strategies, including PRP and targeted ischemic bed ablation, guided by widefield fluorescein angiography, optical coherence tomography (OCT), and OCT angiography. By reframing timing and sequencing of treatment, the CAPA model aims to shift practice toward proactive and structured disease modification, with the goal of preserving vision earlier and reducing long-term sequelae. Prospective studies are needed to determine the safety, cost-effectiveness, and feasibility of implementing CAPA across diverse healthcare settings.