title: Diabetic retinopathy: seeing beyond glucose-induced microvascular disease.
abstract: Diabetic retinopathy remains a frightening prospect to patients and frustrates physicians. Destruction of damaged retina by photocoagulation remains the primary treatment nearly 50 years after its introduction. The diabetes pandemic requires new approaches to understand the pathophysiology and improve the detection, prevention, and treatment of retinopathy. This perspective considers how the unique anatomy and physiology of the retina may predispose it to the metabolic stresses of diabetes. The roles of neural retinal alterations and impaired retinal insulin action in the pathogenesis of early retinopathy and the mechanisms of vision loss are emphasized. Potential means to overcome limitations of current animal models and diagnostic testing are also presented with the goal of accelerating therapies to manage retinopathy in the face of ongoing diabetes.
authors.affiliation: Department of Ophthalmology, Penn State College of Medicine, Hershey, PA 17033, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Antonetti
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Barber
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Bronson
authors.forename: Willard M
authors.initials: WM
authors.lastname: Freeman
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gardner
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Jefferson
authors.forename: Mark
authors.initials: M
authors.lastname: Kester
authors.forename: Scot R
authors.initials: SR
authors.lastname: Kimball
authors.forename: J Kyle
authors.initials: JK
authors.lastname: Krady
authors.forename: Kathryn F
authors.initials: KF
authors.lastname: LaNoue
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Norbury
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Quinn
authors.forename: Lakshman
authors.initials: L
authors.lastname: Sandirasegarane
authors.forename: Ian A
authors.initials: IA
authors.lastname: Simpson
mesh_terms: D003930:Diabetic Retinopathy / Q000150:complications / Q000209:etiology; D005947:Glucose / Q000009:adverse effects; D006801:Humans; D008833:Microcirculation / Q000187:drug effects; D011972:Receptor, Insulin / Q000502:physiology; D012160:Retina / Q000033:anatomy & histology / Q000502:physiology; D012173:Retinitis / Q000503:physiopathology; D014786:Vision Disorders / Q000209:etiology
chemical_list: D011972:Receptor, Insulin; D005947:Glucose