Diabetic retinopathy: seeing beyond glucose-induced microvascular disease.
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.
Antonetti
David A
DA
Department of Ophthalmology, Penn State College of Medicine, Hershey, PA 17033, USA.
Barber
Alistair J
AJ
Bronson
Sarah K
SK
Freeman
Willard M
WM
Gardner
Thomas W
TW
Jefferson
Leonard S
LS
Kester
Mark
M
Kimball
Scot R
SR
Krady
J Kyle
JK
LaNoue
Kathryn F
KF
Norbury
Christopher C
CC
Quinn
Patrick G
PG
Sandirasegarane
Lakshman
L
Simpson
Ian A
IA
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
D011972:Receptor, Insulin; D005947:Glucose