The neurovascular unit and the pathophysiologic basis of diabetic retinopathy.
OBJECTIVE
To relate the concept of the retinal neurovascular unit and its alterations in diabetes to the pathophysiology of diabetic retinopathy.


METHODS
Case illustrations and conceptual frameworks are presented that illustrate adaptive and maladaptive "dis-integration" of the retinal neurovascular unit with the progression of diabetes.


RESULTS
Retinopathy treatment should address pathophysiologic processes rather than pathologic lesions as is current practice.


CONCLUSIONS
Future improvements in the treatment of diabetic retinopathy requires deeper understanding of the cellular and molecular changes induced by diabetes, coupled with the use of quantitative phenotyping methods that assess the pathophysiologic processes.
Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA. tomwgard@umich.edu.
Thomas W
TW
Gardner
Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan Medical School, 1000 Wall St, Ann Arbor, MI, 48105, USA.
Jose R
JR
Davila
D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis*; D018450:Disease Progression; D006801:Humans; D012160:Retina / Q000473:pathology*; D015861:Retinal Neovascularization / Q000175:diagnosis* / Q000209:etiology; D041623:Tomography, Optical Coherence / Q000379:methods*
Diabetic retinopathy; Frequency-doubling perimetry; Neurovascular unit; Sensory neuropathy; Spectral domain optical coherence tomography (SD-OCT)