Abstract
Diabetic retinopathy (DR) and diabetic macular edema (DME) are retinal complications of diabetes that can lead to loss of vision and impaired quality of life. The current gold standard therapies for treatment of DR and DME focus on advanced disease, are invasive, expensive, and can trigger adverse side-effects, necessitating the development of more effective, affordable, and accessible therapies that can target early stage disease. The pathogenesis and pathophysiology of DR is complex and multifactorial, involving the interplay between the effects of hyperglycemia, hyperlipidemia, hypoxia, and production of reactive oxygen species (ROS) in the promotion of neurovascular dysfunction and immune cell polarization to a proinflammatory state. The pathophysiology of DR provides several therapeutic targets that have the potential to attenuate disease progression. Current novel DR and DME therapies under investigation include erythropoietin-derived peptides, inducers of antioxidant gene expression, activators of nitric oxide/cyclic GMP signaling pathways, and manipulation of arginase activity. This review aims to aid understanding of DR and DME pathophysiology and explore novel therapies that capitalize on our knowledge of these diabetic retinal complications.
Highlights
Diabetic retinopathy (DR) is a feared complication of diabetes that dramatically affects quality of life through vision deterioration and loss (Hartnett et al, 2017)
With the prevalence of diabetes on the rise worldwide, more people are at an increased risk of developing visioncompromising DR and diabetic macular edema (DME), necessitating the development of more efficacious and patient-friendly treatment modalities
Studies examining the nuances of the pathogenesis and pathophysiology of DR and DME have elucidated many promising novel therapeutic targets
Summary
Diabetic retinopathy (DR) is a feared complication of diabetes that dramatically affects quality of life through vision deterioration and loss (Hartnett et al, 2017). DR develops with prolonged hyperglycemia, which can occur with both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) (Fong et al, 2004). According to the World Health Organization, the incidence of diabetes increased by approximately 290% between 1980 and 2014, and the frequency of diabetesrelated premature mortality is climbing (WHO, 2021). The increased global prevalence of diabetes has resulted in rampant DR, the leading cause of blindness in working-age adults (WHO, 2021). Does DR affect patients individually, but it represents a significant healthcare and economic burden (WHO, 2021)
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