Abstract
Neurodegeneration plays a significant role in the complex pathology of diabetic retinopathy. Evidence suggests the onset of neurodegeneration occurs early on in the disease, and so a greater understanding of the process is essential for prompt detection and targeted therapies. Neurodegeneration is a common pathway of assorted processes, including activation of inflammatory pathways, reduction of neuroprotective factors, DNA damage, and apoptosis. Oxidative stress and formation of advanced glycation end products amplify these processes and are elevated in the setting of hyperglycemia, hyperlipidemia, and glucose variability. These key pathophysiologic mechanisms are discussed, as well as diagnostic modalities and novel therapeutic avenues, with an emphasis on recent discoveries. The aim of this article is to highlight the crucial role of neurodegeneration in diabetic retinopathy and to review the molecular basis for this neuronal dysfunction, its diagnostic features, and the progress currently made in relevant therapeutic interventions.
Highlights
Diabetic retinopathy is a major cause of preventable vision impairment and blindness worldwide, with increasing prevalence during recent decades [1, 2]
The following keywords were used in various combinations: diabetic retinal neurodegeneration, neurodegenerative, neurodegeneration, neuroprotective, diabetes, diabetic retinopathy, diabetic retinal disease, diabetic macular edema, and diabetic eye disease
Galectin-3 regulates several biological processes, including ones involved in inflammation, oxidative stress, and apoptosis
Summary
Diabetic retinopathy is a major cause of preventable vision impairment and blindness worldwide, with increasing prevalence during recent decades [1, 2]. Vasculopathy has been considered the primary pathophysiologic mechanism responsible for diabetic retinopathy (DR). In recent years, the role of diabetic retinal neurodegeneration (DRN) is increasingly evident and quite possibly supersedes that of vasculopathy as the primary pathogenic event of the disease. The term diabetic retinal disease (DRD) is used to integrate the retinal microvasculopathy and retinal neuropathy caused by diabetes [8]. As current focus of medical practice, in terms of early detection and treatment of DRD, lies on the vascular component of DR, new discoveries regarding DRN’s significance may lead to a paradigm shift. We aim to provide a comprehensive and up-to-date overview of the rapidly expanding body of work elucidating DRN’s role in DRD and its effect on diagnostics and treatment
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