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03-17-2016 | Retinopathy | Article

Diabetic retinopathy

Authors: Tien Y. Wong, Chui Ming Gemmy Cheung, Michael Larsen, Sanjay Sharma, Rafael Simó

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Abstract

Diabetic retinopathy (DR) is a common complication of diabetes mellitus and is a major cause of vision loss in middle-aged and elderly people. One-third of people with diabetes have DR. Severe stages of DR include proliferative DR, caused by the abnormal growth of new retinal blood vessels, and diabetic macular oedema, in which there is exudation and oedema in the central part of the retina. DR is strongly associated with a prolonged duration of diabetes, hyperglycaemia and hypertension. It is traditionally regarded as a microvascular disease, but retinal neurodegeneration is also involved. Complex interrelated pathophysiological mechanisms triggered by hyperglycaemia underlie the development of DR. These mechanisms include genetic and epigenetic factors, increased production of free radicals, advanced glycosylation end products, inflammatory factors and vascular endothelial growth factor (VEGF). Optimal control of blood glucose and blood pressure in individuals with diabetes remains the cornerstone for preventing the development and arresting the progression of DR. Anti-VEGF therapy is currently indicated for diabetic macular oedema associated with vision loss, whereas laser photocoagulation prevents severe vision loss in eyes with proliferative DR. These measures, together with increasing public awareness and access to regular screening for DR with retinal photography, and the development of new treatments to address early disease stages, will lead to better outcomes and prevent blindness for patients with DR.

Nat Rev Dis Primers 2016; 2: 16012. doi: 10.1038/nrdp.2016.12

Diabetes mellitus is a global epidemic with profound morbidity1. Diabetes leads to a range of complications grouped into macrovascular (large blood vessel) complications, such as cardiovascular disease and stroke, and microvascular (small blood vessel) complications, such as kidney disease. Diabetic retinopathy (DR) is a specific microvascular complication of diabetes and is the leading cause of vision loss in the general population in many countries, including the adult working population and the elderly2,​3,​4,​5. Patients with severe degrees of DR have impaired quality of life, reduced physical, emotional and social well-being, and use many health-care resources6.

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