Diabetic Retinopathy: Need for More Research to Understand the Relative Role of Neuropathy and Microvascular Disease

Cunha-Vaz, Josè

doi:10.1159/000438794

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…Nevertheless, some of the earliest alterations are reported to be breakdown of blood-retinal barrier and alterations to the neurosensory retinal function. 42 The initial lesions along with endothelial proliferation, pericyte damage, and microaneurysms have been identified to be focal and in the posterior pole 59 and are therefore more likely to align with our study results. In addition, a decrease in the density of deep capillary plexus at the macular area has been noted in patients with no or a mild stage of DR. 60 Changes in the capillary plexus and therefore the blood supply and nutrients may affect the normal integrity and/or functioning of the ganglion cells and other neural cells in the retina; these are associated with diabetes-induced accelerated ganglion cell death and likely involve bipolar cells and also photoreceptors.…”

Section: Discussionsupporting

confidence: 76%

Corneal and Retinal Neuronal Degeneration in Early Stages of Diabetic Retinopathy

Srinivasan

Dehghani

Pritchard

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To examine the neuronal structural integrity of cornea and retina as markers for neuronal degeneration in nonproliferative diabetic retinopathy (NPDR).METHODS. Participants were recruited from the broader Brisbane community, Queensland, Australia. Two hundred forty-one participants (187 with diabetes and 54 nondiabetic controls) were examined. Diabetic retinopathy (DR) was graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. Corneal nerve fiber length (CNFL), corneal nerve branch density (CNBD), corneal nerve fiber tortuosity (CNFT), full retinal thickness, retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), focal (FLV) and global loss volumes (GLV), hemoglobin A 1c (HbA 1c ), nephropathy, neuropathy, and cardiovascular measures were examined.RESULTS. The central zone (P ¼ 0.174), parafoveal thickness (P ¼ 0.090), perifovea (P ¼ 0.592), RNFL (P ¼ 0.866), GCC (P ¼ 0.798), and GCC GLV (P ¼ 0.338) did not differ significantly between the groups. In comparison to the control group, those with very mild NPDR and those with mild NPDR had significantly higher focal loss in GCC volume (P ¼ 0.036). CNFL was significantly lower in those with mild NPDR (P ¼ 0.004) in comparison to the control group and those with no DR. The CNBD (P ¼ 0.094) and CNFT (P ¼ 0.458) did not differ between the groups.CONCLUSIONS. Both corneal and retinal neuronal degeneration may occur in early stages of diabetic retinopathy. Further studies are required to examine these potential markers for neuronal degeneration in the absence of clinical signs of DR.

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Section: Discussionsupporting

confidence: 76%

Corneal and Retinal Neuronal Degeneration in Early Stages of Diabetic Retinopathy

Srinivasan

Dehghani

Pritchard

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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“…There is extensive evidence that diabetes is accompanied by degeneration of the inner retina, a neurodegeneration that we and others call retinal sensory neuropathy, or DRN. 20 , 80 , 81 DRN is characterized by structural (e.g., neural apoptosis, ganglion cell loss, reactive gliosis, and thinning of the inner retina) and functional (electroretinogram [ERG], dark adaptation, contrast sensitivity, color vision, and microperimetric and perimetric psychophysical testing) deficits of the retina. 82 – 86 Central visual acuity, another aspect affected by DRN, is not affected in early DR and may be normal before clinical DR develops.…”

Section: Dr Grading Systems Do Not Incorporate Recent Findings On Drnmentioning

confidence: 99%

Approach for a Clinically Useful Comprehensive Classification of Vascular and Neural Aspects of Diabetic Retinal Disease

Abràmoff

Fort

Han

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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The Early Treatment Diabetic Retinopathy Study (ETDRS) and other standardized classification schemes have laid a foundation for tremendous advances in the understanding and management of diabetic retinopathy (DR). However, technological advances in optics and image analysis, especially optical coherence tomography (OCT), OCT angiography (OCTa), and ultra-widefield imaging, as well as new discoveries in diabetic retinal neuropathy (DRN), are exposing the limitations of ETDRS and other classification systems to completely characterize retinal changes in diabetes, which we term diabetic retinal disease (DRD). While it may be most straightforward to add axes to existing classification schemes, as diabetic macular edema (DME) was added as an axis to earlier DR classifications, doing so may make these classifications increasingly complicated and thus clinically intractable. Therefore, we propose future research efforts to develop a new, comprehensive, and clinically useful classification system that will identify multimodal biomarkers to reflect the complex pathophysiology of DRD and accelerate the development of therapies to prevent vision-threatening DRD.

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“…To investigate the electrophysiological properties of retinal cells after different times in organotypic culture and how high glucose (HG) conditions affects them is required to validate this model for diabetic retinopathy studies. In general terms, there is a clear need for more basic research to establish the mechanisms by which chronic HG affects neurons in the central nervous system, and a concomitant requirement for pertinent model systems (Cunha‐Vaz, ; Reis et al, ). Such a functional cellular approach could also help to create a foundation for neuroprotective strategies to prevent later stages of diabetic neurodegeneration (Moraes, Layton, & Franzco, ).…”

Section: Introductionmentioning

confidence: 99%

Physiological assessment of high glucose neurotoxicity in mouse and rat retinal explants

Calbiague

Vielma

Cadiz

et al. 2019

J of Comparative Neurology

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Diabetic Retinopathy: Need for More Research to Understand the Relative Role of Neuropathy and Microvascular Disease

Cited by 8 publications

References 13 publications

Corneal and Retinal Neuronal Degeneration in Early Stages of Diabetic Retinopathy

Corneal and Retinal Neuronal Degeneration in Early Stages of Diabetic Retinopathy

Approach for a Clinically Useful Comprehensive Classification of Vascular and Neural Aspects of Diabetic Retinal Disease

Physiological assessment of high glucose neurotoxicity in mouse and rat retinal explants

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