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Diabetic Retinopathy01:27

Diabetic Retinopathy

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DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
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Updated: May 4, 2026

Using Retinal Imaging to Study Dementia
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Understanding nonproliferative diabetic retinopathy progression using noninvasive imaging.

José Cunha-Vaz1,2, Luís Mendes3, Débora Reste-Ferreira3

  • 1AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal. cunhavaz@aibili.pt.

Eye (London, England)
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Summary

Identifying patients with diabetes at risk of vision loss from diabetic retinopathy is crucial. Early detection of rapid progression, focusing on ischemic phenotypes, can help prevent severe complications like vision-threatening macular edema.

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Area of Science:

  • Ophthalmology
  • Diabetology
  • Vascular Biology

Background:

  • Diabetic retinopathy (DR) affects a subset of diabetes patients, leading to vision loss.
  • The Early Treatment Diabetic Retinopathy Study (ETDRS) scale is the standard for grading DR progression.
  • DR pathogenesis involves neurodegeneration, blood-retinal barrier alterations, and ischemia.

Purpose of the Study:

  • To identify patients at risk of rapid diabetic retinopathy progression and vision loss.
  • To understand the progression of ischemic diabetic retinopathy phenotypes.
  • To inform strategies for preventing vision-threatening complications.

Main Methods:

  • Conceptual classification of fundus abnormalities into neurodegeneration, blood-retinal barrier alteration, and ischemia phenotypes.
  • Description of ischemic DR progression: hypoperfusion, deep capillary plexus involvement, and hyperperfusion response.
  • Analysis of microvascular changes leading to clinically significant macular edema (CSME) and proliferative diabetic retinopathy (PDR).

Main Results:

  • Ischemic DR progresses from hypoperfusion to hyperperfusion with dilated shunt vessels and intraretinal microvascular abnormalities.
  • Visual acuity is maintained until CSME or PDR develops.
  • Microvascular changes are key drivers of vision-threatening complications.

Conclusions:

  • Preventing vision loss in diabetic retinopathy may involve halting progressive ischemia or targeting angiogenic/inflammatory responses.
  • Early identification of rapid progression in ischemic DR is critical for intervention.
  • Understanding DR phenotypes aids in developing targeted preventative strategies.