Diabetic retinal disease: A sensory neuropathy

Diabetic retinal disease (DRD), diabetic neuropathy (DN), and nephropathy are increasing in worldwide prevalence, but current methods to identify early abnormalities and predict progression of DRD are limited. DN and DRD share many common risk factors and pathophysiologic features, including altered amino acid, lipid, and carbohydrate metabolism. Of these, we propose that defective insulin receptor signaling, and consequent dysregulated energetic and biosynthetic processes are common initiators of DRD and DN. Of relevance, neurons have high basal metabolic requirements that render them vulnerable to energy depletion and metabolic disruption. We propose that the eye can be used to identify early subclinical abnormalities and test novel interventions in DRD and diabetic neuropathies. The Mary Tyler Moore Vision Initiative serves to catalyze such advances in the field of DRD.