How can nerve changes in the retina predict diabetic retinopathy even before blood vessels are affected?
Recent studies show that many pathological changes occur even before the visible onset of diabetic retinopathy in people with hyperinsulinemia, prediabetes or diabetes.
These changes affect retinal neurons, glial cells (which support and protect neurons), and microvessels (small blood vessels in the retina).
Pre-diabetics and diabetics without retinopathy show significant changes, especially in the nerve layers of the retina. These changes indicate a risk of nerve degeneration before the blood vessels are affected.
Although the blood vessels are not yet showing any damage, significant nerve changes are already present.
In particular, the retinal nerve fiber layer is thinner around the optic nerve, signaling early damage. Other areas of the retina, such as the temporal, nasal, superior and inferior regions, also show thinning.
Taking these early changes into account could improve prevention and open up new avenues for treating the early stages of diabetic retinopathy, helping to reduce the risk of blindness.
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Sources:
Retinal Neurodegeneration in Euglycemic Hyperinsulinemia, Prediabetes, and Diabetes.
Ebrahimi M, Sivaprasad S, Thompson P, Perry G.
Ophthalmic Res. 2023;66(1):385-397. doi: 10.1159/000528503. Epub 2022 Dec 2.
Macular and peripapillary retinal nerve fiber layer thinning in eyes with prediabetes in the elderly population: OTASSHA study.
Toyama T, Kawai H, Hashimoto Y, Azuma K, Shiraya T, Numaga J, Obuchi S, Ueta T; OTASSHA Study Group.
Graefes Arch Clin Exp Ophthalmol. 2023 May;261(5):1275-1281. doi: 10.1007/s00417-022-05925-x.
Retinal Nerve and Vascular Changes in Prediabetes.
Peng RP, Zhu ZQ, Shen HY, Lin HM, Zhong L, Song SQ, Liu T, Ling SQ.
Front Med (Lausanne). 2022 Feb 17;9:777646. doi: 10.3389/fmed.2022.777646. eCollection 2022.