ArticleProceedings of the National Academy of Sciences of the United States of America2016
Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 405 papers, 1 of them a synthesis that pooled it.
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Who cites it
405 citing papers in PubMed, 1 synthesis or guideline pooled it, 654 citations in OpenAlex.
- Clinical characteristics, imaging features, and treatment outcomes of macular telangiectasia type 2: a comprehensive meta-analysis.Scientific reports · 2026Pooled it
- Sodium-glucose cotransporter 2 inhibition and injection burden in mild diabetic macular edema: An exploratory post hoc analysis of the COMET trial.Journal of diabetes investigation · 2026Trial
- Efficacy and Safety of Qiming Granule for Nerve Injury Associated with Non-proliferative Diabetic Retinopathy: A Multicenter, Randomized, Non-inferiority, Active-Controlled Clinical Trial.Chinese journal of integrative medicine · 2026Trial
- Visual Field Changes in Diabetic Retinopathy: Natural History and after Pan-Retinal Photocoagulation in the Diabetic Retinopathy Study and the ETDRS.Ophthalmology. Retina · 2025Trial
- Systemic Diseases and the Eye: A Translational Perspective on Diabetes.Chronic diseases and translational medicine · 2026Review
- Retinal proteomics in neurodegeneration: Insights into ocular and brain disorders.Neural regeneration research · 2026Article
- Beyond Anti-VEGF: Toward Integrated Precision Care in Diabetic Retinal Disease.Pharmaceutics · 2026Review
- Alpinia Oxyphylla-Shenqi Siwu Decoction protects against high glucose-induced retinal pigment epithelial cell injury involving the PI3K/AKT/mTOR pathway.International ophthalmology · 2026Article
- Longitudinal Changes in Ganglion Cell Complex Thickness Before and After Intravitreal Bevacizumab Injections in Diabetic Macular Edema.Diagnostics (Basel, Switzerland) · 2026Article
- Tempol Attenuates Diabetes-induced Transcriptomic Changes in the Rat Retina.Molecular neurobiology · 2026Article
- Dynamic Oculomics for Diagnostic Monitoring: Personal Ocular Trends, Risk Stratification and Treatment Response.Diagnostics (Basel, Switzerland) · 2026Review
- Dysfunction of the Neurovascular Unit in Diabetic Retinopathy: Advances from Molecular Mechanisms to Targeted Interventions.Stem cell reviews and reports · 2026Review
- Exploring Endotoxemia in Age-Related Macular Degeneration, Glaucoma, and Diabetic Retinopathy.Investigative ophthalmology & visual science · 2026Review
- Contrast Sensitivity Impairment in Diabetic Retinopathy: Clinical and Structural Correlates.Diagnostics (Basel, Switzerland) · 2026Review
- Resveratrol attenuates diabetic RGC degeneration through TRIM23-dependent VDAC1 ubiquitination and mitophagy.Cell communication and signaling : CCS · 2026Article
- Retinal and choroidal changes in diabetic patients before definitive diagnosis of diabetic retinopathy: a two-year prospective study.Journal of endocrinological investigation · 2026Article
- Degeneration of Interpericyte Tunneling Nanotubes Can Occur in the Absence of Pericyte Loss in Diabetic Retina Disease.Investigative ophthalmology & visual science · 2026Article
- The Impact of Inflammatory Hyperreflective Spots and Hard Exudates on Retinal Function in Diabetic Retinal Disease.Translational vision science & technology · 2026Article
- Neuroprotection in Early Diabetic Retinal Disease Using Eyedrop Delivery.International journal of molecular sciences · 2026Review
- Prognostic Imaging Biomarkers in Diabetic Macular Edema Treated with Anti-VEGF: A Multicenter AI Perspective.Ophthalmology and therapy · 2026Article
345 more citing papers are in PubMed but not listed here.
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Authors and funding
17 authors at 4 institutions in 2 countries.
Funding
Abstract
Diabetic retinopathy (DR) has long been recognized as a microvasculopathy, but retinal diabetic neuropathy (RDN), characterized by inner retinal neurodegeneration, also occurs in people with diabetes mellitus (DM). We report that in 45 people with DM and no to minimal DR there was significant, progressive loss of the nerve fiber layer (NFL) (0.25 μm/y) and the ganglion cell (GC)/inner plexiform layer (0.29 μm/y) on optical coherence tomography analysis (OCT) over a 4-y period, independent of glycated hemoglobin, age, and sex. The NFL was significantly thinner (17.3 μm) in the eyes of six donors with DM than in the eyes of six similarly aged control donors (30.4 μm), although retinal capillary density did not differ in the two groups. We confirmed significant, progressive inner retinal thinning in streptozotocin-induced "type 1" and B6.BKS(D)-Lepr(db)/J "type 2" diabetic mouse models on OCT; immunohistochemistry in type 1 mice showed GC loss but no difference in pericyte density or acellular capillaries. The results suggest that RDN may precede the established clinical and morphometric vascular changes caused by DM and represent a paradigm shift in our understanding of ocular diabetic complications.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.