Diabetic retinopathy (DR) and diabetic
macular edema (DME) are
retinal complications of diabetes that can lead to loss of vision and impaired quality of life. The current gold standard
therapies for treatment of DR and DME focus on advanced disease, are invasive, expensive, and can trigger adverse side-effects, necessitating the development of more effective, affordable, and accessible
therapies that can target early stage disease. The pathogenesis and pathophysiology of DR is complex and multifactorial, involving the interplay between the effects of
hyperglycemia,
hyperlipidemia,
hypoxia, and production of
reactive oxygen species (ROS) in the promotion of neurovascular dysfunction and immune cell polarization to a proinflammatory state. The pathophysiology of DR provides several therapeutic targets that have the potential to attenuate
disease progression. Current novel DR and DME
therapies under investigation include
erythropoietin-derived
peptides, inducers of
antioxidant gene expression, activators of
nitric oxide/
cyclic GMP signaling pathways, and manipulation of
arginase activity. This review aims to aid understanding of DR and DME pathophysiology and explore novel
therapies that capitalize on our knowledge of these diabetic
retinal complications.