What else can we do to prevent diabetic retinopathy?

The classical modifiable factors associated with the onset and progression of diabetic retinopathy are the suboptimal control of blood glucose levels and hypertension, as well as dyslipidaemia. However, there are other less recognised modifiable factors that can play a relevant role, such as the presence of obesity or the abnormal distribution of adipose tissue, and others related to lifestyle such as the type of diet, vitamin intake, exercise, smoking and sunlight exposure. In this article we revisit the prevention of diabetic retinopathy based on modulating the modifiable risk factors, as well as commenting on the potential impact of glucose-lowering drugs on the condition. The emerging concept that neurodegeneration is an early event in the development of diabetic retinopathy points to neuroprotection as a potential therapeutic strategy to prevent the advanced stages of the disease. In this regard, the better phenotyping of very early stages of diabetic retinopathy and the opportunity of arresting its progression using treatments targeting the neurovascular unit (NVU) are discussed.

Automated summary

The classical modifiable factors associated with the onset and progression of diabetic retinopathy include suboptimal control of blood glucose levels and hypertension, as well as dyslipidaemia. However, there are other less recognized modifiable factors, such as obesity and abnormal distribution of adipose tissue, as well as lifestyle factors like diet, vitamin intake, exercise, smoking, and sunlight exposure, that can play a relevant role. This article discusses the prevention of diabetic retinopathy by modulating these risk factors and explores the potential impact of glucose-lowering drugs on the condition. It also highlights the emerging concept of neurodegeneration as an early event in the development of diabetic retinopathy and discusses the potential of neuroprotection as a therapeutic strategy to prevent advanced stages of the disease.