Hypoxia and Dark Adaptation in Diabetic Retinopathy: Interactions, Consequences, and Therapy
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  • 作者：David J. Ramsey ; G. B. Arden
  • 关键词：Dark adaptation ; Rod photoreceptors ; Light at night ; Hypoxia ; Diabetic retinopathy ; Diabetic macular edema
  • 刊名：Current Diabetes Reports
  • 出版年：2015
  • 出版时间：December 2015
  • 年：2015
  • 卷：15
  • 期：12
  • 全文大小：894 KB
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  • 作者单位：David J. Ramsey (1)
    G. B. Arden (2) (3)

    1. Department of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA, 01805, USA
    2. University College London, London, UK
    3. Moorfields Eye Hospital NHS Foundation Trust, London, UK
  • 刊物主题：Diabetes;
  • 出版者：Springer US
  • ISSN：1539-0829
    • 文摘
    In diabetes, retinal blood flow is compromised, and retinal hypoxia is likely to be further intensified during periods of darkness. During dark adaptation, rod photoreceptors in the outer retina are maximally depolarized and continuously release large amounts of the neurotransmitter glutamate—an energetically demanding process that requires the highest oxygen consumption per unit volume of any tissue of the body. In complete darkness, even more oxygen is consumed by the outer retina, producing a steep fall in the retinal oxygen tension curve which reaches a nadir at the depth of the mitochondrial-rich rod inner segments. In contrast to the normal retina, the diabetic retina cannot meet the added metabolic load imposed by the dark-adapted rod photoreceptors; this exacerbates retinal hypoxia and stimulates the overproduction of vascular endothelial growth factor (VEGF). The use of nocturnal illumination to prevent dark adaptation, specifically reducing the rod photoreceptor dark current, should ameliorate diabetic retinopathy.

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