The neurovascular unit and the pathophysiologic basis of diabetic retinopathy

Purpose To relate the concept of the retinal neurovascular unit and its alterations in diabetes to the pathophysiology of diabetic retinopathy. Methods Case illustrations and conceptual frameworks are presented that illustrate adaptive and maladaptive “dis-integration” of the retinal neurovascular unit with the progression of diabetes. Results Retinopathy treatment should address pathophysiologic processes rather than pathologic lesions as is current practice. Conclusions Future improvements in the treatment of diabetic retinopathy requires deeper understanding of the cellular and molecular changes induced by diabetes, coupled with the use of quantitative phenotyping methods that assess the pathophysiologic processes.