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Diabetic retinal disease

Nature Reviews Disease Primers volume 11, Article number: 62 (2025) Cite this article

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Abstract

Diabetic retinopathy is a complication of diabetes mellitus that is clinically characterized by changes in retinal microvasculature. Diabetic retinopathy is now better defined as diabetic retinal disease (DRD), as diabetes mellitus affects not only the retinal microvasculature but the whole retina, including neurons and glia. A global concerted effort to study preclinical and clinical signs of DRD and their association with visual acuity and patient-reported vision-related quality of life, and the integration of these features with systemic health and biochemical milieu in people with diabetes mellitus is underway. The Diabetic Retinopathy Clinical Research Retina Network trials and other researchers have provided substantial robust evidence on the current management of vision-threatening diabetic retinopathy that includes proliferative diabetic retinopathy and diabetic macular oedema. Progress is also being made to develop, evaluate and implement cost-effective strategies for personalized screening, treatment and monitoring, incorporating artificial intelligence as clinical decision support tools, where appropriate. In addition, novel therapies and modes of delivery are being evaluated to increase durability of interventions and improve affordability to improve vision-related quality of life and reduce the global burden of blindness owing to DRD.

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Fig. 1: Grades of diabetic retinopathy.
Fig. 2: Epidemiology of diabetic retinopathy and principles of management.
Fig. 3: Diabetes affects the whole retina.
Fig. 4: Known changes in the neurovascular unit in diabetes.
Fig. 5: Timeline of diabetic retinopathy management.
Fig. 6: Treatment options for DMO at presentation.
Fig. 7: Summary of anti-VEGF therapy for DMO.

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Authors and Affiliations

  1. National Institute of Health Research Moorfields Biomedical Research Centre, Moorfields Eye Hospital, London, UK

    Sobha Sivaprasad

  2. Institute of Ophthalmology, University College, London, UK

    Sobha Sivaprasad

  3. Beijing Visual Science and Translational Eye Research Institute, Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China

    Tien Yin Wong

  4. Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore

    Tien Yin Wong

  5. Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA

    Thomas W. Gardner

  6. Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Jennifer K. Sun

  7. Beetham Eye Institute, Joslin Diabetes Centre, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA

    Jennifer K. Sun

  8. Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Neil M. Bressler

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  1. Sobha Sivaprasad
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  2. Tien Yin Wong
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  3. Thomas W. Gardner
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  4. Jennifer K. Sun
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  5. Neil M. Bressler
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Contributions

Introduction (S.S.); Epidemiology (T.Y.W.); Mechanisms/pathophysiology (T.W.G.); Diagnosis, screening and prevention (T.Y.W. and S.S.); Management (N.M.B.); Quality of life (S.S.); Outlook (J.K.S.); overview of the Primer (S.S.).

Corresponding author

Correspondence to Sobha Sivaprasad.

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Competing interests

S.S. is the editor-in-chief of EYE; has been a consultant for AbbVie Pte Ltd., Amgen, Adverum, Apellis, Bayer, Biogen, Boehringer Ingelheim, Novartis, Eyebiotech, Eyepoint Pharmaceuticals, Janssen Pharmaceuticals, Ocular Therapeutix, Kriya Therapeutics, OcuTerra, Roche, Stealth Biotherapeutics and Sanofi; has received research support from Boehringer Ingelheim, Roche, Optos and Bayer; and is a Trial Steering Committee member for Novo Nordisk. T.Y.W. is a consultant for Abbvie Pte Ltd., Aldropika Therapeutics, Bayer, Boehringer Ingelheim, Carl Zeiss, Genentech, Iveric Bio, Novartis, Opthea Limited, Plano, Quaerite Biopharm Research Ltd., Roche, Sanofi and Shanghai Henlius. He is an inventor, holds patents and is a cofounder of start-up companies EyRiS and Visre, which have interests in, and develop digital solutions for eye diseases. T.W.G. has had research support from Breakthrough T1D, the Mary Tyler Moore Vision Initiative, the Taubman Medical Research Institute and the Jaeb Center for Health Research and is a cofounder of OcularDx, Inc. J.K.S. has had research support from Adaptive Sensory Technologies, Boehringer Ingelheim, Breakthrough T1D, Genentech/Roche, Jaeb Center for Health Research, Janssen, Mary Tyler Moore Vision Initiative, Massachusetts Lions Eye Research Fund, Novartis, Novo Nordisk, Optovue and Physical Sciences, Inc; and has received travel/food expenses from the Mary Tyler Moore Vision Initiative and Boehringer Ingelheim. N.M.B. is the editor-in-chief of JAMA Ophthalmology; has received grants to Johns Hopkins University from Regeneron, Bayer, and Samsung Bioepis; and is on the board of directors of the JAEB Center for Health Research Foundation, Inc. and the JAEB Center Research Trust, Inc.

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Nature Reviews Disease Primers thanks F. Bandello, T. Bek, P. Massin and R. Simó for their contribution to the peer review of this work.

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Sivaprasad, S., Wong, T.Y., Gardner, T.W. et al. Diabetic retinal disease. Nat Rev Dis Primers 11, 62 (2025). https://doi.org/10.1038/s41572-025-00646-x

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