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Hypoxia and Dark Adaptation in Diabetic Retinopathy: Interactions, Consequences, and Therapy

  • Microvascular Complications—Retinopathy (JK Sun, Section Editor)
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Abstract

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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Acknowledgments

The authors thank Carol Spencer (Lahey Hospital Library) and Judy Rabinowitz (Tufts University Hirsh Health Sciences Library) for research support.

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David J. Ramsey and G.B. Arden declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Ophthalmology, Lahey Hospital & Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA, 01805, USA

    David J. Ramsey

  2. University College London, London, UK

    G. B. Arden

  3. Moorfields Eye Hospital NHS Foundation Trust, London, UK

    G. B. Arden

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  1. David J. Ramsey
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Correspondence to David J. Ramsey.

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This article is part of the Topical Collection on Microvascular Complications—Retinopathy

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Ramsey, D.J., Arden, G.B. Hypoxia and Dark Adaptation in Diabetic Retinopathy: Interactions, Consequences, and Therapy. Curr Diab Rep 15, 118 (2015). https://doi.org/10.1007/s11892-015-0686-2

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