Diabetic retinal disease: a redefined term for diabetic retinopathy_Chinese Journal of Ocular Fundus Diseases

Authors：

 Hui Yannian

Department of Ophthalmology, Xijing Hospital, Eye Institute of PLA, Air Force Medical Univeristy, Xi’an 710032, China;

Corresponding?author：

Hui Yannian, Email: ynlhui@163.com

Keywords：

Diabetic retinopathy; Diabetic retinal disease; Retinal neurovascualar unit; Disease staging; Editorial

DOI：

10.3760/cma.j.cn511434-20251120-00515

Video：

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Diabetic retinopathy (DR) is the most common complication of diabetes mellitus and has been historically regarded as a retinal microangiopathy. Currently, the diagnosis and classification of DR are still based on vascular abnormalities observed by ophthalmoscopy or color fundus photographs. An increasing number of studies have shown that DR is the result of overall structural and functional disorders of the neurovascular unit, and it is a tissue-specific neurovascular complication. Persistent hyperglycemia in DM not only causes microvascular damage and ischemia, but also leads to retinal inflammation and neuronal degeneration. Furthermore, neurodegeneration often occurs before detectable microvascular lesions. Since 2018, DR has been preferably defined as diabetic retinal disease (DRD), which particularly refers to the effects of diabetes on the entire retina, including neural and vascular components, not only on vascular lesions. The evolution of this term reflects a deepening of the overall understanding of the disease, which helps to promote the improvement of prevention and treatment strategies towards a more systematic and earlier stage. Correspondingly, new challenges have been posed for the assessment, diagnosis, disease staging, and whole disease course management of DRD.

Citation： Hui Yannian. Diabetic retinal disease: a redefined term for diabetic retinopathy. Chinese Journal of Ocular Fundus Diseases, 2026, 42(1): 3-7. doi: 10.3760/cma.j.cn511434-20251120-00515 Copy

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3.	Sohn EH, van Dijk HW, Jiao C, et al. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus[J/OL]. Proc Natl Acad Sci USA, 2016, 113(19): E2655-664[2016-05-10]. https://pubmed.ncbi.nlm.nih.gov/27114552/. DOI: 10.1073/pnas.1522014113.
4.	Sukha AY, Rubin A. High, medium, and low contrast visual acuities in diabetic retinal disease[J]. Optom Vis Sci, 2009, 86(9): 1086-1095. DOI: 10.1097/OPX.0b013e3181b48635.
5.	Fendrick AM, Javitt JC, Chiang YP. Cost-effectiveness of the screening and treatment of diabetic retinopathy. What are the costs of underutilization?[J]. Int J Technol Assess Health Care, 1992, 8(4): 694-707. DOI: 10.1017/s0266462300002385.
6.	Deschler EK, Sun JK, Silva PS. Side-effects and complications of laser treatment in diabetic retinal disease[J]. Semin Ophthalmol, 2014, 29(5-6): 290-300. DOI: 10.3109/08820538.2014.959198.
7.	Exalto LG, Biessels GJ, Karter AJ, et al. Severe diabetic retinal disease and dementia risk in type 2 diabetes[J]. J Alzheimers Dis, 2014, 42(3): S109-117. DOI: 10.3233/JAD-132570.
8.	Ajlan RS, Silva PS, Sun JK. Vascular endothelial growth factor and diabetic retinal disease[J]. Semin Ophthalmol, 2016, 31(1-2): 40-48. DOI: 10.3109/08820538.2015.1114833.
9.	惠延年. 神經血管單元與糖尿病視網膜病變[J]. 國際眼科雜志, 2023, 23(3): 353-355. DOI: 10.3980/j.issn.1672-5123.2023.3.01.Hui YN. Neurovascular unit and diabetic retinopathy[J]. Int Eye Sci, 2023, 23(3): 353-355. DOI: 10.3980/j.issn.1672-5123.2023.3.01.
10.	Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
11.	Abramoff MD, Fort PE, Han IC, et al. Approach for a clinically useful comprehensive classification of vascular and neural aspects of diabetic retinal disease[J]. Invest Ophthalmol Vis Sci, 2018, 59(1): 519-527. DOI: 10.1167/iovs.17-21873.
12.	Saurabh K, Roy R. Commentary: from diabetic retinopathy toward diabetic retinal disease[J]. Indian J Ophthalmol, 2021, 69(11): 3248-3249. DOI: 10.4103/ijo.IJO_2131_21.
13.	Bianco L, Arrigo A, Aragona E, et al. Neuroinflammation and neurodegeneration in diabetic retinopathy[J/OL]. Front Aging Neurosci, 2022, 14: 937999[2022-08-16]. https://pubmed.ncbi.nlm.nih.gov/36051309/. DOI: 10.3389/fnagi.2022.937999.
14.	Sivaprasad S, Wong TY, Gardner TW, et al. Diabetic retinal disease[J/OL]. Nat Rev Dis Primers, 2025, 11(1): 62[2025-08-28]. https://pubmed.ncbi.nlm.nih.gov/40877334/. DOI: 10.1038/s41572-025-00646-x.
15.	Iadecola C. The neurovascular unit coming of age: a journey through neurovascular coupling in health and disease[J]. Neuron, 2017, 96(1): 17-42. DOI: 10.1016/j.neuron.2017.07.030.
16.	Metea MR, Newman EA. Signalling within the neurovascular unit in the mammalian retina[J]. Exp Physiol, 2007, 92(4): 635-640. DOI: 10.1113/expphysiol.2006.036376.
17.	Aschauer J, Pollreisz A, Karst S, et al. Longitudinal analysis of microvascular perfusion and neurodegenerative changes in early type 2 diabetic retinal disease[J]. Br J Ophthalmol, 2022, 106(4): 528-533. DOI: 10.1136/bjophthalmol-2020-317322.
18.	Gardner TW, Bek T. Dissecting the neurovascular unit in human diabetic retinal disease[J]. Diabetes, 2024, 73(11): 1791-1792. DOI: 10.2337/dbi24-0036.
19.	Rajagopal R, Kern T. Clinical evidence of a photoreceptor origin in diabetic retinal disease[J/OL]. Ophthalmol Sci, 2024, 5(1): 100591[2024-08-02]. https://pubmed.ncbi.nlm.nih.gov/39328824/. DOI: 10.1016/j.xops.2024.100591.
20.	Hartnett ME, Fickweiler W, Adamis AP, et al. Rationale of basic and cellular mechanisms considered in updating the staging system for diabetic retinal disease[J/OL]. Ophthalmol Sci, 2024, 4(5): 100521[2024-03-27]. https://pubmed.ncbi.nlm.nih.gov/39006804/. DOI: 10.1016/j.xops.2024.
21.	Torm MEW, Dorweiler TF, Fickweiler W, et al. Frontiers in diabetic retinal disease[J/OL]. J Diabetes Complications, 2023, 37(2): 108386[2022-12-21]. https://pubmed.ncbi.nlm.nih.gov/36608490/. DOI: 10.1016/j.jdiacomp.2022.108386.
22.	Levine SR, Sapieha P, Dutta S, et al. It is time for a moonshot to find "Cures" for diabetic retinal disease[J/OL]. Prog Retin Eye Res, 2022, 90: 101051[2022-02-11]. https://pubmed.ncbi.nlm.nih.gov/35165043/. DOI: 10.1016/j.preteyeres.2022.101051.
23.	Sun JK, Aiello LP, Abràmoff MD, et al. Updating the staging system for diabetic retinal disease[J]. Ophthalmology, 2021, 128(4): 490-493. DOI: 10.1016/j.ophtha.2020.10.008.
24.	Rai BB, Maddess T, Nolan CJ. Functional diabetic retinopathy: a new concept to improve management of diabetic retinal diseases[J]. Surv Ophthalmol, 2025, 70(2): 232-240. DOI: 10.1016/j.survophthal.2024.11.010.
25.	Tan TE, Jampol LM, Ferris FL, et al. Imaging modalities for assessing the vascular component of diabetic retinal disease: review and consensus for an updated staging system[J/OL]. Ophthalmol Sci, 2023, 4(3): 100449[2023-12-10]. https://pubmed.ncbi.nlm.nih.gov/38313399/. DOI: 10.1016/j.xops.2023.100449.
26.	Vujosevic S, Cunha-Vaz J, Figueira J, et al. Standardization of optical coherence tomography angiography imaging biomarkers in diabetic retinal disease[J]. Ophthalmic Res, 2021, 64(6): 871-887. DOI: 10.1159/000518620.
27.	Schreur V, Larsen MB, Sobrin L, et al. Imaging diabetic retinal disease: clinical imaging requirements[J]. Acta Ophthalmol, 2022, 100(7): 752-762. DOI: 10.1111/aos.15110.
28.	Bloomquist RF, Bloomquist DT, Gardner TW. Current treatment options for diabetic retinal disease[J]. Diabetes Technol Ther, 2025, 27(4): 248-260. DOI: 10.1089/dia.2024.0548.
29.	Abràmoff MD, Lavin PT, Jakubowski JR, et al. Mitigation of AI adoption bias through an improved autonomous AI system for diabetic retinal disease[J/OL]. NPJ Digit Med, 2024, 7(1): 369[2024-12-19]. https://pubmed.ncbi.nlm.nih.gov/39702673/. DOI: 10.1038/s41746-024-01389-x.
30.	Gupta A, Cavallerano J, Sun JK, et al. Evidence for telemedicine for diabetic retinal disease[J]. Semin Ophthalmol, 2017, 32(1): 22-28. DOI: 10.1080/08820538.2016.1228403.
31.	Domalpally A, Fickweiler W, Levine SR, et al. Data harmonization, standardization, and collaboration for Diabetic Retinal Disease (DRD) research: report from the 2024 Mary Tyler Moore Vision Initiative Workshop on Data[J/OL]. Transl Vis Sci Technol, 2024, 13(10): 4[2024-10-01]. https://pubmed.ncbi.nlm.nih.gov/39361314/. DOI: 10.1167/tvst.13.10.4.
32.	VanderBeek BL, Yu Y, Cardillo S, et al. Twenty-year trends in prevalence and incidence of diabetic retinal disease[J]. Ophthalmology, 2025, 132(7): 767-774. DOI: 10.1016/j.ophtha.2025.01.022.
33.	Vujosevic S, Chew E, Labriola L, et al. Measuring quality of life in diabetic retinal disease: a narrative review of available patient-reported outcome measures[J/OL]. Ophthalmol Sci, 2023, 4(2): 100378[2023-08-09]. https://pubmed.ncbi.nlm.nih.gov/37868790/. DOI: 10.1016/j.xops.2023.100378.
34.	Mellor J, Jeyam A, Beulens JWJ, et al. Role of systemic factors in improving the prognosis of diabetic retinal disease and predicting response to diabetic retinopathy treatment[J/OL]. Ophthalmol Sci, 2024, 4(4): 100494[2024-02-17]. https://pubmed.ncbi.nlm.nih.gov/38694495/. DOI: 10.1016/j.xops.2024.100494.

1. 惠延年. 精確評估和控制糖尿病視網膜病變的進展[J]. 中華眼底病雜志, 2021, 37(1): 1-4. DOI: 10.3760/cma.j.cn511434-20201224-00634.Hui YN. Accurate assessment and control of the progression of diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2021, 37(1): 1-4. DOI: 10.3760/cma.j.cn511434-20201224-00634.
2. 惠延年. 優化整合糖尿病視網膜病變治療方案[J]. 中華眼底病雜志, 2025, 41(1): 1-6. DOI: 10.3760/cma.j.cn511434-20250102-00001.Hui YN. Optimizing integration of treatment options for diabetic retinopathy[J]. Chin J Ocul Fundus Dis, 2025, 41(1): 1-6. DOI: 10.3760/cma.j.cn511434-20250102-00001.
3. Sohn EH, van Dijk HW, Jiao C, et al. Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus[J/OL]. Proc Natl Acad Sci USA, 2016, 113(19): E2655-664[2016-05-10]. https://pubmed.ncbi.nlm.nih.gov/27114552/. DOI: 10.1073/pnas.1522014113.
4. Sukha AY, Rubin A. High, medium, and low contrast visual acuities in diabetic retinal disease[J]. Optom Vis Sci, 2009, 86(9): 1086-1095. DOI: 10.1097/OPX.0b013e3181b48635.
5. Fendrick AM, Javitt JC, Chiang YP. Cost-effectiveness of the screening and treatment of diabetic retinopathy. What are the costs of underutilization?[J]. Int J Technol Assess Health Care, 1992, 8(4): 694-707. DOI: 10.1017/s0266462300002385.
6. Deschler EK, Sun JK, Silva PS. Side-effects and complications of laser treatment in diabetic retinal disease[J]. Semin Ophthalmol, 2014, 29(5-6): 290-300. DOI: 10.3109/08820538.2014.959198.
7. Exalto LG, Biessels GJ, Karter AJ, et al. Severe diabetic retinal disease and dementia risk in type 2 diabetes[J]. J Alzheimers Dis, 2014, 42(3): S109-117. DOI: 10.3233/JAD-132570.
8. Ajlan RS, Silva PS, Sun JK. Vascular endothelial growth factor and diabetic retinal disease[J]. Semin Ophthalmol, 2016, 31(1-2): 40-48. DOI: 10.3109/08820538.2015.1114833.
9. 惠延年. 神經血管單元與糖尿病視網膜病變[J]. 國際眼科雜志, 2023, 23(3): 353-355. DOI: 10.3980/j.issn.1672-5123.2023.3.01.Hui YN. Neurovascular unit and diabetic retinopathy[J]. Int Eye Sci, 2023, 23(3): 353-355. DOI: 10.3980/j.issn.1672-5123.2023.3.01.
10. Solomon SD, Chew E, Duh EJ, et al. Diabetic retinopathy: a position statement by the American Diabetes Association[J]. Diabetes Care, 2017, 40(3): 412-418. DOI: 10.2337/dc16-2641.
11. Abramoff MD, Fort PE, Han IC, et al. Approach for a clinically useful comprehensive classification of vascular and neural aspects of diabetic retinal disease[J]. Invest Ophthalmol Vis Sci, 2018, 59(1): 519-527. DOI: 10.1167/iovs.17-21873.
12. Saurabh K, Roy R. Commentary: from diabetic retinopathy toward diabetic retinal disease[J]. Indian J Ophthalmol, 2021, 69(11): 3248-3249. DOI: 10.4103/ijo.IJO_2131_21.
13. Bianco L, Arrigo A, Aragona E, et al. Neuroinflammation and neurodegeneration in diabetic retinopathy[J/OL]. Front Aging Neurosci, 2022, 14: 937999[2022-08-16]. https://pubmed.ncbi.nlm.nih.gov/36051309/. DOI: 10.3389/fnagi.2022.937999.
14. Sivaprasad S, Wong TY, Gardner TW, et al. Diabetic retinal disease[J/OL]. Nat Rev Dis Primers, 2025, 11(1): 62[2025-08-28]. https://pubmed.ncbi.nlm.nih.gov/40877334/. DOI: 10.1038/s41572-025-00646-x.
15. Iadecola C. The neurovascular unit coming of age: a journey through neurovascular coupling in health and disease[J]. Neuron, 2017, 96(1): 17-42. DOI: 10.1016/j.neuron.2017.07.030.
16. Metea MR, Newman EA. Signalling within the neurovascular unit in the mammalian retina[J]. Exp Physiol, 2007, 92(4): 635-640. DOI: 10.1113/expphysiol.2006.036376.
17. Aschauer J, Pollreisz A, Karst S, et al. Longitudinal analysis of microvascular perfusion and neurodegenerative changes in early type 2 diabetic retinal disease[J]. Br J Ophthalmol, 2022, 106(4): 528-533. DOI: 10.1136/bjophthalmol-2020-317322.
18. Gardner TW, Bek T. Dissecting the neurovascular unit in human diabetic retinal disease[J]. Diabetes, 2024, 73(11): 1791-1792. DOI: 10.2337/dbi24-0036.
19. Rajagopal R, Kern T. Clinical evidence of a photoreceptor origin in diabetic retinal disease[J/OL]. Ophthalmol Sci, 2024, 5(1): 100591[2024-08-02]. https://pubmed.ncbi.nlm.nih.gov/39328824/. DOI: 10.1016/j.xops.2024.100591.
20. Hartnett ME, Fickweiler W, Adamis AP, et al. Rationale of basic and cellular mechanisms considered in updating the staging system for diabetic retinal disease[J/OL]. Ophthalmol Sci, 2024, 4(5): 100521[2024-03-27]. https://pubmed.ncbi.nlm.nih.gov/39006804/. DOI: 10.1016/j.xops.2024.
21. Torm MEW, Dorweiler TF, Fickweiler W, et al. Frontiers in diabetic retinal disease[J/OL]. J Diabetes Complications, 2023, 37(2): 108386[2022-12-21]. https://pubmed.ncbi.nlm.nih.gov/36608490/. DOI: 10.1016/j.jdiacomp.2022.108386.
22. Levine SR, Sapieha P, Dutta S, et al. It is time for a moonshot to find "Cures" for diabetic retinal disease[J/OL]. Prog Retin Eye Res, 2022, 90: 101051[2022-02-11]. https://pubmed.ncbi.nlm.nih.gov/35165043/. DOI: 10.1016/j.preteyeres.2022.101051.
23. Sun JK, Aiello LP, Abràmoff MD, et al. Updating the staging system for diabetic retinal disease[J]. Ophthalmology, 2021, 128(4): 490-493. DOI: 10.1016/j.ophtha.2020.10.008.
24. Rai BB, Maddess T, Nolan CJ. Functional diabetic retinopathy: a new concept to improve management of diabetic retinal diseases[J]. Surv Ophthalmol, 2025, 70(2): 232-240. DOI: 10.1016/j.survophthal.2024.11.010.
25. Tan TE, Jampol LM, Ferris FL, et al. Imaging modalities for assessing the vascular component of diabetic retinal disease: review and consensus for an updated staging system[J/OL]. Ophthalmol Sci, 2023, 4(3): 100449[2023-12-10]. https://pubmed.ncbi.nlm.nih.gov/38313399/. DOI: 10.1016/j.xops.2023.100449.
26. Vujosevic S, Cunha-Vaz J, Figueira J, et al. Standardization of optical coherence tomography angiography imaging biomarkers in diabetic retinal disease[J]. Ophthalmic Res, 2021, 64(6): 871-887. DOI: 10.1159/000518620.
27. Schreur V, Larsen MB, Sobrin L, et al. Imaging diabetic retinal disease: clinical imaging requirements[J]. Acta Ophthalmol, 2022, 100(7): 752-762. DOI: 10.1111/aos.15110.
28. Bloomquist RF, Bloomquist DT, Gardner TW. Current treatment options for diabetic retinal disease[J]. Diabetes Technol Ther, 2025, 27(4): 248-260. DOI: 10.1089/dia.2024.0548.
29. Abràmoff MD, Lavin PT, Jakubowski JR, et al. Mitigation of AI adoption bias through an improved autonomous AI system for diabetic retinal disease[J/OL]. NPJ Digit Med, 2024, 7(1): 369[2024-12-19]. https://pubmed.ncbi.nlm.nih.gov/39702673/. DOI: 10.1038/s41746-024-01389-x.
30. Gupta A, Cavallerano J, Sun JK, et al. Evidence for telemedicine for diabetic retinal disease[J]. Semin Ophthalmol, 2017, 32(1): 22-28. DOI: 10.1080/08820538.2016.1228403.
31. Domalpally A, Fickweiler W, Levine SR, et al. Data harmonization, standardization, and collaboration for Diabetic Retinal Disease (DRD) research: report from the 2024 Mary Tyler Moore Vision Initiative Workshop on Data[J/OL]. Transl Vis Sci Technol, 2024, 13(10): 4[2024-10-01]. https://pubmed.ncbi.nlm.nih.gov/39361314/. DOI: 10.1167/tvst.13.10.4.
32. VanderBeek BL, Yu Y, Cardillo S, et al. Twenty-year trends in prevalence and incidence of diabetic retinal disease[J]. Ophthalmology, 2025, 132(7): 767-774. DOI: 10.1016/j.ophtha.2025.01.022.
33. Vujosevic S, Chew E, Labriola L, et al. Measuring quality of life in diabetic retinal disease: a narrative review of available patient-reported outcome measures[J/OL]. Ophthalmol Sci, 2023, 4(2): 100378[2023-08-09]. https://pubmed.ncbi.nlm.nih.gov/37868790/. DOI: 10.1016/j.xops.2023.100378.
34. Mellor J, Jeyam A, Beulens JWJ, et al. Role of systemic factors in improving the prognosis of diabetic retinal disease and predicting response to diabetic retinopathy treatment[J/OL]. Ophthalmol Sci, 2024, 4(4): 100494[2024-02-17]. https://pubmed.ncbi.nlm.nih.gov/38694495/. DOI: 10.1016/j.xops.2024.100494.

Chinese Journal of Ocular Fundus Diseases

Diabetic retinal disease: a redefined term for diabetic retinopathy

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