Review Article June 24, 2026 June 24, 2026

Neurodegenerative manifestations in diabetic retinopathy

DOI: 10.37039/1982.8551.20260060

ABSTRACT

Diabetic retinopathy is the leading cause of vision loss among working-age adults in the Western world. Although it has traditionally been considered a microvascular disease, growing evidence suggests that neurodegenerative changes may occur even before the appearance of microvascular damage. The aim of this review was to provide a comprehensive summary of the current evidence regarding neurodegenerative changes in diabetic retinopathy. This is a narrative review, in which we performed a comprehensive literature search from August 15, 1998, to June 20, 2025, using MEDLINE® (via PubMed®) and Lilacs (via the Virtual Health Library) to identify studies on neurodegenerative changes in diabetic retinopathy. The search strategy included combinations of keywords and MeSH terms such as „neurodegeneration” and „diabetic retinopathy”. After screening titles and abstracts based on predefined criteria and removing two duplicates, we included 236 relevant publications, including reviews, case reports, randomized controlled trials, meta-analyses, and guidelines. Of these, 73 articles were selected for an in-depth qualitative review on the subject. Current evidence indicates that neurodegenerative changes play a significant role in the early stages of diabetic retinopathy in a substantial proportion of patients, supporting the understanding of the disease as a neurovascular disorder.