Patients with diabetes continue to suffer from impaired visual performance before the appearance of overt damage to the retinal microvasculature and later sight-threatening complications. This diabetic retinopathy (DR) has long been thought to start with endothelial cell oxidative stress. Yet newer data surprisingly finds that the avascular outer retina is the primary site of oxidative stress before microvascular histopathology in experimental DR. Importantly, correcting this early oxidative stress is sufficient to restore vision and mitigate the histopathology in diabetic models. However, translating these promising results into the clinic has been stymied by an absence of methods that can measure and optimize anti-oxidant treatment efficacyin vivo.Here, we review imaging approaches that address this problem. In particular, diabetes-induced oxidative stress impairs dark–light regulation of subretinal space hydration, which regulates the distribution of interphotoreceptor binding protein (IRBP). IRBP is a vision-critical, anti-oxidant, lipid transporter, and pro-survival factor. We show how optical coherence tomography can measure subretinal space oxidative stress thus setting the stage for personalizing anti-oxidant treatment and prevention of impactful declines and loss of vision in patients with diabetes.

中文翻译：

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通过减轻体内视网膜下间隙氧化应激预防糖尿病视网膜病变

糖尿病患者在出现明显的视网膜微血管损伤和随后的威胁视力的并发症之前，仍会遭受视力受损的困扰。长期以来，人们一直认为这种糖尿病视网膜病变 (DR) 始于内皮细胞氧化应激。然而，更新的数据令人惊讶地发现，在实验性 DR 中，在微血管组织病理学之前，无血管外层视网膜是氧化应激的主要部位。重要的是，纠正这种早期氧化应激足以恢复视力并减轻糖尿病模型中的组织病理学。然而，由于缺乏可以测量和优化抗氧化治疗效果的方法，阻碍了将这些有希望的结果转化为临床体内。在这里，我们回顾了解决这个问题的成像方法。特别是，糖尿病引起的氧化应激会损害视网膜下空间水合作用的暗光调节，从而调节光感受器间结合蛋白 (IRBP) 的分布。IRBP 是一种对视力至关重要的抗氧化剂、脂质转运蛋白和促生存因子。我们展示了光学相干断层扫描如何测量视网膜下空间氧化应激，从而为个性化抗氧化治疗和预防糖尿病患者的影响性衰退和视力丧失奠定基础。