Vision loss, among the most feared complications of diabetes, is primarily caused by diabetic retinopathy, a disease that manifests in well-recognized, characteristic microvascular lesions. The reasons for retinal susceptibility to damage in diabetes are unclear, especially considering that microvascular networks are found in all tissues. However, the unique metabolic demands of retinal neurons could account for their vulnerability in diabetes. Photoreceptors are the first neurons in the visual circuit and are also the most energy-demanding cells of the retina. Here, we review experimental and clinical evidence linking photoreceptors to the development of diabetic retinopathy. We then describe the influence of retinal illumination on photoreceptor metabolism, effects of light modulation on the severity of diabetic retinopathy, and recent clinical trials testing the treatment of diabetic retinopathy with interventions that impact photoreceptor metabolism. Finally, we introduce several possible mechanisms that could link photoreceptor responses to light and the development of retinal vascular disease in diabetes. Collectively, these concepts form the basis for a growing body of investigative efforts aimed at developing novel pharmacologic and nonpharmacologic tools that target photoreceptor physiology to treat a very common cause of blindness across the world.

中文翻译：

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糖尿病视网膜病变发病机制中光感受器对光的反应

视力丧失是糖尿病最可怕的并发症之一，主要是由糖尿病视网膜病变引起的，这种疾病表现为公认的特征性微血管病变。糖尿病患者视网膜易受损伤的原因尚不清楚，特别是考虑到微血管网络存在于所有组织中。然而，视网膜神经元独特的代谢需求可以解释它们在糖尿病中的脆弱性。光感受器是视觉回路中的第一个神经元，也是视网膜中最需要能量的细胞。在这里，我们回顾了将光感受器与糖尿病视网膜病变发展联系起来的实验和临床证据。然后，我们描述了视网膜光照对光感受器代谢的影响，光调制对糖尿病视网膜病变严重程度的影响，最近的临床试验测试了通过影响光感受器代谢的干预措施治疗糖尿病视网膜病变。最后，我们介绍了几种可能的机制，这些机制可以将光感受器对光的反应与糖尿病视网膜血管疾病的发展联系起来。总的来说，这些概念构成了越来越多的研究工作的基础，这些研究旨在开发针对光感受器生理学的新型药理学和非药理学工具，以治疗全世界非常常见的失明原因。