Understanding why diabetes damages the retina, with the goal of helping persons with diabetes maintain their vision.
The overall goal of our research and clinical care is to help people with diabetes maintain good vision. We approach the problem by combining evaluations of patients and laboratory studies to determine how diabetes impacts the eye and the molecular mechanisms that give rise to these changes, and to develop new therapies.
Laboratory studies are testing the general hypothesis that altered growth factor signaling, combined with inflammation, impairs the survival of retinal nerve cells. We discovered the retina possesses a highly active insulin receptor signaling system and its activity is reduced by diabetes, and restored with systemic and intraocular insulin treatment. The retinal insulin receptor signaling pathway, including Akt and mTOR kinases, serves to maintain retinal cell survival in the face of diabetes, and insulin treatment reduces the rate of neuron apoptosis, but the activity of the pathway is impaired by excess nutrients such as glucose. Current studies are also investigating the role of diabetes on retinal protein synthesis and the underlying metabolic pathways.
Clinical studies are examining the impact of diabetes on visual function and retinal structure, and the impact of novel therapies, in patients with diabetic retinopathy. We hope to develop quantitative and sensitive measures of diabetic retinopathy so that treatment can be initiated while vision remains intact. Additional work is aimed at restoring vision in persons who have completed treatment for their retinopathy but whose vision is still reduced.