Purpose: To relate the concept of the retinal neurovascular unit and its alterations in diabetes to the pathophysiology of diabetic retinopathy.
Methods: Case illustrations and conceptual frameworks are presented that illustrate adaptive and maladaptive "dis-integration" of the retinal neurovascular unit with the progression of diabetes.
Results: Retinopathy treatment should address pathophysiologic processes rather than pathologic lesions as is current practice.
Conclusions: Future improvements in the treatment of diabetic retinopathy requires deeper understanding of the cellular and molecular changes induced by diabetes, coupled with the use of quantitative phenotyping methods that assess the pathophysiologic processes.
Keywords: Diabetic retinopathy; Frequency-doubling perimetry; Neurovascular unit; Sensory neuropathy; Spectral domain optical coherence tomography (SD-OCT).