Current Diabetes Reports

, 15:118 | Cite as

Hypoxia and Dark Adaptation in Diabetic Retinopathy: Interactions, Consequences, and Therapy

  • David J. Ramsey
  • G. B. Arden
Microvascular Complications—Retinopathy (JK Sun, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Microvascular Complications—Retinopathy


In diabetes, retinal blood flow is compromised, and retinal hypoxia is likely to be further intensified during periods of darkness. During dark adaptation, rod photoreceptors in the outer retina are maximally depolarized and continuously release large amounts of the neurotransmitter glutamate—an energetically demanding process that requires the highest oxygen consumption per unit volume of any tissue of the body. In complete darkness, even more oxygen is consumed by the outer retina, producing a steep fall in the retinal oxygen tension curve which reaches a nadir at the depth of the mitochondrial-rich rod inner segments. In contrast to the normal retina, the diabetic retina cannot meet the added metabolic load imposed by the dark-adapted rod photoreceptors; this exacerbates retinal hypoxia and stimulates the overproduction of vascular endothelial growth factor (VEGF). The use of nocturnal illumination to prevent dark adaptation, specifically reducing the rod photoreceptor dark current, should ameliorate diabetic retinopathy.


Dark adaptation Rod photoreceptors Light at night Hypoxia Diabetic retinopathy Diabetic macular edema 



The authors thank Carol Spencer (Lahey Hospital Library) and Judy Rabinowitz (Tufts University Hirsh Health Sciences Library) for research support.

Compliance with Ethical Standards

Conflict of Interest

David J. Ramsey and G.B. Arden declare that they have no conflict of interest

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Ophthalmology, Lahey Hospital & Medical CenterTufts University School of MedicineBurlingtonUSA
  2. 2.University College LondonLondonUK
  3. 3.Moorfields Eye Hospital NHS Foundation TrustLondonUK

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