Age-Related Neurovascular Dysfunction in the Retina and Potential Pathogenic Mechanisms

With the accelerating global demographic shift toward an aging population, retinal aging has emerged as a major contributor to visual decline in older individuals and represents a key risk factor for several age-associated ocular diseases. Age-associated changes in the retinal neurovascular system have been increasingly investigated as potential contributors to the structural and functional alterations observed during normal retinal aging. Neurons, glial cells, and vascular endothelial cells exhibit age-related structural and metabolic adaptations, which may influence vascular regulation and tissue homeostasis in the aging retina. Alterations in components of the neurovascular unit have been proposed to affect metabolic coupling, vascular regulation, and inflammatory signaling. This review systematically summarizes the alterations in neurovascular anatomy and changes in function during retinal aging, and discusses mechanistic insights and emerging strategies that may help to preserve retinal resilience during aging.