Comparative Analysis of Retinal Microvascular Alterations in Type 1 vs. Type 2 Diabetes

Diabetic retinopathy (DR) is a major cause of blindness in the world since it affects individuals with Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM). DR is a consequence of microvascular injury to the retina secondary to chronic hyperglycemia; however, the course and pathophysiology of the disease vary significantly between T1DM and T2DM. DR in T1DM occurs at an earlier age, and it quickly progresses to proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) because of insulin deficiency. Conversely, metabolic comorbidities like hypertension, dyslipidemia, and obesity tend to worsen in T2DM, although the disease has a sluggish course in progression, which exacerbates the retinal damage. Optical coherence tomography angiography (OCTA), fluorescein angiography, and optical coherence tomography (OCT) are the diagnostic methods that play an essential role in early diagnosis, whereas anti-VEGF therapies, laser therapies, and new approaches, including gene therapy and stem cell therapies, are promising new hope for treatment. The reliance on total cholesterol and genetic profiling with lifestyle behaviors and comorbid conditions is needed to enhance outcomes and the management of DR in both types of diabetes.