Fig. 3

Role of ER stress and oxidative stress in retinal neurovascular damage in diabetic retinopathy (DR). Disturbance in glucose supply (hyperglycemia, hypoglycemia, glucose fluctuation, etc.) leads to metabolic defects, mitochondrial dysfunction, NADPH oxidase activation, resulting in increased ER stress and oxidative stress. Enhanced ER stress and oxidative stress play a central role in inducing vascular endothelial cell and pericyte damage, blood-retinal barrier (BRB) breakdown, glial activation, inflammation and diabetic macular edema. Cumulative loss of vascular cells and capillaries resulting in retinal ischemia, which ultimately leads to retinal neovascularization and neurodegeneration contributing to vision impairment in DR