Diabetic retinopathy is usually considered to be a disease of the retinal blood vessels, capable of causing visual deficits from macular edema, vitreous hemorrhage, and vitreoretinal tractional complications. However, it may also be useful to view diabetic retinopathy more broadly as a neurosensory disorder with functional deficits reflecting the systemic and local metabolic defects of diabetes mellitus, as well as the more obvious retinal vascular changes. To call diabetic retinopathy a disease only of the retinal blood vessels is analogous to considering diabetic neuropathy as a disease only of the neural vessels; while the vascular component is obviously important, it may not be the sole or even the primary cause of dysfunction.
See also p 997.
To demonstrate neurosensory deficits in diabetes as in other retinal disorders, testing more sophisticated than routine visual acuity measurement is required. An apt example is the demonstration by Higgins et al in this issue
Bresnick GH. Diabetic Retinopathy Viewed as a Neurosensory Disorder. Arch Ophthalmol. 1986;104(7):989-990. doi:10.1001/archopht.1986.01050190047037