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June 28, 1976

Diabetic Retinopathy

Author Affiliations

Wiesbaden-Biebrich, West Germany

JAMA. 1976;235(26):2813. doi:10.1001/jama.1976.03260520013006

To the Editor.—  I refer to the editorial by Dr Vaisrub(233:1303, 1975) where several intravascular factors in diabetic retinopathy are enumerated. Hemorrheological research within the last decade disclosed that additional factors have to be taken into consideration. It seems that disturbed flow properties of whole blood and plasma play a role in the development of diabetic retinopathy or microangiopathy, respectively. More than 30 articles cite an increase in whole blood or plasma viscosity in diabetics. This increase is caused by factors mentioned in the editorial (fibrinogen, α2-macroglobulin), but additional changes in blood constituents as β-globulins,1 hemoconcentration,2 pH changes,3,4 and changes in plasma osmolarity in diabetic coma (influence on red blood cell deformability) have to be considered. Microrheological changes in the blood of diabetics might be responsible for the development of diabetic microangiopathy, since these alterations act mainly in the microcirculation. Furthermore, recent research has shown