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Spare the rod and spoil the eye

¹ Henry Wellcome Laboratories, Applied Vision Research Centre, Department of Optometry and Visual Science, City University, London EC1V 0HB, UK
² Neurology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
³ The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
⁴ Medical Retina Unit, Department of Ophthalmology, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, Netherlands

Correspondence to:
Correspondence to:
G B Arden
Henry Wellcome Laboratories, Applied Vision Research Centre, Department of Optometry and Visual Science, City University, Northampton Square, London EC1V 0HB, UK; g.arden{at}city.ac.uk

This review presents a new unified view of the pathogenesis of three common causes of acquired retinal degenerative disease—diabetic retinopathy, age related macular degeneration, and retinopathy of prematurity. In these three conditions, angiogenesis has a predominant role in the development of sight threatening pathology. Angiogenesis is controlled by among other factors the expression of vascular endothelial growth factor (VEGF), which in turn is regulated by absolute and relative lack of oxygen. The severe pathological manifestations of these three conditions are not part of a general underlying disease process because they are peculiar to the eye, and the profound hypoxia that develops in normal retina during dark adaptation (rod driven hypoxia) is an adequate and elegant additional factor to explain their pathogenesis. A large number of experimental reports support this conclusion, although rod driven anoxia is not generally considered as a causal factor in ocular disease. However, the hypothesis can be critically tested, and also suggests novel methods of treatment and prevention of these conditions that may be simpler and more inexpensive than current therapies and that have a smaller potential for adverse effects.

Abbreviations: AGEs, advanced glycation end products; ARM, age related maculopathy; ARMD, age related macular degeneration; CNV, choroidal neovascularisation; DR, diabetic retinopathy; PRP, panretinal photocoagulation; ROP, retinopathy of prematurity; VEGF, vascular endothelial growth factor

Keywords: diabetic retinopathy; age related macular degeneration; retinopathy of prematurity; hypoxia; rods; dark adaptation

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