A woman receiving eye drops from a healthcare professional.

What is Diabetic Keratopathy and Its Treatment?

Diabetic Keratopathy is a common but often under-recognized complication of diabetes. It encompasses a spectrum of corneal abnormalities—including epithelial defects, recurrent erosions, delayed reepithelialization, impaired wound healing, epithelial fragility, reduced corneal sensitivity, ulcers, edema, and increased susceptibility to injury. These complications are particularly concerning given the growing popularity of refractive procedures (e.g., LASIK) and the high frequency of cataract surgery among diabetic patients.

Loss of corneal sensitivity is especially important, as corneal nerves regulate tear production by detecting osmotic changes in the tear film. This helps explain why more than 70% of diabetics develop diabetic keratopathy and show associated morphological corneal changes, often accompanied by dry eye disease (DED).

Although strict blood sugar control can lessen disease severity, medical interventions have had limited success. Trials with growth factors, cytokines, opioid growth factor antagonists, and immunosuppressives have not provided consistent or significant clinical benefit.

A more direct approach lies in targeting the underlying biochemical mechanism: corneal epithelial and endothelial cells express the enzyme aldose reductase, which drives the accumulation of toxic sugar alcohols in diabetes. Laboratory and pilot clinical studies have demonstrated that aldose reductase inhibitors (ARIs) can beneficially modify diabetic corneal pathology by:

  • Reducing Superficial Punctate Keratitis (SPK) and surface epithelial defects
  • Improving corneal sensitivity
  • Preserving epithelial cell morphology and barrier function
  • Reducing endothelial cell death and preventing persistent corneal edema

Importantly, these protective effects are most evident in the perioperative setting, where diabetic patients undergoing cataract surgery face significantly greater corneal risk.

By developing topical ARIs such as Kinostat®, Therapeutic Vision, Inc. (TVI) is advancing a disease-modifying therapy for diabetic keratopathy. Unlike current treatments, Kinostat® directly addresses the biochemical cascade responsible for corneal dysfunction, offering the potential to improve corneal health, reduce post-surgical complications, and lower the incidence of DED in diabetic patients.