Astragaloside IV, a major active compound extracted from Astragalus membranaceus, has been investigated in preclinical studies for its potential protective effects against diabetic retinopathy (DR). Several in vitro and animal studies have demonstrated that Astragaloside IV can attenuate hyperglycemia-induced retinal damage. Proposed mechanisms include the inhibition of oxidative stress, suppression of inflammation, and protection of retinal microvascular cells. Notably, Astragaloside IV has been shown to downregulate the expression of VEGF (vascular endothelial growth factor) and other pro-angiogenic and pro-inflammatory mediators implicated in the progression of DR. Additionally, it appears to modulate the PI3K/Akt and NF-κB signaling pathways, which are closely related to cellular survival and inflammation in diabetic retinal tissues.

However, the majority of evidence supporting Astragaloside IV’s role in diabetic retinopathy comes from animal models or cellular experiments. There are currently no robust clinical trials in humans specifically assessing its efficacy or safety for diabetic retinopathy. Thus, while there is a scientific rationale and preclinical validation for its potential benefit, clinical evidence is lacking. More high-quality human studies are needed before Astragaloside IV can be recommended as a treatment or adjunct for diabetic retinopathy in clinical practice.