Abstract

Diabetic retinopathy (DR) is one of the most prevalent and debilitating microvascular complications of diabetes 
mellitus and remains a leading cause of vision impairment and blindness globally. This narrative review examines 
the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, management strategies, and 
public health implications of diabetic retinopathy, with attention to disparities across geographic, racial, and 
socioeconomic groups. Evidence indicates that chronic hyperglycemia, duration of diabetes, hypertension, 
dyslipidemia, and obesity are central drivers of DR onset and progression, mediated through complex metabolic 
and inflammatory pathways that result in retinal microvascular damage and neurodegeneration. Despite declining 
incidence in some high-income settings, the global burden of DR continues to rise, particularly in low- and middle
income countries, where limited access to screening and treatment exacerbates preventable vision loss. Current 
management approaches, including glycemic control, laser photocoagulation, intravitreal anti-vascular endothelial 
growth factor therapy, and surgical interventions, can reduce disease progression but often fail to fully restore 
visual function and may be associated with adverse effects. Emerging strategies such as artificial intelligence
assisted screening, telemedicine, and integrated care models show promise in improving early detection and access 
to care. Addressing diabetic retinopathy requires coordinated clinical, technological, and public health 
interventions focused on early prevention, equitable screening, and health system strengthening to mitigate its 
growing global impact.