From pathophysiology to rehabilitation: Addressing low vision in diabetic retinopathy

Diabetic Retinopathy (DR) is a major microvascular complication of diabetes mellitus and one of the leading causes of low vision and blindness globally. As the prevalence of diabetes increases, DR-related visual impairment poses significant clinical and public health challenges. This review explores the pathophysiological mechanisms underlying DR, its contribution to low vision, and rehabilitation strategies to improve patient outcomes. Relevant peer-reviewed articles, guidelines, and reports from 1990 to 2024 were reviewed from databases including PubMed, Scopus, and Google Scholar. The focus was on studies addressing the pathogenesis of DR, the prevalence of DR-related low vision, and evidence-based rehabilitation interventions. The pathophysiology of DR involves chronic hyperglycemia, oxidative stress, microvascular damage, and breakdown of the blood-retinal barrier, leading to retinal ischemia, neovascularization, and irreversible vision loss. DR accounts for an estimated 4.8% of global blindness, with rising prevalence in low- and middle-income countries. While medical and surgical treatments, such as laser photocoagulation, intravitreal anti-VEGF therapy, and vitrectomy, slow disease progression, many patients develop irreversible visual impairment. Rehabilitation through optical aids, electronic devices, orientation and mobility training, and psychosocial support significantly enhances quality of life. Addressing low vision in DR requires a dual approach: early detection and intervention to prevent progression, and comprehensive rehabilitation services to optimize residual vision. Integrating low vision care into diabetes and ophthalmology services is essential to reduce disability and improve functional independence in affected individuals.