Background <p>Diabetic retinopathy (DR), a leading cause of preventable blindness, is now recognized as a neurovascular disorder. This condition develops through four key harmful processes: oxidative stress from toxic oxygen buildup, mitochondrial dysfunction causing cell energy loss, chronic inflammation, and epigenetic dysregulation that can lock in damaging gene patterns.</p> Objective <p>To synthesize evidence on DR pathogenesis, global disparities, and emerging therapies, with emphasis on feasibility in low- and middle-income countries.</p> Methods <p>Review of clinical, epidemiological, and translational studies integrating molecular mechanisms, population disparities, and therapeutic readiness.</p> Results <p>Three patterns emerge: rural/remote populations face reduced screening; national programs reduce blindness; racial/ethnic disparities persist. Anti-vascular endothelial growth factor (anti-VEGF) drugs, which block abnormal new blood vessel growth, remain the standard treatment but face safety and adherence challenges. Implants, neuroprotective agents, gene/stem cell therapies, and artificial intelligence (AI)-based teleophthalmology (remote eye care using digital tools) show promise but are constrained by cost, access, and regulation.</p> Conclusion <p>A practical path forward involves connecting molecular findings with health system realities. This includes expanding AI-based screening programs, supporting affordable neuroprotection trials, and building collaborations between public and private sectors to reduce DR-related blindness. This narrative review employs a Technology Readiness Level (TRL) framework adapted for low- and middle-income country (LMIC) contexts. We prioritized clinical epidemiological and translational evidence relevant to LMIC adoption and implementation feasibility rather than exhaustive systematic retrieval allowing us to synthesize diverse evidence types and provide actionable programmatic insights</p> Graphical abstract <p></p>