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1 Introduction Diabetic retinopathy (DR), a leading cause of vision impairment among working-age adults, affects approximately 146 million individuals globally, with projections estimating an increase to 180 million by 2030, driven by the rising prevalence of diabetes, particularly in low- and middle-income countries ( The pathophysiology of early DR involves a complex interplay of hyperglycemia-induced microvascular damage, inflammation, oxidative stress, and advanced glycation end product (AGE) accumulation ( Advances in diagnostic technologies, including ultra-widefield fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and artificial intelligence (AI)-based algorithms, have revolutionized early NPDR detection, achieving over 95% accuracy and enabling prediction of systemic risks ( This review synthesizes the molecular basis of early-stage DR, compares its pathophysiology between T1DM and T2DM, evaluates diagnostic innovations, and explores therapeutic advancements supported by recent clinical trials and real-world data

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