A Literature Review of Underlying Molecular Factors Contributing to the Pathogenesis of Diabetic Eye Disease

Diabetic eye disease, the leading microvascular complication of diabetes mellitus (DM), is one of the leading causes of blindness worldwide, whose disease burden and demographics are only expected to grow in the coming decade. Advances in molecular biology techniques have enabled the identification and study of several proteins and transcription factors believed to play key roles in the underlying disease pathogenesis. A majority of these factors work together, contributing to both angiogenic (formation of new blood vessels) and inflammatory processes underlying diabetic retinopathy (DR).As a result, emerging therapies are increasingly targeting specific molecular mechanisms. In parallel, nonpharmacological interventions are being proposed to inform the development of appropriate clinical diagnostic and treatment guidelines. These approaches aim to address the early stages of disease and slow or prevent progression to chronic, later stages that may result in vision loss. This review synthesizes foundational and recent evidence using a qualitative narrative approach, focusing on hypoxia-driven molecular pathways rather than quantitative meta-analysis. Although numerous studies have consistently identified key molecular factors that contribute to the pathogenesis of diabetic eye disease, additional details regarding the specific roles of some factors listed herein, as well as the discovery and involvement of other factors in the pathway, remain to be fully explored and understood.