THE GUT–RETINA AXIS IN DIABETIC RETINOPATHY: AN INTEGRATIVE PERSPECTIVE THROUGH THE AYURVEDIC CONCEPT OF PRAMEHA

Background: Emerging evidence suggests that Diabetic Retinopathy (DR) is not solely a microvascular complication of chronic hyperglycemia but a manifestation of systemic metabolic–inflammatory dysregulation. The Gut- Retina Axis-a bidirectional network connecting intestinal microbiota, gut permeability, circulating metabolites, systemic inflammation, has gained prominence in explaining DR progression beyond glycemic load. Parallelly, classical Ayurvedic texts describe Prameha and its ocular complication through a sequence of Agnimandya, Ama Utpatti, Srotodushti. A conceptual integration of these models can provide a unified and deeper understanding of the DR pathogenesis. Objective: To develop an integrative framework that correlates the modern retina-gut axis with Ayurvedic Prameha Samprapti, offering a comprehensive systems-based perspective on the onset and progression of Diabetic Retinopathy. Methodology: A narrative conceptual analysis was conducted using classical Ayurvedic texts like the Brihattrayi, alongside the contemporary literature on the retina-gut axis, microbiome biology, metabolic inflammation and neurodegeneration associated with Diabetic Retinopathy. Results: In Prameha, Manda Agni initiates Ama formation which vitiates Rasa Dhatu and creates khavaiguṇya in Rasa–Raktavaha srotasas. The Apakva Rasa which is systemically dispersed by Vyana Vata, along with Kapha–Meda Prakopa and Medodhatvagni-mandya, drives the urdhvagati of vitiated doshas toward the Netra. These doshas lodge in the sukshma siras of the Drishti-marga leading to Raktavaha Srotodusti and Patalagata vikara, especially in the Tritiya and Chaturtha Patala. These microvascular derangements clinically parallel the retinal microangiopathy of Diabetic Retinopathy and correlate with modern findings on the gut–retina axis, where dysbiosis-driven inflammation affects retinal microvasculature. Conclusion: Integrating the gut- retina axis with Prameha samprapti reveals gut-driven metabolic dysfunction aligning with Agni-mandya, Ama, and Meda-Kapha dushti, and by adopting Ayurvedic strategies to modulate microvascular damage can help slow diabetic retinopathy progression which demands further research on the same.