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Background: Diabetic retinopathy is a leading cause of preventable blindness in working-age adults, and India’s large diabetic population makes it a major public health problem. Classical Ayurvedic texts do not describe diabetic retinopathy as a distinct entity, but modern Ayurvedic scholars interpret it as Madhumehajanya Timira or Pramehaja Timira, visual impairment arising from Prameha (diabetes). Objective: To review the modern understanding and management of diabetic retinopathy, its Ayurvedic interpretation, and the available evidence for Ayurvedic and herbal interventions, and to propose a safe integrated model of care. Methods: Narrative review of classical texts on Prameha and Timira, international clinical literature on diabetic retinopathy, and Ayurvedic and herbal studies. Results: Glycaemic and blood pressure control, regular screening, laser photocoagulation, intravitreal anti-vascular endothelial growth factor agents and vitreoretinal surgery are established, evidence-based treatments. Ayurvedic interpretations emphasise Dosha imbalance, Avarana (obstruction) and Dhatukshaya (tissue depletion) affecting the layers of the eye (Patalas). Ayurvedic evidence is limited to conceptual reviews and case reports. A Cochrane review of single herbal medicines, mostly Chinese herbs, found low-certainty evidence for visual acuity gains when added to conventional care. Preclinical studies show aldose reductase inhibition and antioxidant effects for plants such as Phyllanthus emblica. Conclusion: Ayurveda may contribute to diabetes control, lifestyle modification and possibly adjunctive care, but there is no evidence that it can replace screening, laser or anti-vascular endothelial growth factor treatment. Integrated care with ophthalmological monitoring is essential, and controlled trials are needed.

KEYWORDS: diabetic retinopathy; Madhumehajanya Timira; Prameha; Timira; Shalakya Tantra; integrative ophthalmology; anti-VEGF; herbal medicine