Abstract
Pakistan has the world's highest reported age-standardized prevalence of diabetes mellitus, and diabetic retinopathy (DR), its leading microvascular complication and a major preventable cause of blindness, is a large, poorly quantified source of economic loss. This narrative review synthesizes epidemiological, health economic, and macroeconomic evidence to describe the burden DR places on patients, the health system, and Pakistan's economy, situating it against national income and public health spending. Pooled estimates place DR prevalence among adults with type 2 diabetes at roughly one third, with vision-threatening disease affecting close to one in twelve people with diabetes nationally. No published study has directly costed DR in Pakistan; using available prevalence data, general diabetes cost-of-illness figures, and an international benchmark cost for advanced retinal therapy, this review builds a transparent, illustrative estimate of the affected population and implied expenditure, set against public health spending of well under one percent of GDP. Even conservative assumptions place the cost of managing DR, especially its vision-threatening stages, beyond what many Pakistani households could absorb without catastrophic expenditure or forgone care. The review closes with policy directions, including population-based screening, provincial targeting, and subsidized anti-VEGF therapy, to reduce the long-run cost of this complication.