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10 Discussion and future directions While the compelling evidence underscores the immense potential of miRNAs as sensitive diagnostic biomarkers for non-invasive liquid biopsy-based staging and multi-target therapeutic agents capable of modulating key hyperglycemia-induced pathways (oxidative stress, inflammation, angiogenesis, neurodegeneration) in DR, significant translational challenges necessitate focused future research, including rigorously validating the diagnostic accuracy, specificity, and predictive power of candidate miRNAs across diverse, large-scale longitudinal cohorts and ethnic populations using standardized, sensitive profiling techniques like ddPCR to overcome limitations of variability and establish clinically actionable thresholds

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