Diabetes-Related Eye Disease Prevalence Remains High in US

More than a quarter of Americans with diabetes have diabetic retinopathy, and for 1.84 million of them, it is vision-threatening.

Diabetes-related eye disease prevalence remains high in the US, according to an estimate of 2021 records published in JAMA Ophthalmology. The report shows diabetic retinopathy (DR) effects more than a quarter of individuals in the US with diabetes, and that more than 5% of that group are likely to experience vision-threatening diabetic retinopathy (VTDR).

The researchers utilized data gathered in several nationally representative and local population-based studies. They used bayesian meta-regression methods to estimate the prevalence of diabetes-related eye disease, and vision-threatening retinopathy as stratified by age, a nondifferentiated sex and gender measure, race, ethnicity, and US county/state.

The findings show that approximately 9.60 million people (95% CI, 7.90-11.55) in the US are living with diabetic retinopathy, corresponding to a prevalence rate of 26.43% (95% CI, 21.95-31.60) among people with diabetes.

The study authors also estimated 1.84 million people (95% CI, 1.41-2.40) living with vision-threatening diabetic retinopathy, corresponding to a prevalence rate of 5.06% (95% CI, 3.90-6.57) among those with diabetes. Demographic characteristics and geography contributed to variability in the prevalence of both types of diabetes-related eye disease.

The US prevalence of diabetes-related eye disease remains high and may grow in the coming decades due to the increasing burden of diabetes among youth and adults.

A widely cited 2004 study — from the Eye Diseases Prevalence Research Group (EDPRG) — demonstrated 40.3% of adults older than age 40 who had diabetes had DR, and 8.2% had VTDR. The new estimates are higher than previously estimated by the EDPRG, which found that 4.1 million individuals had DR and 899,000 individuals had VTDR. The EDPRG’s findings were based on much older data, the researchers explain. “In the intervening period, studies have documented an increase in diabetes prevalence among US adults 18 years or older from 9.8% in 1999 to 2000 to 14.3% in 2017 to 2018,” according to the study authors, who clarified that the EDPRG’s data only included those older than 40 years of age.

“The US prevalence of diabetes-related eye disease remains high and may grow in the coming decades due to the increasing burden of diabetes among youth and adults,” the study authors report.

The researchers explained that the estimates identified by the study may be useful in informing the allocation of public health resources and interventions to the most high-risk communities and populations, “such as expanding teleretinal imaging to improve DR screening in counties with the highest prevalence.”

The investigation included data from the National Health and Nutrition Examination Survey (2005 to 2008 and 2017 to March 2020), Medicare fee-for-service claims (2018), IBM MarketScan commercial insurance claims (2016), population-based studies of adult eye disease (2001 to 2016), 2 studies of diabetes in youth (2021 and 2023), and a previously published analysis of diabetes by county (2012). Population estimates were taken from the US Census Bureau.

Study limitations include the use of possibly outdated NHANES data (from 2005 to 2008), and possible confounding of data due to imputing diabetes-related eye disease values for participants with missing information.


Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of diabetic retinopathy in the US in 2021. JAMA Ophthalmol. Published online June 15, 2023. doi:10.1001/jamaophthalmol.2023.2289