A new study from the University of Pennsylvania’s Perelman School of Medicine offers a nuanced view of how diabetes is affecting eye health in the United States.
Published in Ophthalmology, the research shows that while more people with diabetes are being diagnosed with retinal diseases, the most severe and vision-threatening forms are actually becoming less common.
The findings are based on data from over six million patients with diabetes, pulled from commercial insurance and Medicare Advantage records between 2000 and 2022.
Researchers analyzed both the prevalence (how many people had the disease) and incidence (how many new cases occurred each year) of diabetes-related retinal conditions—diseases that affect the retina, the light-sensitive layer at the back of the eye.
Here’s what the study found:
- Between 2014 and 2021, the percentage of people with diabetes who had any form of diabetic retinal disease rose from 10.8% to 20.8%.
- The rate of new diagnoses (incidence) nearly doubled during this period, going from 17.7 to 32.2 new cases per 1,000 person-years.
But while more people are developing retinal conditions overall, the picture changes when you look at the most severe forms—the ones that can cause vision loss or blindness:
- The incidence of vision-threatening retinal conditions dropped 51% between 2009 and 2022, from 12.4 to 6.1 cases per 1,000 person-years.
- One of the most serious conditions, proliferative diabetic retinopathy, saw an especially dramatic drop—nearly 300% since 2002, from 8.3 to 2.6 per 1,000 person-years.
So why is this happening?
Dr. Brian VanderBeek, the study’s lead author, offers two possible explanations. One is more concerning: with diabetes diagnoses continuing to rise—affecting over 38 million Americans and another 98 million with pre-diabetes—we may just be seeing the early stages of a wave of eye problems that hasn’t fully hit yet.
But VanderBeek leans toward a more optimistic view: health care for diabetes is improving, helping prevent the most serious complications.
One reason for this improvement? Better access to care. Programs like the Affordable Care Act have allowed more people to get routine screenings, helping doctors catch problems earlier and manage them more effectively.
This could explain both why more cases are being diagnosed (better screening) and why severe complications are becoming less common (better treatment).
Even with the good news, the study is a reminder that more than 30% of people with diabetes now show signs of retinal disease. That means millions are at risk of vision loss—and continued effort is needed to support screening, early treatment, and access to care.
Looking ahead, the research team plans to dive deeper into the data. They hope to understand how these trends may vary by race, ethnicity, and diabetes type (Type 1 vs. Type 2). This could help target resources and improve outcomes even further.
This study paints a hopeful but cautious picture. Yes, diabetic eye diseases are increasing, but the most dangerous forms are declining, likely thanks to earlier diagnosis, better insurance coverage, and more effective treatment.
For people living with diabetes, this highlights the importance of regular eye exams and diabetes management. For health professionals and policymakers, it’s a sign that prevention and care efforts are working—but must be sustained and expanded to meet the growing need.
In short, while the number of people at risk is rising, we’re getting better at protecting their vision—a testament to progress in public health and clinical care.
If you care about eye health, please read studies about how vitamin B may help fight vision loss, and MIND diet may reduce risk of vision loss disease.
For more information about eye disease, please see recent studies about how to protect your eyes from glaucoma, and results showing this eye surgery may reduce dementia risk.
The research findings can be found in Ophthalmology.
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