Diabetic Eye Disease on the Rise, but Most Severe Forms Declining Since 2014

The prevalence of diabetes-related eye diseases has nearly doubled since 2014, yet the most severe forms of the disease have shown a steady decline, according to a recent study led by the Perelman School of Medicine at the University of Pennsylvania. Published in Ophthalmology, the findings suggest advancements in diabetes diagnosis and treatment are preventing severe vision loss, despite the growing number of diabetes-related retinal conditions.

Rising Diabetes-Related Retinal Diseases

Lead researcher Brian VanderBeek, MD, MPH, MSCE, an associate professor of Ophthalmology, emphasized the growing concern:

"Our work shows that more than 30% of all patients with diabetes now have some form of diabetic retinal disease, which means the number of people at risk for vision loss continues to grow. But our work has maybe also revealed that the most severe forms of the disease are becoming less common, suggesting clinicians may be getting better at treating systemic diabetes."

Currently, over 38 million Americans have diabetes, with an additional 98 million classified as pre-diabetic. These rising numbers highlight the importance of monitoring diabetes-related risks, particularly those associated with vision loss.

Study Insights: The Numbers Behind the Trends

To understand how diabetes is affecting eye health, researchers analyzed medical claims data from more than six million individuals diagnosed with diabetes between 2000 and 2022. The study examined two key metrics:

       • Prevalence: The percentage of individuals diagnosed with diabetic retinal disease in a given population.

       • Incidence: The rate of new cases occurring over time.

Key Findings:

       • The prevalence of diabetes-related retinal diseases increased from 10.8% to 20.8% between 2014 and 2021.

       • The incidence rate nearly doubled from 17.7 new cases per 1,000 person-years in 2013 to 32.2 in 2022.

       • Severe vision-threatening conditions, however, decreased by 10% in prevalence over recent years.

       • Incidence rates for vision-threatening conditions saw a 51% drop from 2009 to 2022 (from 12.4 to 6.1 cases per 1,000 person-years).

       • Proliferative diabetic retinopathy cases fell nearly 300% from 8.3 per 1,000 person-years in 2002 to just 2.6 in 2022.

Why Are Severe Cases Declining?

Despite the increasing number of diabetes-related eye conditions, the most severe forms of the disease have become less common. Researchers point to two possible explanations:

       1. A Lag in Data: More individuals may be developing diabetes and diabetic retinal disease, but severe cases could still be on the rise, with the data yet to fully capture this trend.

       2. Improved Diabetes Care: Advancements in treatment, earlier diagnosis, and better access to care are preventing the progression of diabetes into severe, vision-threatening forms.

VanderBeek favors the latter explanation, attributing improvements to expanded insurance coverage and preventive healthcare:

"One of the reasons for that, I think, is the same as why we have more diabetes retinal diseases being diagnosed: The population has become better insured over the years we studied because of things like the Affordable Care Act, which gave people access to care and screening."

Future Directions: Addressing Disparities

The study team plans to delve deeper into the collected data, analyzing disparities among racial and ethnic subpopulations, as well as differences between type 1 and type 2 diabetes patients. This research could provide a more detailed understanding of who is most at risk and how to tailor interventions accordingly.

Conclusion

While the growing prevalence of diabetic retinal diseases remains a concern, the decline in severe cases offers a hopeful outlook. Improved access to healthcare and advancements in diabetes management appear to be contributing to a reduction in vision-threatening conditions. Continued research and public health efforts will be critical in sustaining these positive trends and preventing future waves of severe diabetic eye disease.

Reference:

Brian L. VanderBeek et al, Twenty year trends in prevalence and incidence of diabetic retinal disease, Ophthalmology (2025). DOI: 10.1016/j.ophtha.2025.01.022