5 Things to Know About Diabetes-Related Eye Disease Awareness Month

Diabetic retinopathy is a leading cause of blindness among working-age adults in the US, yet much of the vision loss it causes is preventable with timely detection and treatment. An estimated 9.6 million people in the US have the condition, a number that has grown substantially since prevalence was last estimated in 2004.¹

Prevent Blindness designates November as Diabetes-Related Eye Disease Awareness Month to promote early detection and access to care.² In observance, here are 5 things to know about how many people diabetic eye disease affects, who is being missed by screening, and the policy and coverage questions facing health plans and providers this year.

1. An Estimated 9.6 Million People in the US Have Diabetic Retinopathy

A CDC-led study published in JAMA Ophthalmology combined national health survey data, Medicare and commercial insurance claims, and population-based eye studies to model prevalence for 2021 at the national, state, and county levels.¹ The estimate of 9.6 million people with diabetic retinopathy (DR) carries an uncertainty interval of 7.9 to 11.6 million and represents 26.4% of people with diabetes. Of those, 1.84 million (5.1% of people with diabetes) had vision-threatening DR (VTDR), defined as severe nonproliferative DR, proliferative DR, panretinal photocoagulation scars, or macular edema.

Unlike earlier national estimates, which covered only adults 40 and older, the study also estimated prevalence in younger people. More than 1 in 10 people with diabetes younger than 25 years had DR, rising to nearly 1 in 5 among those aged 25 to 39 years. With diabetes increasingly diagnosed in youth and young adults, the burden is expected to grow in the coming decades. Additionally, the disease does not affect all groups equally. Standardized VTDR prevalence was 8.7% among Black individuals and 7.1% among Hispanic individuals with diabetes, compared with 3.6% among White individuals. After standardizing for age, sex, and race and ethnicity, DR rates also varied by state, from 21.2% in Nevada to 34.2% in Hawaii.

2. Nearly Half of Medicare Beneficiaries With Diabetes Miss Annual Eye Screening

Annual dilated eye exams are the cornerstone of DR prevention, but many patients do not get them. In a nationwide analysis of more than 1 million Medicare fee-for-service beneficiaries with diabetes, published in the American Journal of Ophthalmology in August 2026, annual screening rates ranged from only 51.7% to 55.3% between 2016 and 2022.³ Screening fell consistently as neighborhood deprivation rose. After adjusting for demographics, comorbidities, the COVID-19 pandemic, and county resources, patients in the most deprived neighborhoods were 16% less likely to be screened than those in the least deprived (relative risk, 0.84; 95% CI, 0.84-0.85).³

Regional data show the same pattern. In a 2026 PLOS ONE study of 15,656 adults with diabetes in a university-based health system in Monroe County, New York, 31.5% were nonadherent to Healthcare Effectiveness Data and Information Set (HEDIS) eye exam standards; nonadherence ranged from 13% to 50% by ZIP code and was strongly associated with higher poverty.⁴

3. Autonomous AI Screening Was Linked to More Specialist Visits Among Black Patients in a 3745-Patient Study

Autonomous artificial intelligence (AI) systems can screen for DR during a primary care visit. They analyze retinal images taken with a nonmydriatic camera and return a result during the appointment, without an eye care professional on site.⁵

In a retrospective study published in npj Digital Medicine in March 2026, researchers at Johns Hopkins Medicine compared 3745 adults with diabetes referred to the Wilmer Eye Institute either by a primary care provider or after a positive or nondiagnostic autonomous AI result. After adjusting for social determinants of health and clinical variables, the AI-assisted program was associated with increased presentation to specialist eye care among African American patients (odds ratio, 1.15; 95% CI, 1.02-1.29; P = .02). The authors noted the analysis was exploratory, was conducted in a single health system, and should be validated further.

A 2026 comparative cost analysis published in BMJ Open Ophthalmology evaluated autonomous AI screening using real-world data from 202 patients at a single primary care clinic in Ontario, Canada. AI-based screening cut the cost per diagnosed DR case by 52% compared with a modeled physician-referral scenario, largely through lower patient and caregiver time and travel costs. As Canada has no billing code for autonomous AI retinal analysis, the model priced the AI fee using US Medicare’s Current Procedural Terminology (CPT) code 92229.⁶

4. The FDA Now Requires an Optic Neuropathy Warning on All GLP-1 Receptor Agonists

On November 9, 2026, the FDA issued a Drug Safety Communication requiring manufacturers of all glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to add information on the risk of nonarteritic anterior ischemic optic neuropathy (NAION) to the Warnings and Precautions section of their labeling. NAION is a rare condition that can cause sudden, painless vision loss in one eye, including permanent vision loss.⁷

In the FDA's meta-analysis of 126 randomized trials (134,253 patients), the incidence of NAION was 6.4 events per 100,000 person-years with a GLP-1 RA vs 3.8 per 100,000 person-years with placebo or a non-GLP-1 glucose-lowering drug, based on 15 probable events in total: 10 among GLP-1 RA users and 5 among placebo recipients. Published estimates put the background incidence of NAION at 2.3 to 10.2 cases per 100,000 people per year among adults older than 50. In Sentinel data on adults with type 2 diabetes starting therapy between 2019 and 2024, risk was higher with GLP-1 RAs than with DPP-4 inhibitors (HR, 1.43; 95% CI, 1.02-2.01), but not significantly different from SGLT2 inhibitors (HR, 1.19; 95% CI, 0.91-1.54). The FDA noted that adverse event reports were difficult to interpret because NAION risk factors often overlap with conditions common in patients taking GLP-1 RAs, and it described its conclusion as a potential increased risk.

The FDA advises clinicians to promptly refer patients with suspected NAION to an ophthalmologist and to consider discontinuing the GLP-1 RA in patients who develop it, unless the benefits clearly outweigh the risk. Given how widely these drugs are now used for diabetes and obesity, the warning adds a new reason for prescribers, endocrinologists, and eye care providers to coordinate, particularly for patients with a prior NAION event.

5. Step Therapy Was Linked to 47% of Eyes Switching Anti-VEGF Drugs vs 31% Under Traditional Medicare in a Wet AMD Study

For patients whose DR progresses to diabetic macular edema or proliferative disease, intravitreal anti–vascular endothelial growth factor (VEGF) injections are the standard of care, and payers increasingly manage them through step therapy and prior authorization in Medicare Advantage (MA), which CMS has allowed for physician-administered Part B drugs since 2019. In a single-practice retrospective study of 1794 eyes presented at the American Society of Retina Specialists 2025 meeting, 47% of eyes covered by MA plans with step therapy were switched to a different anti-VEGF agent within the first year, compared with 31% under traditional Medicare. The study focused on neovascular age-related macular degeneration (AMD) rather than diabetic eye disease, and the difference in injection counts was not statistically significant.⁸

A 2023 study in JAMA Health Forum identified aflibercept (Eylea) as the second most expensive drug by total Medicare Part B spending in 2020, at more than $3 billion, with ranibizumab (Lucentis) sixth at more than $1 billion; those figures span all indications, not diabetic eye disease alone.⁸ Biosimilars are adding another variable. In June 2026, the FDA approved ranibizumab-hkdz (Ranluspec; Lupin), an interchangeable biosimilar to Lucentis indicated for diabetic macular edema and DR, among other conditions.⁹

What Is Next for Diabetic Eye Disease?

Anti-VEGF therapy may also become an alternative to laser treatment for advanced disease. In the company-sponsored phase 3 CONDOR trial, brolucizumab was superior to panretinal photocoagulation in preserving visual acuity at week 54 among 689 patients with proliferative DR, challenging a long-standing standard of care. Intraocular inflammation, including retinal vasculitis, occurred in 5.2% of patients receiving brolucizumab vs 0.6% of those receiving laser, and 96-week results are still to come.¹⁰

For the rest of November, Prevent Blindness is offering free fact sheets, videos, and an audio library on diabetes-related eye disease in English and Spanish.

"Vision loss from diabetes is not inevitable, but protecting sight requires awareness, access to care, and early action," said Jeff Todd, president and CEO of Prevent Blindness.²

References

1. Lundeen EA, Burke-Conte Z, Rein DB, et al. Prevalence of diabetic retinopathy in the US in 2021. JAMA Ophthalmol. 2023;141(8):747-754. doi:10.1001/jamaophthalmol.2023.2289
2. Prevent Blindness offers resources for Diabetes-Related Eye Disease Month. Vision Monday. November 3, 2026. Accessed November 13, 2026. https://www.visionmonday.com/eyecare/eye-health/article/prevent-blindness-offers-resources-for-diabetes-related-eye-disease-month/
3. Borkar DS, Ford CB, Song A, et al. Neighborhood socioeconomic deprivation and adherence to diabetic retinopathy screening guidelines. Am J Ophthalmol. 2026;292:275-283. doi:10.1016/j.ajo.2026.07.054
4. Dogra NS, Geiss MP, Gearinger T, Delmerico A, Ramchandran RS. Mapping disparities in diabetic eye exam adherence using geographic information systems. PLoS One. 2026;21(2):e0340804. doi:10.1371/journal.pone.0340804
5. Leong A, Wolf RM, Channa R, et al. Autonomous AI-assisted diabetic retinopathy screening at primary care is associated with increased presentation to eye care by at risk patients. NPJ Digit Med. 2026;9:310. doi:10.1038/s41746-026-02460-5
6. Di Matteo L, Whitestone N, Bhambhwani V. Screening for diabetic retinopathy with artificial intelligence in a primary care setting: a comparative cost analysis. BMJ Open Ophthalmol. 2026;11(3):e002904. doi:10.1136/bmjophth-2026-002904
7. FDA requires safety labeling changes for glucagon-like peptide-1 receptor agonists (GLP-1 RAs) due to potential increased risk of rare but serious eye condition. Drug Safety Communication. FDA. November 9, 2026. Accessed November 13, 2026. https://www.fda.gov/drugs/drug-safety-communications/fda-requires-safety-labeling-changes-glucagon-peptide-1-receptor-agonists-glp-1-ras-due-potential
8. Wehrwein P. Step therapy associated with more switching of anti-VEGF treatment, study finds. Managed Healthcare Executive. August 2, 2025. Accessed November 13, 2026. https://www.managedhealthcareexecutive.com/view/step-therapy-associated-with-more-switching-of-anti-vegf-treatment-study-finds-asrs-2025
9. FDA approves ranibizumab-hkdz as first interchangeable biosimilar ranibizumab available in both vials and prefilled syringes. Modern Retina. June 5, 2026. Accessed November 13, 2026. https://www.modernretina.com/view/fda-approves-ranibizumab-hkdz-interchangeable-biosimilar
10. Wolf S, Chen Y, Li X, et al. Brolucizumab in the treatment of proliferative diabetic retinopathy: the CONDOR randomized clinical trial. JAMA Ophthalmol. 2026;144(6):500-507. doi:10.1001/jamaophthalmol.2026.1008