Over half of America's 9.6 million diabetic retinopathy patients skip recommended eye screenings, with Black patients 47% more likely to have the disease than White patients

Only 44-50% of the 37 million Americans with diabetes adhere to recommended annual dilated eye exams, despite diabetic retinopathy (DR) being the leading cause of blindness in working-age adults and despite treatments that can reduce severe vision loss by up to 94% when caught early. Why it matters: more than half of diabetic patients skip screening, so one quarter of diabetic inpatients have previously undiagnosed retinopathy discovered incidentally during hospitalization, so vision-threatening DR progresses silently until irreversible damage occurs, so 1.84 million Americans already have vision-threatening DR as of 2021, so the US healthcare system spends billions treating advanced DR that could have been prevented with a $50-$150 screening exam. The structural root cause is that diabetic eye screening requires a separate visit to an eye specialist (not the primary care physician managing the diabetes), creating a fragmented care pathway where the referring physician has no mechanism to ensure follow-through, and the populations most affected -- Black (38.8% DR prevalence), Hispanic (31.0%), and low-income communities -- face the greatest barriers to specialist access including transportation, time off work, and lack of vision insurance.