Project Abstract: Diabetic retinal disease (DRD) is the leading cause of vision loss among working age adults costing the U.S. an estimated $4.5 billion per year and disproportionately affects racial and ethnic minorities.2,3 As with any pressing public health concern, tracking the prevalence and incidence of the disease is paramount to understanding the impact on society and creating successful policies to counteract it. The previously preferred method of assessing U.S. DRD rates has been regional population-based studies, but even the most recent of these has not been updated in over 10 years.6–10 The National Eye Institute’s currently published DRD rates are derived from expert consensus agreed upon in 2001.2,15 The issue of comparisons across time and regions becomes even more pronounced when discussing U.S. racial and ethnic disparities. While known disparities exist among minorities in DRD screening rates, severity of DRD and associated vision loss,6–9 the primary study used to quote rates of DRD in Black/African Americans is the Salisbury Eye Study. This was undertaken in the 1990’s and focused solely on people living in Maryland.19 Data on US Hispanics comes only from Los Angles and Arizona and have not been updated in 20 years.20,21 Lastly, relying on regional and outdated data ignores the last 20 years of national macro-environmental trends that likely have had a direct impact on DRD rates. How the conflicting trends of improved systemic DM care and increasing DM incidence have impacted the overall rates of DRD, the time to DRD progression and whether racial and ethnic disparities have changed has yet to be assessed.22 We hypothesize that while national DRD prevalence is increasing (due to more people living with the disease), DRD incidence is decreasing due to better systemic DM care. In addition, similar to the reduced DRD incidence rates, we hypothesize that due to new tools for systemic monitoring and treatment, the time to DRD progression is increasing (i.e. improving). We also hypothesize that despite the improvements in DRD incidence, DRD racial and ethnic disparities are continuing to widen, exacerbated by increasing disparities in underlying systemic DM incidence rates. The goal of this grant will be to create accurate, current national prevalence and incidence measurements of DRD. Furthermore, understanding the trajectory of the disease, particularly differences between racial and ethnic minorities will allow for both more effective policy creation tailored to the groups most in need and the tracking of the effectiveness of these policies by providing a baseline for future assessments.