Key Takeaways

  • Severity of diabetic retinopathy is strongly associated with increased risk of all-cause mortality, with higher stages indicating greater risk
  • The relationship persists even after adjusting for age, comorbidities, and socioeconomic factors, suggesting retinopathy reflects systemic vascular damage
  • Routine eye exams may serve as a valuable tool for identifying high-risk patients and guiding more comprehensive, multidisciplinary care

A new study published in Ophthalmology suggests that the severity of diabetic eye disease could offer critical insight into a patient’s overall survival—highlighting the eye as a powerful indicator of systemic health.1

The research, titled “Towards an Era of Oculomics: The Relationship Between Baseline Severity of Diabetic Retinopathy and Risk of Mortality,” analyzed data from more than 524,000 patients with diabetes across U.S. health systems. Investigators linked electronic health records with national mortality data to evaluate how different stages of retinopathy correlate with long-term outcomes.

The study found a clear, graded relationship between DR severity and mortality risk. Compared with patients who had diabetes but no retinopathy, those with early-stage disease already faced significantly higher risk, while advanced disease was associated with markedly worse outcomes. Patients with non-proliferative diabetic retinopathy (NPDR) had approximately a 30–34% increased risk of death, while those with proliferative diabetic retinopathy (PDR) faced more than double the risk in some cases.

These associations remained significant even after adjusting for factors such as age, glycemic control and other clinical variables, suggesting that retinal disease severity independently reflects broader systemic health.

The findings support the growing field of oculomics, which seeks to use retinal imaging as a noninvasive tool to detect and predict systemic disease. Because the retina contains a dense network of blood vessels, it can reveal microvascular damage occurring throughout the body.

Previous research has also linked advanced diabetic retinopathy to increased risks of stroke, cardiovascular disease, and other serious complications.

Experts say patients with advanced DR may benefit from closer coordination between ophthalmologists, primary care physicians and endocrinologists, as well as more aggressive management of cardiovascular and metabolic conditions.

Reference: 

1. Lee S, Marwah S, Gaddam S, et al. Towards an Era of Oculomics: The Relationship Between Baseline Severity of Diabetic Retinopathy and Risk of Mortality. Ophthalmology. 026;S0161-6420(26)00210-1. doi:10.1016/j.ophtha.2026.00210-1.