This large U.S. claims-based study (2016–2022) found that the prevalence of diabetic retinal disease (DRD) increased in both type 1 (T1DM) and type 2 diabetes (T2DM), while incidence generally declined—particularly in T1DM—narrowing the gap over time. However, T1DM consistently had substantially higher prevalence and incidence of DRD and vision-threatening complications (VTDR, DME, PDR) compared with T2DM across all years.