Diabetic retinopathy (DR) is a leading cause of vision loss globally, affecting approximately one-third of people with diabetes, with a further third having vision-threatening DR, including diabetic macular edema (DME). Established risk factors like hyperglycemia and hypertension are crucial for prevention, while novel factors like inflammation and oxidative stress are increasingly understood. Genetic studies are also exploring disease susceptibility. This review summarizes trends in DR and DME prevalence, incidence, progression, and regression, highlighting key risk factors. DR prevalence varies by region and population, with higher rates in type 1 diabetes in Western countries and type 2 diabetes in Asia. In Singapore, DR prevalence is higher than in many Asian countries, with ethnic differences contributing to variation. In the Middle East, DR prevalence is comparable to Western countries, but VTDR is more common. In China, DR prevalence is higher in rural areas than urban. Asian countries like Hong Kong and South Korea have lower DR prevalence than the global average. Incidence of DR is lower in Spain compared to Western countries, attributed to better glycemic control. Progression of DR is more common than regression, with studies showing varying rates. DME prevalence is lower than DR, with higher rates in some populations. Risk factors for DR and DME include duration of diabetes, hyperglycemia, hypertension, and dyslipidemia. Obesity has conflicting effects on DR in type 1 and type 2 diabetes. Inflammation and oxidative stress are key mechanisms in DR pathogenesis. Anti-VEGF agents are effective for DME treatment. Vitamin D deficiency is linked to increased DR prevalence. Genetic factors contribute to DR susceptibility, with polymorphisms in genes like apM-1 influencing risk. Overall, managing risk factors and early detection are critical for preventing vision loss in diabetes.Diabetic retinopathy (DR) is a leading cause of vision loss globally, affecting approximately one-third of people with diabetes, with a further third having vision-threatening DR, including diabetic macular edema (DME). Established risk factors like hyperglycemia and hypertension are crucial for prevention, while novel factors like inflammation and oxidative stress are increasingly understood. Genetic studies are also exploring disease susceptibility. This review summarizes trends in DR and DME prevalence, incidence, progression, and regression, highlighting key risk factors. DR prevalence varies by region and population, with higher rates in type 1 diabetes in Western countries and type 2 diabetes in Asia. In Singapore, DR prevalence is higher than in many Asian countries, with ethnic differences contributing to variation. In the Middle East, DR prevalence is comparable to Western countries, but VTDR is more common. In China, DR prevalence is higher in rural areas than urban. Asian countries like Hong Kong and South Korea have lower DR prevalence than the global average. Incidence of DR is lower in Spain compared to Western countries, attributed to better glycemic control. Progression of DR is more common than regression, with studies showing varying rates. DME prevalence is lower than DR, with higher rates in some populations. Risk factors for DR and DME include duration of diabetes, hyperglycemia, hypertension, and dyslipidemia. Obesity has conflicting effects on DR in type 1 and type 2 diabetes. Inflammation and oxidative stress are key mechanisms in DR pathogenesis. Anti-VEGF agents are effective for DME treatment. Vitamin D deficiency is linked to increased DR prevalence. Genetic factors contribute to DR susceptibility, with polymorphisms in genes like apM-1 influencing risk. Overall, managing risk factors and early detection are critical for preventing vision loss in diabetes.