Diabetic retinopathy in Querétaro, Mexico: A subset analysis of the RAAB survey 2025

Purpose To estimate the prevalence of diabetes and diabetic retinopathy (DR) in Querétaro, Mexico, using a population-based Rapid Assessment of Avoidable Blindness (RAAB7) survey with a DR module, and to describe patterns of screening coverage and vision outcomes. Design Population-based cross-sectional study. Subjects Adults aged ≥50 years living in 187 randomly selected clusters (112 urban and 75 rural; 35 individuals per cluster) from Querétaro, Mexico. Methods A two-stage cluster sample was used to examine adults aged ≥50 years across Querétaro in 2022. Diabetes status was defined by self-report or random blood glucose level ≥200 mg/dL. Participants with known or suspected diabetes underwent dilated fundus examination, with DR graded using the Scottish Diabetic Retinopathy Grading System. Primary outcomes included the prevalence of diabetes, DR, maculopathy, and sight-threatening DR; secondary outcomes included time since last eye examination and levels of vision impairment. Results Of 5700 individuals enrolled, 5111 were examined and 4675 (82%) had diabetes status assessed. Diabetes prevalence was 21.5% and increased with age. Among people with diabetes, 65.0% reported never having had an eye examination for DR. Of the 746 individuals who underwent dilation, 55.9% had retinopathy (95% CI 51.1%–60.7%), 17.2% had maculopathy (95% CI 14.1–20.2%), and 7.5% had sight-threatening DR (95% CI 5.4–9.6%). Vision impairment was more common in people with diabetes than in people without diabetes, particularly moderate-to-severe impairment (18.8%vs 9.0%). Conclusions Diabetes and DR are highly prevalent in older adults in Querétaro, with substantial unmet need for screening and early management. The high proportion of individuals who have never undergone an eye examination suggests longstanding system-level barriers. Strengthening DR detection through people-centered strategies, including telemedicine, portable retinal imaging, and culturally sensitive, women-friendly and Indigenous-friendly service models, will be essential to prevent avoidable vision loss in this rapidly ageing population.