Patients who are uninsured are more likely to present with advanced non-proliferative diabetic retinopathy (NPDR) and experience higher risk for progression to proliferative DR (PDR), according to results published in Ophthalmology Science. Catherine Sun, MD, and colleagues examined whether baseline DR severity mediates the relationship between health insurance status and DR progression among 716 adults. Most patients (81%) had Medicare or private insurance, 15% had Medicaid, and 4.0% were uninsured. Patients who were uninsured or had Medicaid had a greater proportion of moderate or severe NPDR at baseline and a greater proportion of progression to PDR. Following adjustment for confounders and NPDR severity, uninsured patients had a significantly higher risk for progression to PDR versus patients with Medicare or private insurance (HR, 2.63; 95% CI, 1.10-6.25). NPDR severity at baseline mediated 41% of the impact of insurance status on PDR progression for no insurance versus Medicare or private insurance.