• A total of 533 diabetic individuals using the Marshall, Minn, medical care system were identified as potential subjects for a study of unrecognized eye disease. Of these, 172 (32%) stated they had never had an ophthalmologic eye examination and subsequently were defined as being at high risk for unrecognized diabetic eye disease. Ophthalmic examination was performed on 145 (84%) of these high-risk individuals and revealed that 61% had clinical characteristics consistent with diabetic retinopathy, glaucoma, cataract, or other eye abnormalities. Twenty-five (17%) of these subjects presented with eye disease that required immediate treatment, referral, or accelerated follow-up. Of those indicating they had an ophthalmologist, approximately 35% reported a time since last visit of 2 years or greater. These findings indicate a high prevalence of ocular morbidity among diabetic individuals who are not under routine ophthalmic surveillance and suggest that improvements in patient and professional compliance with recommended guidelines for eye care are warranted.