Limited research has tracked long-term trends within the diabetic population in California, particularly in the context of the COVID-19 pandemic. Authors aimed to estimate the 11-year secular trend in eye care utilization among adult diabetic patients in California, USA. This was a secondary analysis of public-use data from the California Health Interview Survey (CHIS) conducted from 2011 to 2021. Data analyses were conducted from January 2023 to April 2024. The primary outcome was the weighted percentage of diabetic adults who reported undergoing a dilated eye exam within the past year. Survey-weighted multivariable logistic regression analyses were conducted to evaluate the association between sociodemographic risk factors and the outcome.

Findings: The prevalence of recent dilated eye exams declined by 8.3% in the two years following the onset of the COVID-19 pandemic (2020-2021) compared to the two years prior (2018–2019) among adults with diabetes in California. This decline was more pronounced among adults aged ≥ 60 years and was limited to urban residents. However, it did not disproportionately affect Hispanic or Black Americans. In conclusion, eye care utilization among the diabetic adults in California declined significantly from 2018–2019–2020–2021, a trend largely attributable to the impact of the COVID-19 pandemic.