IMPORTANCE Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. OBJECTIVE To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure.We estimated crude and adjusted rate ratios (aRRs) and 95%CIs for the association between eye care use and selected clinical and demographic characteristics. RESULTS There were 867 patients with diabetes identified: 61.9%were women, 76.2%were non-Hispanic African American, and 61.4%were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2%within 1 and 45.0%within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95%CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95%CI, 0.38-0.99). CONCLUSIONS AND RELEVANCE Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes. Copyright 2014 American Medical Association. All rights reserved.