Purpose: The objective of this study was to investigate the prevalence of DR and to determine its risk factors in patients with T2DM in Middle Delta, Egypt. Methods: This retrospective study was conducted at Tanta Ophthalmic Hospital on patients with T2DM during the period from January 2019 to August 2022. The medical records of 1267 patients with T2DM were reviewed. Results:. It was found that 907 patients (71.6%) were females, the mean age was 57 years and 958 patients (75.6%) were non-occupied. Risk factors included un-controlled blood glucose in 748 patients (59%), hypertension in 712 patients (56.2%), hyperlipidemia in 329 patients (26%), obesity and ischemic heart disease in 188 patients (14.8%), 164 patients (12.9%) were smokers, and 57 patients (4.5%) had diabetic nephropathy. The mean duration since the diagnosis of DM was 13.45±7.64 years and the mean HbA1C was 8.31±2.02%. This study found that the prevalence of DR was 52.6% and it was categorized into mild non-proliferative diabetic retinopathy (NPDR) in 216 patients (17%), moderate NPDR in 170 patients (13.4%), severe NPDR in 100 patients (7.9%) and proliferative diabetic retinopathy in 181 patients (14.3%). and the prevalence of DME was 30.5%. The duration of DM, the serum level of HbA1C, age, and non-occupation correlated pos-itively with an increasing prevalence of DR. Conclusion: The prevalence of DR in the Middle Delta district was 52.6% and DME was 30.5%. The duration of DM, serum level of HbA1C, age, and non-occupation correlated positively with the increasing prevalence of DR.