Are patients from lower-income households more likely to present with severe diabetic retinopathy (DR)? Ben Young, MD, moderates a discussion with Phoebe Mellen, MD, and Jordan Deaner, MD, about a new retrospective cohort study from the Duke Eye Center than examines differences in DR severity at presentation between patients from the lowest- and highest-income ZIP codes, explores how income-based barriers to care may impact disease progression, and discusses how this data might affect clinical care, screening strategies, and public health priorities.