Introduction <p>This study aimed to analyze the patterns and trends in the burden of blindness due to diabetic retinopathy (DR) from 1990 to 2021 at the global, regional, and national levels.</p> Methods <p>We conducted a population-based analysis using the latest data from the Global Burden of Disease Study 2021. We examined the prevalence and number of cases of DR-related blindness stratified by type of diabetes, sex, age, and sociodemographic index (SDI) level. The trends in the blindness burden were quantified via the average annual percentage changes. A decomposition analysis was performed to identify key drivers of the changing burden. A Bayesian age‒period‒cohort model was used to predict the future burden of DR-related blindness from 2022 to 2035.</p> Results <p>Globally, the number of people blind due to DR increased by 326.0% from 1990 to 2021, with the age-standardized prevalence rate (ASPR) increasing from 7.59 to 15.28 per 100,000 population. Regionally, Tropical Latin America had the highest ASPR in 2021, whereas South Asia and East Asia had the greatest number of prevalent cases. Nationally, India and China had the highest number of prevalent cases in 2021, whereas Marshall Islands reported the highest ASPR. In 2021, the middle SDI group had the greatest number of patients who became blind due to DR. Decomposition analysis revealed that the increased global burden between 1990 and 2021 was driven by population growth, population aging, and epidemiological changes. Predictions suggest the burden will continue to rise through 2035.</p> Conclusions <p>The global burden of DR-related blindness has increased significantly over the past three decades, with notable disparities across regions, countries, and SDI groups. More efforts should be made to mitigate the growing impact of DR-related blindness.</p>