Purpose: To determine the prevalence and determinants of diabetic retinopathy (DR) in patients ≧18 years at the Cairo University and Sixth of October University hospitals. Patients and Methods: This is a cross-sectional survey among known diabetic patients attending diabetic clinics. Patients were randomly selected to complete an interviewer-administered questionnaire and a medical assessment. All patients had a dilated fundus examination for evidence of DR using slit-lamp biomicroscopy. Results: A sample of 1,325 patients was selected with a mean age of 49 years (SD ±12.9). DR was found in 20.5% of patients. Most patients (82%) were not aware of the hazards of diabetes mellitus for the eyes. The prevalence of DR was statistically significantly higher in females (22 vs.17%, p < 0.05), with longer diabetes disease duration (p < 0.001), hypertension (p < 0.001) and absence of hypertension control (p < 0.001), especially proliferative DR. Increasing age and poor glycemic control were associated with a nonsignificant increase in the rate of DR (p = 0.340 and p = 0.444, respectively). Conclusion: The prevalence of DR in our study population is 20.5%. Regular screening is highly recommended for early detection of DR where timely laser photocoagulation is known to reduce the risk of visual loss in these patients.