PURPOSE. To examine the role of ocular axial length an ocular parameter for the prevalence and. severity of diabetic retinopathy (DR). METHODS. The cross-sectional Kailuan Diabetic Retirtopathy Study included patients with diabetes who participated in the community-based longitudinal Kailuan Study and who had undergone ocular ffindus photography. The ffindus photographs were graded using the Early Treatment of Diabetic Retinopathy Study criteria. RESULTS. The study included 1096 patients with diabetes (mean age: 60.8 +/- 9.4 years; axial length: 23.37 +/- 0.92 mm). In binary regression analysis, a higher DR prevalence WaS associated with. shorter axial length (P = 0.007; odds ratio [On 0.81; 95% confidence interval [CIL 0.70, 0.95) after adjusting for lon.ger known duration of diabetes (P = 0.02; OR: 1.1.3; 95%CI: 1.02, 1.24) and higher fasting blood glucose concentration (P < 0.001; OR: 1.38; 95%0: 1.26, 1.52). A more severe DR stage was associated (regression coefficient r: 0.46) with shorter ocular axial length (P = 0.047; standardized regression coefficient P: 0.06) after adjusting for higher fasting blood glucose (P < 0.001; beta: 0.41) and longer known duration of diabetes (P = 0.045; beta: 0.07). Longer axial length was associated with a lower DR prevalence (P = 0.003; beta: -0.10) after adjusting for younger age (P < 0.001), male sex (P < 0.001), higher body mass index (P (1016), and lower fasting blood glucose concentration (P = 0.036). CONCLUSIONS After adjusting for systemic risk factors, DR prevalence decreased by 19% (95%Cl: 5, 30) for each millimeter increase in axial length. With longer axial length being a surrogate for axial myopia, the marked increase in myopia prevalence worldwide may lead to a relative decrease in the prevalence and incidence of DR in future.