PURPOSE: To identify the associations between social determinants of health (SDoH) and the progression of proliferative diabetic retinopathy (PDR). DESIGN: Secondary analysis of a retrospective cohort study. PARTICIPANTS: We extracted data from electronic medical records of individuals at the Yale Eye Center or Dana Eye Clinic, ages ≥18 years, who had a documented diagnosis of nonproliferative diabetic retinopathy (NPDR) at their first recorded (index) ophthalmology visit within the study period. METHODS: We identified participants with NPDR whose disease progressed to PDR during the study time period. We assigned Distressed Communities Index (DCI) scores using participants' zip codes and created a visualized geographic distribution of scores using ArcGIS. We assessed differences in sociodemographic and health characteristics between participants whose disease progressed to PDR and those whose disease did not progress using 2-sample tests, chi-square, and Fisher exact tests where appropriate. We used logistic regression to assess the associations between SDoH and progression to PDR. We conducted a time-to-event analysis using Cox proportional hazards regression, adjusting for relevant confounders. MAIN OUTCOME MEASURES: The primary outcome was the progression from NPDR to PDR. RESULTS: Among the 1354 participants, 137 (10%) developed PDR within the study's 7-year period. Of the 137, 54% were male, 46% were aged ≥65 years, 35% identified as White or Caucasian, and 34% identified as Black or African American. Those whose disease progressed to PDR had significantly worse DCI scores compared to those whose disease did not progress (mean [standard deviation 64 (26) vs. 58 (27), = 0.015). Unadjusted logistic regression revealed a significant association between DCI and progression to PDR ( = 0.037), whereas the adjusted model did not ( = 0.124). CONCLUSIONS: Participants with disease progression to PDR were more likely to live in disadvantaged areas. Using socioeconomic data and geographic mapping to identify high-risk populations may help health care professionals implement early screening and provide better resources for those at risk of retinal disease progression. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.