Purpose : Diabetic retinopathy (DR) is a major microvascular complication of diabetes and a leading cause of preventable vision loss. Although regular fundus examination is essential for early detection, screening remains underutilized. This study examined factors associated with a fundus examination and with DR among Korean adults with diabetes. Methods : Data were drawn from the 2021 Korea National Health and Nutrition Examination Survey. Adults aged 19–64 years with diagnosed diabetes were included. Sociodemographic characteristics, diabetes treatment status, fasting glucose, glycated hemoglobin (HbA1c), receipt of a fundus examination within the past year, and DR status were assessed. Associations were evaluated using logistic regression. Results : Gender was the only factor significantly with receiving a fundus examination; women were more likely than men to undergo screening (OR = 1.99, 95% CI = 1.10–3.59, p = 0.023). Age, education, income, and HbA1c were not significantly associated with screening. In contrast, DR was significantly associated with education level and HbA1c. Lower educational attainmet was associated with a higher risk of DR (OR = 5.20, 95% CI = 1.70–15.93, p = 0.004), and each 1% increase in HbA1c was associated with a 1.86-fold increase in DR risk (OR = 1.86, 95% CI = 1.32–2.61, p ＜ 0.001). Other variables were not significant. Conclusion : Educational disparities and poor glycemic control are key factors associated with DR among working-age Korean adults with diabetes. Strengthening diabetes education and promoting regular fundus screening-particularly for socioeconomically vulnerable groups-may reduce DR-related vision loss.