Hemoglobin A1c (HbA1c) and blood pressure currently represent the only reversible risk factors associated with diabetic retinopathy.1 Physical activity (PA) is another potential modifiable risk factor for preventing diabetic ocular complications, although studies investigating this association have produced conflicting results.2 These studies have relied exclusively on self-report to quantify PA, which is prone to considerable error. Herein, we assess whether accelerometer-defined PA is associated with more advanced retinopathy independent of HbA1c level and blood pressure in a nationally representative sample of patients with diabetes mellitus.