Background: Diabetic retinopathy (DR) is a major complication of diabetes mellitus (DM) that affects the blood vessels of the retina and cause vision loss and blindness. DR is a major public health problem worldwide, especially in low-and middle-income countries where access to screening and treatment is limited. Although Ethiopia has implemented a strategic plan targeting DM care improvement to reduce complications from 2020 to 2025, retinopathy is a severe complication among DM patients. Therefore, this study aimed to assess diabetic retinopathy among DM patients after treatment initiation in Ethiopia from 2020/2021 to 2024/2025 after the strategy was implemented. Method: Using the preferred reporting items for systematic reviews and meta-analysis guidelines, we systematically reviewed and meta-analyzed articles from Scholar, PubMed, Excerpta Medical Database (EMBASE), Cochrane Library, and MESH Medline. The data were extracted using Microsoft Excel and analyzed using STATA version 17. The pooled risk of new diabetic retinopathy among diabetes patients who started DM treatment was estimated. To minimize the effect of heterogeneity, subgroup analysis was performed by geographical region and year of publication (between 2020 and 2023). Publication bias was detected using a funnel plot, with P