With the highest prevalence of diabetes in the United States, American Indians and Alaska Natives are at greatest risk for diabetic eye disease (DED), a leading cause of blindness. The National Eye institute (NEI) conducted formative research to understand DED-related knowledge, identify approaches to managing this disease, and design a communication plan to increase awareness and reduce DED among these populations. The NEI conducted qualitative research at five locations in indian country with representatives from national organizations, tribal members, and healthcare providers. While diabetes ranked high on their list of primary community health issues in need of attention, study participants had only a basic level of diabetes-related knowledge, acknowledged the need for DED education, and underscored the importance of the use of interpersonal and culturally appropriate communication strategies. This is the first exploratory qualitative research study to examine the status of diabetic eye disease among American indians and Alaska Natives whose primary purpose was to inform the design of a national DED communication campaign.