BACKGROUNDTessellated/tigroid fundus appearance are polygonal dark areas of choroid in between choroidal vessels -due to retinal pigment epithelium atrophy and prominent choroid pigmentation and large surface area along with retinal thinning. Low ocular perfusion pressure associated with thin and or long retinal arterioles reduces the occurrence of Diabetic Retinopathy (DR) compared to non-tessellated fundus. METHODSThis cross-sectional observational study was conducted among Type 2 Diabetes Mellitus (DM) patients who attended as outpatient and admitted in the wards at Department of Ophthalmology, Govt. Rajaji Hospital, Madurai, to determine whether tessellated fundus is a protective factor for incidence and severity of DR, and to compare the duration and severity of DR in tessellated and non-tessellated fundus. All the patients with DR were examined and assessment of DR done with + 90 D lens under slit lamp microscope. Fundus Fluorescein Angiography (FFA) was performed and grading of DR done as per Early Treatment of Diabetic Retinopathy Study classification (ETDRS) to analyse severity and duration of DR in Type 2 diabetes patients with tessellated and non-tessellated fundus. RESULTSAmong the 60 patients, 30 had tessellated fundus and 30 had non-tessellated fundus. The average age group of patients presenting with DR in this study was 45-70 years with male preponderance; 32 patients were myopic, 23 were hyperopic and 5 were emmetrope. On fundus examination, 93.33% of patients with diabetes for more than 5 years showed majority DR changes. Incidence of Proliferative DR was less in myopes compared to hyperopes; 13 patients had mild non-proliferative diabetic retinopathy (NPDR), 25 had moderate NPDR, 12 had severe NPDR, 2 had very severe NPDR, 5 had early Proliferative Diabetic Retinopathy (PDR) and 3 had high risk PDR. Very severe NPDR, Early PDR and High risk PDR was 100% absent in tessellated ('p' value was 0.03). CONCLUSIONHence, tessellated fundus is a protective factor for incidence and severity of DR.