Background: Proliferative diabetic retinopathy (PDR) is the advanced stage of diabetic retinal disease that can lead to severe vision loss. Global estimates indicate that diabetes mellitus affects over 529 million people. In Pakistan, which ranks among the countries with the highest diabetes prevalence, DR is a significant public health problem. This study aimed to determine the prevalence of PDR among diabetic patients aged ≥40 years in the twin cities of Islamabad and Rawalpindi. Methods: We conducted a hospital based cross-sectional study of 200 diabetic patients (128 from Rawalpindi and 72 from Islamabad) between April 2024 and July 2024. All participants underwent a comprehensive ophthalmic examination to grade retinopathy. Demographic and clinical data (age, sex, duration of diabetes, co-morbid conditions, treatment type) were recorded. Descriptive statistics were calculated. Results: The study sample had a mean age of 57 years; 110 (55%) were male, and 90 (45%) were female. 40% of patients had hypertension, 15% dyslipidemia, and 10% reported poor long-term glycemic control. Overall, 50% had some form of DR: 76 (38%) with non-proliferative DR and 24 (12%) with PDR. Thus, the prevalence of PDR in this cohort was 12%. PDR was more common in patients with longer diabetes duration and those with poor glycemic control. Conclusions: The Study concluded that PDR prevalence among diabetic patients was 12%, underscoring the need for aggressive screening and management. Given that even a few percent of vision threatening retinopathy represent a major burden, our findings support intensified DR screening programs and risk factor control in Pakistani diabetes care.