Background: Diabetic retinopathy (DR) is a serious complication of diabetes that can lead to vision loss if untreated. Early detection and management through patient awareness and knowledge are crucial for prevention. This systematic review aims to assess the level of knowledge and awareness of diabetic retinopathy among diabetic patients in Saudi Arabia (KSA). Methods: A comprehensive search was conducted across PubMed, MEDLINE, Scopus, EMBASE, Web of Science, and Google Scholar to identify studies assessing diabetic patients' knowledge and awareness of diabetic retinopathy in Saudi Arabia. Cross-sectional, cohort, and case-control studies were included, focusing on adults with diabetes in various regions of KSA. The study selection followed PRISMA guidelines, with two independent reviewers screening and extracting data. Results: Of the initial 94 studies identified, 20 met the inclusion criteria, with a total sample of 7546 diabetic patients across various regions. The review revealed a high awareness level of DR in most studies, averaging 80%, with some studies reporting over 90%. However, knowledge about specific DR complications and preventive practices showed considerable variation, ranging from 28% to 99%. Annual eye examination adherence was inconsistent, with rates as high as 100% in some regions but as low as 0% in others, indicating substantial barriers to regular screenings. Conclusion: This review highlights that while awareness of diabetic retinopathy among diabetic patients in KSA is relatively high, there are significant gaps in specific knowledge and adherence to preventive eye care practices. Region-specific educational programs and improved access to screening services are recommended to enhance patient knowledge and encourage regular eye examinations. Addressing these disparities is essential to reducing the incidence of DR-related vision loss among diabetic patients in Saudi Arabia.