Objective This study aimed to investigate the prevalence of frailty and its influencing factors among older individuals diagnosed with proliferative diabetic retinopathy, a predominant complication of diabetes that frequently leads to visual impairment. Additionally, this study aimed to identify key demographic, socioeconomic, and clinical determinants linked to frailty within this specific patient population. Methods This multicenter cross-sectional study enrolled 600 patients with proliferative diabetic retinopathy (aged >= 60 years) from two tertiary hospitals in Baoding (February to August 2024). The patients were categorized into frailty (n = 345) and nonfrailty (n = 255) groups using standardized criteria. The data collected included demographic characteristics, medical history, frailty assessment (frailty phenotype), and social support rating scale scores. Results The frailty prevalence among the participants was 57.46%. Significant between-group differences (P < 0.05) were observed in diabetes duration, social support, monthly income, bilateral eye involvement, living alone, and having >= 3 comorbidities. Frailty scale scores were inversely correlated with social support (r = -0.42, P < 0.001). Multivariate analysis identified the following independent predictors: low income (odds ratio = 2.34; 95% confidence interval: 1.67-3.28), solitary living (odds ratio = 1.89; 95% confidence interval: 1.32-2.71), multiple complications (odds ratio = 3.12; 95% confidence interval: 2.18-4.46), prolonged diabetes (odds ratio = 1.45/year; 95% confidence interval: 1.32-1.59), and poor social support (odds ratio = 0.92/point; 95% confidence interval: 0.89-0.95). Conclusions Over half of the older patients with proliferative diabetic retinopathy exhibit frailty, which is significantly associated with socioeconomic disadvantages, clinical severity, and inadequate social support. These findings highlight the need for comprehensive geriatric assessment in proliferative diabetic retinopathy management.