Two hundred fifteen diabetic patients (430 eyes) with early proliferative retinopathy, moderate-to-severe nonproliferative retinopathy, and/or diabetic macular edema in each eye were examined for the presence of white centered retinal hemorrhages (WCRHs). Of the eyes examined, 15.6% demonstrated at least one WCRH and 4.9% showed five or more WCRHs. The prevalence of WCRHs was not significantly related to hypertension, anemia, leukocytosis, thrombocytopenia, thrombocytosis, abnormalities of coagulation, increased serum creatinine, or ingestion of oral contraceptives. Local factors associated with microvascular damage and repair are likely responsible for WCRHs in diabetics. Microaneurysms are at the center of many diabetic WCRHs, and the pale centers of many WCRHs in diabetic retinopathy may be platelet-fibrin aggregates.