Background: Diabetes is a metabolic syndrome that is a common cause of visual disturbances including blindness. Significant number of patients with type 2 diabetes develop ocular neurovascular complications over a period. These complications can be well assessed by ultrasonic imaging coupled with color doppler. Methods: This hospital-based, case-control study included 50 diabetic patients using strict inclusion and exclusion criterion in addition to 50 control subjects without diabetes or any other disease known to produce ocular neurovascular changes. All patients and controls underwent B-mode ultrasonography and color doppler flow imaging to obtain peak systolic velocity (PSV), end-diastolic velocity (EDV) & resistive index (RI) from central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) in addition to optic nerve and optic nerve sheath diameters (OND & ONSD). The values obtained were then analyzed using appropriate statistical tools and methods. Results: Variable degrees of negative correlation was noted between fundoscopic grading and OND & ONSD. Variable degree of negative correlation was achieved between PSV & EDV in OA, PCA & RA and positive correlation with RI in all the three arteries. There was significant reduction in PSV with increase in RI in diabetic patients compared to normal subjects in all the three arteries. Conclusion: Ocular neurovascular alterations are significant cause of morbidity in patients with type 2 diabetes. USG and color doppler can detect changes in the neural thickness and vascular parameters in early stages of disease, hence should be included in the routine ophthalmic screening protocol of diabetic patients. © 2022 Elsevier B.V., All rights reserved.