Diabetic retinopathy was rare 50 years ago. Since then it has become the commonest cause of visual loss in the working age population. Initially the only treatment available was pituitary ablation, and that only worked for some patients with proliferative retinopathy. In the 1970s laser treatment revolutionised the management of retinopathy. Improvements in the assessment and management of retinopathy stimulated research with controlled clinical trials. This has resulted in evidence-based recommendations for improvement in glucose and blood pressure control which has been shown to reduce the prevalence of retinopathy. Screening procedures are now available for most people with diabetes. New treatments under development, directed at the pathogenic mechanisms of retinopathy, offer hope that the laser will eventually be replaced by more effective and better tolerated treatment.
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