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Abstract Background Diabetic Retinopathy (DR) is a leading cause of visual impairment in the United States. The CDC estimates that the prevalence of DR will triple from 2005 to 2050. Main body The report summarizes major past advances in diabetes research and their impact on clinical practice. Current paradigms and future directions are also discussed. Conclusions DR is a leading cause of visual impairment in the US. Significant progress has been made in the understanding and treatment of DR, but rising prevalence demands innovative approaches to management in the future.