Within the first weeks to months of diabetes, the retina adapts to a lower metabolic steady-state with reduced electrical and biosynthetic activity, adaptive autophagy and apoptosis, and impaired autoregulation. Vision remains intact and there is no clinical evidence of diabetic retinopathy. After 5 - 10 years of diabetes, adaptive mechanisms begin to decompensate with the appearance of mild nonproliferative retinopathy, and early impairment of vision. Aberrant repair can ensue with the onset of proliferative retinopathy and loss of vision. Regulatory strategies are currently limited to the latter two stages (3). Artwork by David Murrel, MFA.