The threat of blindness creates a difficult and challenging environment for communication between patients and their ophthalmologists. This study examined concordance between what patients want to know from their physicians about their eye condition and what physicians believe their patients need to know. Eight retinal specialists and 24 of their patients with proliferative diabetic retinopathy and at risk of blindness were interviewed using parallel-constructed instruments. Although all recognized that blindness was the patients' greatest concern, disparities were noted that involved the desire/need to know about the possibility of vision loss, the causes of the eye condition, the results of each eye exam, and the extent of patient confusion. Physicians, while conscientious about informed consent, described various communication behaviors to avoid discussing bad news.