This review article attempts to clarify current and future issues concerning diabetic retinopathy in the elderly. This retinopathy is often part of multiple geriatric ophthalmological diseases (cataract, glaucoma, age-related macular degeneration [ARMD]). Current management is insufficient. A variety of factors come together to aggravate the situation: the increase in the number of elderly diabetic patients and the decrease in the number of ophthalmologists. Through a review of the literature, seriously lacking in prospective studies specific to the geriatric population, we discuss the epidemiology, the screening problems, and the various issues concerning the overall ophthalmologic and diabetologic management inherent to these patients' age and condition. We stress the seriousness of the visual disability of the older subject, but also the overall morbidity and mortality. We observe that recommendations can only be based on expert opinion. Each section includes a warning on the high iatrogenic risk in this area. The caregiver should avoid two pitfalls: a lax attitude related to fear or defeatism and excessive interventionism that may be inappropriate to the patient's condition.