The year 2026 marks the 40th anniversary of Bresnick’s call to view the impact of diabetes on the retina as a neurosensory disorder. Multiple clinical observations and studies in animal models have since supported this perspective, yet its integration into clinical practice has been limited. This limitation is owing to the incomplete understanding of the structural and functional impact of diabetes on the retina beyond microvascular lesions and the lack of specific identifiable therapies to intervene in the presymptomatic state. Nevertheless, the condition long known as diabetic retinopathy is now termed diabetic retinal disease to reflect the impact on the entire retinal neurovascular unit. The nerve fiber, ganglion cell, and inner plexiform layers most prominently undergo thinning as defined by optical coherence tomography (OCT) scanning.