AIM: To determine the adherence to recommended glycemic and blood pressure levels in patients with diabetic retinopathy (DR). METHODS: A retrospective study in a tertiary eye clinic in Melbourne, Australia. Data pertaining to blood pressure (BP) and glycosylated hemoglobin (HbA1c) level were extracted from charts over a 3-month period. Optimal HbA1c was defined as levels <7%, and optimal BP control was defined as systolic/diastolic <130/80mmHg. RESULTS: Of the 483 patients with DR in this study, only 54% (259/482) had a recorded HbA1c measurement. Of these, only 14% (36/259) had an optimal HbA1c level. Patients with longer diabetes duration were less likely to attain optimal HbA1c levels (age and gender adjusted odds ratio (OR) 0.23; 95% confidence intervals (CIs) 0.08-0.71 for diabetes duration 11-19 years, and OR 0.18%, 95% CI 0.06-0.58 for duration >20 years versus =5 years). Optimal BP control was attained in only 18% (86/483) and was associated with younger age (OR 0.98; 95% CI 0.96-0.99, per year increase in age). CONCLUSION: Adherence to clinical guidelines for glycemic and BP control in patients with DR was low, even in a well-developed healthcare system with free ophthalmic care access.