Diabetic retinopathy is one of the common and serious microvascular complications of diabetes. In foreign countries, DR is the leading cause of blindness in the working age group(20-64 years). In China, the incidence of DR and the rate of blindness increase year by year, which seriously affects the patients' quality of life. Previous studies on the pathogenesis and treatment of diabetic retinopathy were mainly focused on the microvascular; in recent years, with the deepening of researches, more and more scholars believe that DR is no longer simply a kind of microangiopathy, but is also accompanied by retinal neurodegeneration. However, studies on the pathogenesis of microvascular disease and neurodegenerative changes of diabetic retinopathy in the literature domestic and abroad are mostly single. This article reviews the relationship between microvascular disease and neurodegenerative changes in diabetic retinopathy.