Diabetic retinopathy was found in 47.8% of 153 consecutive diabetic clinic patients examined in Maseru, Lesotho. Background retinopathy was present in 78% of patients with retinopathy, compared with 22% with proliferative changes. While no difference in prevalence of diabetic retinopathy could be demonstrated between the sexes, an association between diabetic retinopathy and hypertension and peripheral neuropathy was observed. The prevalence and severity of diabetic retinopathy was significantly related to the duration of disease. The pitfalls inherent in comparing the results of the current study with other published reports are considered. Better epidemiological surveys are required to determine the true prevalence of diabetic retinopathy among different racial, ethnic, religious, and tribal groups in Africa.