Adaptive optics (AO) has recently achieved success in a range of high resolution retinal imaging applications in ophthalmology using instruments from flood illumination full-field retinal cameras and confocal scanning laser ophthalmoscopes (SLO) to optical coherence tomography (OCT). AO is being used as a tool to understand structural and functional aspects of vision, the elegant but complex retinal circuitry, and the dissolution of that structure, wiring and processes during the progression of disease. It has been used in direct measurements of the foveal avascular zone, retinal capillary erythrocyte and leukocyte velocity, pulsatility, and other functional dynamics. The RPE cell mosaic is being mapped in monkeys and humans and correlated to the cone mosaic. Diseases such as rod-cone dystrophy and genetic defects are confirmed and explored directly in the live eye. High-resolution retinal imaging is being applied to advanced molecular and gene therapies, both in their development and as the primary method to determine treatment efficacy at the cellular level. Systems are slowly migrating from the research lab into the clinic for use on patients with a variety of diseases and conditions. New developments such as dark-field imaging methods and OCT Angiography are clearly making their mark on ophthalmology research and practice.