Ratoon stunting disease (RSD) of sugarcane is the single most significant biotic factor to impact sugarcane production in Australia. With direct economic losses exceeding $AUD200 million annually, the disease results in major environmental impacts associated with increased nutrient and sediment loads entering sensitive marine catchments. RSD is difficult to identify because it has no specific external symptoms, while only an infinitesimally small percentage of crops are tested. For many years the incidence of RSD was underestimated, but now it is known to have a high incidence and to be poorly managed in most parts of the Australian sugar industry. This presentation explores the hidden impacts of RSD in Australia, details recent improvements in RSD diagnostics, management and grower engagement, and identifies gaps that need to be addressed to improve sugarcane sustainability and profitability.