A benthic assessment of the isolated Cayman Islands was completed at 42 sites. Major changes in the reef community structure were documented by comparison with earlier studies. Acropora palmata and A. cervicornis, once abundant as shallow framework builders, were uncommon. Diseased stony corals were seen in >90% of the study sites, with the highest averages in Little Cayman, especially at Bloody Bay which is one of the most highly regulated marine parks in the Cayman Islands. The Montastraea annularis species complex accounted for two-thirds of the diseased corals which, along with other massive species, were affected largely by white-plague disease. Recent partial-colony mortality was particularly high in Grand Cayman. However, small- to intermediate-sized (M. annularis complex) suggest a strong potential for population regeneration. Algal competition generally did not appear to be a problem for stony corals, and bleaching was insignificant, yet more prevalent, in the deeper (>10 m) sites.