There's a wide variety of lighting available, including side lights, main lights, spot-lights, and sunlight. I simply choose the type of light and then customize it to suit my drawing. I have the options of changing light color, intensity, angle, and transparency - everything I need to imitate the real thing. Backgrounds aren't any problem. I can use anything I want, and I find that doing a professional render job requires nothing more than a blank background.
Materials are the only problem.
You are only given a choice of 6 basic materials. As well as this, there's no way to customize color or texture of an object. There is also no way to import materials or textures into the program. I have found that when drawing something with a specific look, I need some way to exhibit a specific substance, feel, or surface. Although the program is not designed as a 3D package, I think Visio has left this component incomplete if you're looking for intense realism and detail, but if you are producing a simple 3D showcase, the program fulfills its task well.