Diabetic retinopathy is the leading cause of blindness of patients of working age in the UK and represents a significant workload for the health services.1 Currently at least 2% of the UK population are known to have diabetes, of whom 10-13% have sight-threatening diabetic retinopathy.
It is widely accepted that screening for diabetic retinopathy represents both good clinical practice and cost-effective healthcare. The natural history of the disease is known, and early detection and treatment of retinopathy has been shown to be effective in preventing visual impairment.5-6 With appropriate medical and ophthalmological intervention, including good glycaemic and blood pressure control, it has been estimated that blindness may be prevented in at least one ye in 60-70% of cases with maculopathy and 90% of cases of proliferative retinopathy. The disability caused by blindness and partial sight, as well as the social costs in terms of loss of earning capacity and the required social support are considerable.7 Lack of screening may also result in costly compensation claims. The recent debate has focused on what is the most suitable screening test to use.