Based on an assessment of available cohort studies, the most effective strategy for testing is the use of mydriatic retinal photography with the additional use of ophthalmoscopy for cases where photographs are ungradable. This does not exclude the use of ophthalmoscopy alone for opportunistic case finding but there is evidence of considerable variation in effectiveness of this test.

This paper is based on EVective Health Care, volume 5, number 4, 1 which is based on two systematic reviews undertaken to inform national clinical practice guidelines for type 2 diabetes.2 3 The first part of the article looks at screening for diabetic retinopathy and the second at the prevention and treatment of diabetic foot ulcers.Two of the most common complications of diabetes are visual problems caused by retinopathy, and problems with the feet, particularly persistent ulcers. These result from microvascular and macrovascular complications, often exacerbated by chronically raised blood glucose levels. Around 2% of the UK population are believed to have diabetes, of whom perhaps 200 000 have type 1 (insulin dependent) diabetes, and more than a million have type 2 (non-insulin dependent) diabetes.

Our study suggests that people with diabetes undergoing diabetic retinopathy screening would accept a greater screening interval, provided that adequate clinical evidence and medical reassurance were given.

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