Visual impairment in diabetes is much more common than blindness, and causes major functional disability. Much of this could be avoided by early detection using comprehensive eye screening programmes. These would be most efficiently delivered by digital photography, and automated grading of normal images. Slit lamp examination would provide back-up for patients whose eyes are difficult to examine. It may be possible to extend screening intervals for patients with no baseline retinopathy. There is strong evidence that aggressive glycaemic and blood pressure control prevent development and progression of retinal disease. Laser treatment is less successful in preventing visual loss in maculopathy than in proliferative retinopathy. New drugs such as protein kinase-C inhibitors may become available to treat diabetic retinal disease.
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