Screening for diabetic retinopathy, revisited.

A PPROXIMATELY 20 YEARS AGO, IT WAS OBSERVED that diabetic patients at risk for loss of vision from severe retinopathy who might benefit from laser photocoagulation were not receiving appropriate ophthalmologic care.1 Based on models incorporating epidemiologic and clinical trial data, it was estimated that early detection and timely photocoagulation treatment of proliferative retinopathy and clinically significant macular edema (vision-threatening retinopathy) would result in a considerable amount of person-years of sight saved, would be “cost-effective,” and would reduce human suffering and lost productivity due to blindness.2 This resulted in the development of new guidelines recommending specific schedules for initial ophthalmic evaluation and for follow-