Screening and prevention of diabetic blindness

Diabetic eye disease remains a major cause of blindness in the world. Laser treatment for proliferative diabetic retinopathy and diabetic macular edem a became available more than two decades ago. The outcome of treatment depe nds on the timing of laser treatment. The laser treatment is optimally deli vered when high-risk characteristics have developed in proliferative retino pathy or diabetic macular edema and before this has significantly affected vision. Laser treatment is usually successful if applied during this optima l period whereas the treatment benefit falls sharply if the treatment is ap plied too late. In order to optimize the timing of laser treatment in diabe tic eye disease screening programs have been established. The oldest screen ing program is 20 years old and several programs have been established duri ng the last decade. In this paper the organisation and methods of screening programs are described including direct and photographic screening. The in cidence and prevalence of blindness is much lower in populations where scre ening for diabetic eye disease has been established compared to diabetic po pulations without screening. Technical advantages may allow increased effic iency and telescreening. From a public health standpoint screening for diabetic eye disease is one o f the most cost effective health procedures available. Diabetic eye disease can be prevented using existing technology and the cost involved is many t imes less than the cost of diabetic blindness.