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The strategy of using photography rather than direct examination
assumes that it is only diabetic retinopathy that needs to be screened for
in people with diabetes.
Focussing on diabetic retinopathy ignores the fact that other ocular
problems, particularly glaucoma and cataracts are common and treatable
causes of visual loss. Other recommended screening programs eg for
glaucoma, require direct examination,and would need to be superimposed on
any photographic method. Unfortunately, this makes any discussion of the
cost-effectiveness of an alternate to direct examination rather academic.
In the real world of patient care, there is no satisfactory alternative to
regular direct ocular examination for the full range of problems that may
No competing interests
16 June 2000
Director Medical Services
International Diabetes Institute, Melbourne, Australia