The best method of screening for diabetic retinopathy is still debated: fundus photography, general practitioners, hospital physicians and ophthalmic opticians have been advocated. This study compared the performance of an ophthalmic optician with an ophthalmologist, both using mydriatic and slit lamp biomicroscopy and direct ophthalmoscopy. A total of 474 eyes of diabetics in a single group practice were examined by both practitioners at their annual check. There was total agreement about presence or absence of retinopathy in 366 eyes (77%). Although the optician diagnosed less background diabetic retinopathy (83 versus 123 eyes) and diabetic maculopathy (47 eyes versus 63 eyes), he would have referred 20 of 26 eyes with moderate or severe maculopathy and 33 of 36 eyes with moderate or severe background retinopathy: sensitivities of 0.77 and 0.92 respectively. This compares favourably with previous studies and we suggest that ophthalmic opticians with suitable training would be an effective body to screen for diabetic retinopathy.
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