Manual vs. automated: the diabetic retinopathy screening debate

Systematic screening for diabetic retinopathy (DR) has been identified as a cost-effective use of health service resources,1-4 with national screening programmes based on digital photography being implemented across Europe. In Scotland, images are captured at local screening centres and sent electronically to one of nine regional grading centres, where they are manually graded using a three-level system (Figure 1).