To the Editor.
—Dr Brechner and colleagues1 point out in their recent article that "about half of adults with diabetes in the United States are not receiving timely and recommended eye care to detect and treat retinopathy." Screening for retinopathy can identify early disease and prevent major vision loss. However, we have still not determined the most cost-effective screening method.Numerous articles have been published evaluating the accuracy and cost-effectiveness of various strategies of screening for diabetic retinopathy. Most have defined "accuracy" as diagnosing specific grades of diabetic retinopathy. For example, Singer et al2 reviewed a previous study by Moss et al3 and calculated that ophthalmoscopy had a sensitivity of 79% and a specificity of 99% for the detection of proliferative retinopathy. Of the patients known to have proliferative retinopathy by the criterion standard examination in the study by Moss et al,3 screening identified proliferative retinopathy