ABSTRACT

For clinicians to appreciate the potential for these systems, several things had to change. Finally, in the 1980s and early 1990s, several positive circumstances became aligned. Most important, evidence based medicine, meaning clinical diagnoses and disease management based on scientific, well designed studies, and not on oral tradition, gained traction. Specifically in ophthalmology, the Diabetes Control and Complications Trial (DCCT, 1983-1993) [2] and the Early Treatment Diabetic Retinopathy Study (ETDRS, 1979-1989) [3-8], the largest clinical trials of their time, were monumental. As the reader may be aware, the reason we are discussing automatic screening and screening for diabetic retinopathy at all is because these trials showed that it was rational to look for early signs of retinopathy. If early diagnosis were possible, but no effective treatment had been available, there would be no rationale for screening.