Although all stages of diabetic retinopathy (DR) have been declining since 1980 in populations with improved diabetes control, the crude prevalence of visual impairment and blindness caused by DR has increased in recent years. This is mainly due to the global increase of type 2 diabetes. Screening for DR is essential to detect referable cases that need timely full ophthalmic examination and treatment in order to avoid permanent visual loss. In recent years personalized screening intervals taking into account several risk factors has been proposed with a good costeffectiveness ratios. However, limited resources are available for nationwide screening programs. New technologies such as scanning confocal ophthalmology with ultrawide field imaging and mobile hand-held devices, tele-ophthalmology for remote grading and artificial intelligence for automated detection and classification of DR are changing screening strategies and improving its cost-effectiveness. The emergent evidence that retinal imaging is useful for identifying subjects at risk of cardiovascular disease or cognitive impairment is also a challenge that could change the concept of DR screening into a more broad examination, not limited to prevent sight-threatening disease. Box. Searching strategy and selection criteria We identified references for this review through searches of PubMed and Google Scholar for articles published in English up to November 7 th , 2019. The key words used included "diabetic retinopathy", "screening of diabetic retinopathy", "retinal imaging", "retinal neurodegeneration", "tele-ophthalmology", "artificial intelligence", "diabetic complications", "diabetic retinopathy and cardiovascular disease", "diabetic retinopathy and dementia". These keywords were used as single search terms or in combination. We also searched the reference list of original articles, clinical guidelines, systematic reviews and meta-analyses for further relevant material. All the authors conducted the literature search but with pre-specified assigned areas. Articles were initially selected for inclusion on the basis of the opinion of the contributing authors, with each section covered by two or three authors with particular expertise. The selected references were reviewed by all the members of the authorship when reading successive drafts. DCCT, UKPDS Chew EY, Davis MD, Danis RP, et al.; Action to Control Cardiovascular Risk in Diabetes Eye Study Research Group. The effects of medical management on the progression of diabetic retinopathy in persons with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Eye Study. Ophthalmology 2014;121:2443-2451 Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Eye Study Group and the Action to Control Cardiovascular Risk in Diabetes Follow-On (ACCORDION) Study Group. Persistent Effects of Intensive Glycemic Control on Retinopathy in Type 2 Diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Follow-On Study. Diabetes Care. 2016 Jul;39(7):1089-100 Ot...

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