Diabetic retinopathy is the most frequent cause of new cases of blindness among adults. Prospective clinical trials have shown that treatment can reduce the risk of severe visual loss, but the effectiveness of treatment depends on timely detection of retinopathy. Unfortunately, on average, more than half the diabetic patients do not visit an ophthalmologist as recommended. EyeTel proposes to improve the examination rate of this unscreened population by developing the DIGISCOPE. An imaging system, the DIGISCOPE, will be placed in primary care physicians' offices. The DIGISCOPE will be designed as a low cost, easily operated camera capable of generating digital stereoscopic fundus images of the same screening quality as 'gold standard' fundus photography. The DIGISCOPE will also assess visual acuity. The data will be automatically transferred to a center of excellence where they will be processed by computers. The results will be presented to expert readers who will determine, under the supervision of retinal specialists, the presence or absence of each type of retinal pathology). EyeTel will provide the Digiscope at a lower cost than the presently required dilated eye exam. In phase I an upgraded prototype of the Digiscope will be constructed. The performance of the Digiscope will be formally pilot-tested by comparing the classification of retinopathy based on grading of DIGISCOPE images with the classification of retinopathy based on the 'gold standard' grading of stereoscopic fundus images. PROPOSED COMMERCIAL APPLICATION The diabetic population in the US is 16 million and growing as our population ages. Annual retinal screening for diabetics is included as a quality measure on MCO scorecards such as HEDIS. The current national screening rate is 37 percent. The trend in the managed care environment has been to have the primary care physician handle more of the patient care. Therefore, a screening service performed at the primary care office would have tremendous appeal. Preliminary contacts with 6 MCO has confirmed this strong interest.