Polaroid photography in diabetic retinopathy screening allows instant image availability to enhance the results of ophthalmoscopy. Retinal cameras are now being developed which use video/digital imaging techniques to produce an instant enlarged retinal image on a computer monitor screen. We aimed to compare one such electronic imaging system, attached to a Canon CR5 45NM, with standard Polaroid retinal photography. Two hundred and thirteen eyes from 107 diabetic patients were photographed through dilated pupils by both systems in random order and the images were analysed blind. Diabetic retinopathy was present in 58 eyes of which 55/58 (95%) were detected on the electronic image and only 49/58 (84%) on the Polaroid. Of 34 eyes requiring ophthalmologist referral according to standard European criteria, 34/34 (100%) were detected on the electronic image and only 24/34 (71%) on the Polaroid. Side by side comparisons showed electronic imaging to be superior to Polaroid at lesion detection. Using linear analogue scales, the patients assessed the electronic imaging photographic flash as less uncomfortable than the Polaroid equivalent (p < 0.0001). Other advantages of electronic imaging include: ready storage of the images with other patient clinical data on the diabetes computerized register/database; potential for image enhancement and analysis using image analysis software and electronic transfer of images to ophthalmologist or general practitioner. Electronic imaging systems represent a potential major advance for the improvement of diabetic retinopathy screening.