Diabetic patients were screened for diabetic eye disease by hospital-based optometrists using a slit lamp with a 78-dioptres Volk lens. Visual acuity and intraocular pressure were also measured. Of 622 patients screened, 149 (24.0%) had background and 32 (5.1%) advanced retinopathy/maculopathy. The fundus was inadequately visualised in four (0.6%) patients. Following screening, 86 (13.8%) patients were referred to the ophthalmology clinic for appropriate treatment and follow up. Hospital-based optometrists using a slit lamp offer a useful new method for screening for diabetic eye disease. They can identify previously unrecognised sight-threatening diabetic eye disease and important non-diabetic eye disease requiring intervention, and are relatively cheap. This method is ideally suited for rapid referral to the specialist. The results merit larger-scale studies both to confirm the effectiveness of this method and to assess whether hospital trained optometrists could perform screening in the community.