 The primary intervention will involve the use of an innovative Progressive Reminder and Scheduling System in which intensity of the reminders is based on the patients degree of risk for developing proliferative diabetic retinopathy or macular edema. At the intervention sites, there will be separate clinics for screening those whose last examination was normal and surveillance those with known retinopathy. This two-year prototype translational project will have a quasi-experimental design. Six facilities will be recruited: three will receive the intervention without the system design components. The control and intervention sites will be matched for comparability to baseline screening rates and similar patient populations. The intervention will be evaluated using historical controls pre-post analyses and by comparison to control sites. 