Hospital optometrists are involved in the care of diabetic patients in a variety of ways, e.g. performing screening as well as training, coordinating and acting in an advisory capacity in local schemes involving GOS optometrists. In response to local need and purchaser interest, an optometrically led diabetic eye screening service has been set up at Walton Hospital. All patients are referred from the Walton Hospital Diabetic Centre, screened by the hospital optometrists and either reviewed by the optometrists or referred to an ophthalmologist routinely for review or referred immediately if it is considered that laser treatment may be required.This paper reports on the protocols, implementation and first year of operation of the service. Patients referred to the clinic were those who had not had an eye examination within the last 12 months (excluding newly diagnosed insulin‐dependent patients) and all newly diagnosed non‐insulin dependent diabetics. An audit was performed over the first 3 months (n = 85). At the same visit, each patient was examined by an HES optometrist using a Volk lens with dilation, the patient was assessed by a consultant ophthalmologist with a specialty interest in diabetics and retinal photography was performed. The same consultant also assessed the slides. The mean age of the patients was 64 years (SD 12 years) and only 6.0% were frank type 1 insulin‐dependent patients.Laser treatment for retinopathy was required in 7.1% of patients and other treatable pathology was found in 9.4% of patients. When compared with the consultant's assessment, the optometrists' examination showed a sensitivity of 87.5% and specificity of 93.5% in the detection and appropriate referral of diabetic eye disease. Peripheral new vessels were missed in one patient due to the presence of lens opacities, and thus the patient was referred routinely instead of immediately. Using the photographic technique, a significant number of images were ungradeable due to poor quality, and the sensitivity was only 66.7%. The lower sensitivity resulted from the inability to detect macula oedema in the absence of hard exudates and peripheral proliferative retinopathy outside the field photographed. In addition, inadequate resolution confounded the detection of microaneurysms in non‐referrable cases. Over the following 9 months a further 182 patients were examined. Laser treatment for retinopathy was required in 6.6% of patients and other treatable pathology was found in 8.2% of patients.Additional funding to expand the service in 1995 has been successfully sought from the purchasers. The results and experiences from this study will be considered in relation to the HES optometrist working within a trust, the St Vincent's declaration and some economic aspects of diabetic healthcare.