who have poor glycemic control are the most at risk of presenting with R3 retinopathy to screening, and thus only being referred to the hospital eye service at this advanced stage of disease. Measures that might address these issues include: targeted education on glycemic control in these high-risk groups, improved interpreter services, more flexible appointments for younger patients who work during the day, and pre-attendance telephone calls to act as reminders and to provide opportunities for discussion of the patient’s potential concerns. Before prioritizing any of these interventions we need greater clarity regarding the specific barriers that these patients encounter that result in these late presentations of R3 retinopathy, and to this end we are planning a qualitative study utilizing interviews with these late-presenting patients. It is clear that these vulnerable groups need to be prioritized by public health policy to help reduce the burden of diabetic eye disease on the individual and society.