Diabetic retinopathy (DR) and diabetic macular edema (DME) are among the leading causes of vision loss worldwide. Early detection and timely intervention are crucial in decreasing the risk of vision impairment worldwide. Optical Coherence Tomography Angiography (OCTA) is an emerging imaging modality that has advantages to the current standard for assessing retinal microvascular changes in diabetic eye diseases. This study aims to evaluate the cost-effectiveness of different screening strategies incorporating OCTA for the detection and management of DR and DME. A decision tree model (Figure 2) was created to estimate the cost consequences of different screening strategies for clinically significant macular edema (CSME) and severe DR in the United States. The model can be used to compare two screening arms: A) standard fluorescein angiography (FA) and optical coherence tomography (OCT) scans with standard of care follow-up.; and B) Universal OCTA imaging with FA and OCT scans with standard of care follow-up. In both strategies, screening will start with the most sensitive imaging (OCTA > OCT > FA) that is available. Strategy A will serve as the control with the current standard image screening protocol for DME and DR diagnosis, which is based on the National Institute of Clinical Excellence (NICE) guidelines used in both the U.S. and U.K. These guidelines include FA imaging and a visual acuity test within 3 months of diagnosis of diabetes. In accordance with the guidelines, if DR or CSME is identified the participant will subsequently be referred to an ophthalmologist at which point OCT will also be obtained at this visit. If no DR or CSME is identified during imaging, the guidelines state that follow-up imaging should be conducted every 6 months. Strategy B will involve universal OCTA Imaging, FA imaging, OCT scans and a visual acuity test. Screening with OCTA imaging should be conducted before proceeding to screen the FA images taken. If criteria for CSME or severe DR is met, then the participant will be referred to an ophthalmologist. If criteria for CSME or severe DR is not met, then the participant will receive follow up imaging every 6 months.