Diabetic eye screening using a hand-held non-mydriatic digital retinal camera: experience from a lower middle-income country

Diabetes mellitus (DM) is a fast-growing epidemic in the world. Diabetic Eye Disease (DED) is a common microvascular complication of DM that could lead to sight loss if not detected and treated on time. It is a major cause of avoidable blindness and visual impairment. Barriers to implement systematic diabetic eye screening (DES) in low- and middle-income countries are mostly related to major system factors such as lack of human resources and DES infrastructure leading to unavailability of services. Digital retinal imaging is the most advanced and commonly used retinal imaging method currently in use, yet it is a costly intervention for resource poor settings. Therefore, more affordable strategies such as hand-held retinal imaging become popular in DES. Our aim in this chapter is to describe how countries with low resources can improve DES or at least case finding at the outset, by laying out the steps of development and testing of a DES model in Sri Lanka as a case study. In our feasibility study, we demonstrated that DES by physicians using a hand-held digital retinal camera at a medical clinic is one way of case finding that could contribute to systematic screening. We identified that the selection of primary graders, different screening pathways, and transferrable learning methods should be adopted according to local contextual requirements.