Community-Based Diabetic Retinopathy Screening

We invited the entire population with DM living in communities to participate in the DR screening program at local community health centers. All the participants underwent a series of screening tests conducted by trained general practitioners, ophthalmic technicians, optometrists, and ophthalmologists. The screening included a vision acuity test, refraction measurement by an autorefractor, and fundus photography using a non–mydriatic fundus camera. The data were transferred to the corresponding designated diagnosis center through a telemedicine platform after the completion of all the tests. After all the participants in 1 community health center completed the annual screening, the community health center contacted the designated diagnosis center, and 2 retinal experts (ophthalmologists) began to make the diagnosis based on retinal photography. In 2 weeks, screening results were provided as feedback to the community health center, where residents could receive medical advice from the general practitioners. Finally, patients with suspected STDR were referred to specialized ophthalmic hospitals or tertiary hospitals for a detailed re-examination to confirm the diagnosis (Multimedia Appendix 5 shows the screening and referral pathway). Those who were confirmed to have STDR were assumed to receive appropriate treatment and routine clinical care according to the severity of DR.