Diabetic retinopathy screening at primary and community health centers in Maharashtra

In order to integrate and improve eye care in noncommunicable disease (NCD) clinics, screening for diabetic retinopathy (DR) in people with diabetes mellitus (DM) was introduced in primary and secondary-level government health facilities. Initially, the project was carried out at the fixed health facilities at one district hospital (DH), two sub-district hospitals (SDH) and two community health centers (CHCs). This was combined with training of existing health care personnel, information-education-communication (IEC) campaign among patients and service providers along with the provision of essential equipment required for screening. In the revised strategy, NCD nurses were also trained for screening. Of 12,788 DM patients registered in NCD clinics, 63.8% (n = 8159) were screened for DR by trained paramedical ophthalmic assistants and the four trained NCD nurses using non-mydriatic fundus camera and teleophthalmology supported remote grading of retinopathy. DR was detected in 9.45% (n = 771) patients and sight-threatening DR (STDR) was detected in 2.35% (n = 192) in one or both eyes. Of 8,159 people screened, 55% (n = 4481) and 45% (n = 3678) were screened at CHC and mobile screening at primary health centers (PHC), respectively. DR screening in a fixed facility at CHC combined with the mobile screening at PHC level and fixed-day screening strategy provides effective coverage.