Tele-ophthalmology: Opportunities for improving diabetes eye care in resource- and specialist-limited Sub-Saharan African countries.

Tele-ophthalmology using portable retinal imaging technology, mobile phone and Internet connectivity offers a solution to improve access to diabetic retinopathy (DR) screening services in sub-Saharan African (SSA) countries where the burden of diabetes is increasing and there is limited access to eye care services and specialists. The Zimbabwe Retinopathy Telemedicine Project (ZRTP) established routine DR screening at a hospital-based diabetic clinic in the urban capital city, Harare. A handheld 'point and shoot' digital camera operated by a trained nurse was used to acquire retina images of 203 diabetic patients. A secured 'store-and forward' approach was set up and used for sharing and transfer of images to a retinal specialist at a remote site for reading. This method enabled detection of non-macular DR (11%), diabetic macular oedema (5%), cataract (5%) and glaucoma (6%) among the patients screened. ZRTP demonstrated the utility of tele-ophthalmology for routine retinal screening for diabetic patients in Zimbabwe who have limited access to eye care services. In addition, ZRTP showed how tele-ophthalmology services can provide an empirical framework for providing patient education, and a platform for research in the detection of DR. This approach could be used as a model to address the DR challenges in other countries in SSA.