Tele-ophthalmology: Opportunities for improving diabetes eye care in resource- and specialist-limited Sub-Saharan African countries
Abstract
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.
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Remote grading of retinal images was widely utilized, with 18 out of 30 studies relying on this approach.
“Remote grading of retinal images is widely utilized, with 18 out of 30 studies relying on this approach [10, 15, 16, 18, 21–27, 29–35, 37]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [18]
The International Clinical Diabetic Retinopathy severity scale was the most commonly utilized severity scale, used in 15 out of 30 studies.
“Various severity scales are used to classify diabetic retinopathy (DR), with the International Clinical Diabetic Retinopathy (ICDR) severity scale being the most commonly utilized in 15 out of 30 studies [9, 11–13, 15, 18, 21–23, 32, 34–36].”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [18]
Image acquisition was often performed by trained non-physician staff, while final grading was typically carried out by ophthalmologists or retinal specialists in 22 out of 30 studies.
“Image acquisition was often performed by trained non-physician staff (technicians, optometrists, nurses, paramedics), while final grading was typically carried out by ophthalmologists or retinal specialists (22/30 studies) [8–13, 15, 16, 18, 21, 22, 24, 26, 27, 30–37]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [18]
Mydriasis was employed in 17 out of 30 studies, while the remainder used non-mydriatic techniques when clinically appropriate.
“Mydriasis was employed in 17/30 studies, while the remainder used non-mydriatic techniques when clinically appropriate [9, 12, 18, 22, 24, 27, 33, 35, 36].”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [18]
The predominant method for managing remotely graded images was store and forward (14 out of 30 studies), with seven studies adopting real-time processing.
“The predominant method for managing these remotely graded images is ‘store and forward’ (14 out of 30 studies) [15, 16, 18, 22–24, 26–30, 33, 35, 37], with seven studies adopting the ‘real-time’ processing method [8, 10, 11, 25, 31, 32, 34]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [18]
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- Authors
- Matimba, A., Woodward, R., Tambo, E., Ramsay, M., Gwanzura, L., & Guramatunhu, S.
- Affiliations
- University of Zimbabwe (ZW)
- Columbia University (US)
- University of the Witwatersrand (ZA)
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, South Africa
- Greenwood Park Eye Clinic, Harare, Zimbabwe
- Corresponding author
- Matimba, Alice
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2015-09-24
- Volume
- 22
- Issue
- 5
- Pages
- 311-316
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W2334098582
- Cited by
- 53
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 6 · 2022: 7 · 2021: 9 · 2020: 6 · 2019: 4 · 2018: 6 · 2017: 6 · 2016: 2
- FWCI
- 4.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Beit Trust
- Medical Research Council
- Topics
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Visual Health Research
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- teleophthalmology, diabetic retinopathy screening, store-and-forward telemedicine, access to eye care, diabetic macular edema, cataract, glaucoma, patient education, sub-Saharan Africa
- MeSH terms
- Adult, Aged, Diabetic Retinopathy, Eye Diseases, Female, Glaucoma, Humans, Male, Mass Screening, Middle Aged, Ophthalmology, Patient Education as Topic, Photography, Zimbabwe, Telemedicine, Cell Phone, Diabetes Complications
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