Tele Diabetic Retinopathy Screening


Diabetic retinopathy (DR) is the commonest microvascular complication in diabetes and the major cause of blindness among working group. Longer duration and poor control are the major risk factors for DR. However, early detection and treatment will prevent blindness.
Diabetics need regular eye examinations. Clinical Practice Guideline recommended the initial assessment is at the time of diagnosis for type 2 DM, and within 5 years of diagnosis for type 1 DM, and annually thereafter for both groups. However, the 2006 National Health and Morbidity Survey (NHMS III) revealed only 45% of known diabetic ever had eye examinations.
The high prevalence of DM (14.9% among adult e30 years, NHMS III) makes it almost impossible for ophthalmologists to examine all the diabetics in this country. Hence, regular eye examinations will have to be done by doctors who treat them and refer those indicated to eye trained doctors.
The use of nonmydriatic digital fundus camera in diabetic eye examinations is promising. Fundus images captured can be graded either on site or be sent via internet to a centre where ophthalmologists can grade and provide consultation on further management.
Tele-Diabetic Retinopathy (Tele-DR) is a telehealth project coordinated by National Eye Database. It will be piloted in October 2008 in Terengganu with participation of 7 MOH health clinics and Department of Ophthalmology, Hospital Sultanah Nur Zahirah, Kuala Terengganu.


General Objective of Tele-DR pilot project


To test the feasibility of using telehealth approach in the screening for Diabetic Retinopathy by Fundus Photography


Specific Objectives


To develop and apply a workprocess for image capturing and grading


To determine the turn around time from image capturing, grading and feedback to primary care provider


To study the quality of images captured


To study the effectiveness of diabetic eye screening using information technology


Parameters to be measured


Workprocess developed


Average turn around time - to specify/establish standard


Proportion of ungradable fundus image - to specify/establish standard


Percentage of target population screened (denominator - number of diabetics due for screening)


Time taken for referral and intervention - date of fundus photo taken to date of seen at eye clinic



All diabetic patients aged 12 years and above who require diabetic eye examinations at pilot sites : Klinik Kesihatan Kuala Besut, Hiliran, Bukit Payong, Permaisuri, Kerteh, Ketengah Jaya, and Kuala Berang.

Grading site

Department of Ophthalmology, Hospital Sultanah Nur Zahirah , Kuala Terengganu.


Coordinating site

National Eye Database, Clinical Research Centre, Hospital Selayang.

The pilot project is supported by special registry grant, MOH.

Downloadable Data Collection Form

1. Tele Diabetic Retinopathy Screening Form  (PDF 133 Kb)


Downloadable CPG References

1. DR Screening Training Module 1
2. DR Screening Training Module 2
3. DR Screening Training Module 3
4. DR Screening Training Module 4 (Part 1)
5. DR Screening Training Module 4 (Part 2)
6. DR Screening Training Module - assessment photos
7. DR Screening Training Module - Test Answer Form

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is a disease clinical database, designed as a prospective, ongoing systematic collection of data pertaining to specific visual threatening eye diseases, such as cataract, diabetic retinopathy, glaucoma, contact lens related corneal ulcer, and outcome of cataract surgery.