Primary care is one of the strongest places to expand retinal care for people with diabetes. It is also one of the hardest. That is where volume, diverse demand, limited time, and the need to solve concrete problems without unnecessary complexity all meet.
That is why, when a municipal, provincial, or territorial network wants to build a diabetic retinopathy screening program in primary care, it helps to think less about technology alone and more about the end-to-end workflow.
Why primary care is a strong starting point
Most people with diabetes have at least some regular contact with primary care, chronic disease programs, or territorial teams. That makes primary care a logical place to:
- identify the eligible population
- reach patients who do not make it to ophthalmology on their own
- sustain repeatable, non-isolated screening efforts
- follow up patients who need referral
The opportunity is large, but only if the program is designed as a process rather than as an event.
The real goal of the program
The goal is not just to “take retinal pictures.” The goal is to build a workflow that can:
- detect people who are overdue for retinal care
- capture usable studies
- prioritize risk
- refer when needed
- close the follow-up loop
If any of those steps fails, apparent coverage can rise while real impact remains low.
An operational checklist to get started
1. Define the initial cohort
There is no need to start with the entire territory. It is often better to begin with a concrete first cohort, such as:
- people with diabetes followed in selected primary care centers
- patients overdue for eye checks
- a prioritized catchment area
2. Choose where capture happens
Capture can be organized through:
- primary care centers
- mobile units
- referral hospitals with territorial scheduling
What matters is that the capture point is sustainable and easy for both teams and patients to understand.
3. Solve image quality from day one
A program with many ungradable studies loses efficiency and credibility. That is why it helps to include training, simple criteria, and, when relevant, technological support for image quality control. We explored that in Retinal image quality: how to reduce ungradable studies in screening programs.
4. Design reading and prioritization
Before scaling volume, teams need to answer:
- who reviews the studies
- within what response times
- which findings trigger priority referral
- how recaptures are handled
5. Protect referral capacity
Many programs fail here. If patients with relevant findings cannot access appointments or there is no protected capacity to absorb demand, screening loses value.
6. Measure a small set of indicators consistently
For an initial stage, indicators such as these are usually enough:
- eligible versus screened patients
- gradable versus ungradable studies
- time from capture to report
- referred patients
- referred patients who complete care
7. Assign an operational owner
Every program needs someone watching the full workflow, not just one piece of it. That might be a local coordinator, chronic-care lead, or territorial operations role, but without it execution fragments quickly.
The role of teleophthalmology in primary care
Teleophthalmology brings capture closer to the territory while concentrating specialist reading where real capacity exists. That can be especially useful in networks with long distances, specialist shortages, or multiple sites to support.
It does not turn primary care into ophthalmology. What it does is make a scalable, traceable coverage model more viable.
Common mistakes
Some mistakes appear repeatedly:
- launching a campaign without a continuity plan
- measuring only capture volume and not loop closure
- failing to define what happens to ungradable studies
- referring patients without protected slots or prioritization
- depending on a single trained person without operational backup
How Retinar can help
At Retinar, we work with an approach that fits primary care and territorial networks:
- decentralized capture
- image quality support and usable studies
- study prioritization by risk
- remote reading and reporting with human review
- traceability across capture, reporting, and referral
Conclusion
Building a diabetic retinopathy screening program in primary care does not require waiting for a perfect system. It requires starting with a clear, measurable, sustainable workflow and improving it with real data.
If your network is evaluating how to bring retinal screening into primary care without depending on isolated campaigns, contact us to design a phased implementation model.