How Teleretinal Screening Works in Primary Care

A patient with diabetes may already see their primary care doctor a few times a year and still miss an eye screening. Sometimes it is just because the eye exam means making another appointment somewhere else.

With teleretinal screening, the retinal photos can be taken during the same visit. The pictures are sent for review later. If something looks wrong, the patient can then be sent to an eye doctor.

Taking the picture is usually the easy part. Problems tend to come after that. A blurry photo may need to be taken again, and if something shows up, someone still has to make sure the result gets back to the patient and is followed up.

So it is not really just about having a camera. The clinic has to make the whole process work.

What Is Teleretinal Screening?

In primary care, the retinal photo can sometimes be taken during the same visit. The patient does not always have to go to an eye clinic just to get the picture done.

The photos are taken first and looked at later by an eye doctor or another trained reader. That person may be somewhere else, so they do not need to be in the clinic when the photo is taken.

This is often used for people with diabetes. A patient can have the retinal photos taken while they are already there for a regular checkup. If something in the pictures looks like it needs more attention, they can then be sent for a full eye exam.

How Teleretinal Screening Fits Into a Primary Care Visit

Before the camera even comes out, someone has to notice that the patient is due for screening. In one clinic, that may be an alert in the medical record. In another, staff may catch it while checking the chart or a diabetes list. If the patient is already there for a regular visit, the retinal photo can often be done at the same time.

An eye doctor does not have to take the photo. In many clinics, a nurse, medical assistant, or technician does it. If the camera can get a clear picture without dilation, the patient does not have to wait for drops to work.

A 2025 study in Boston community health centers worked this way too. Clinic staff took the retinal photos and eye specialists reviewed them later. The clinics did not all do it the same way. Each one worked the screening into its usual day.

Even with a good camera, the program can be hard to keep up with if it adds too much extra work to a busy visit. Seven-step teleretinal screening workflow in primary care, from patient identification and retinal image capture to remote review, reporting, and referral.

Image Quality Comes Before Interpretation

Not every retinal photo is usable. Sometimes the patient blinks or moves. Sometimes the eye is a little off, the pupil is too small, or glare gets in the way. Cataracts can make the picture harder to see too.

If the photo is too blurry to judge, staff may just take it again before the patient leaves. If they still cannot get a good one, the patient may need dilation or another eye exam.

In the 2025 Boston study, about 7% of the photos could not be read well enough. Those patients needed another image or more follow-up. Staff were trained with example photos, and extra training was given when needed.

For a clinic, this is worth paying attention to. A camera can look great on paper, but the bigger question is whether staff can get a clear photo from most patients without having to keep retaking it.

Comparison of a gradable retinal image with a clear fundus view and an ungradable image affected by poor fixation or media opacity.

What Happens After the Images Are Taken?

Once the photos are taken, someone still has to look at them.

In many programs, the photos are sent out for review and the clinic gets the result later. Some clinics also use software to flag poor images or help with the first check. But if the picture is unclear or something looks unusual, someone still has to follow it up.

Getting the result back into the patient’s chart can be more work than it sounds. If the camera and the clinic system do not connect well, staff may have to move files around by hand, upload reports, message the doctor, or set up a referral.

So when a clinic looks at a camera, it is worth asking what happens after the picture is taken. Can the image be sent easily? Can the result get back into the chart without a lot of extra steps? Things like Wi-Fi, USB, DICOM, PACS, cloud software, and EHR connection all affect that.

And once the image has been read, there still needs to be a next step. Some patients are fine to come back for routine screening. Some need to see an eye doctor. If the photo was not clear enough to read, that also needs to be followed up.

Why Primary Care Is an Important Place for Retinal Screening

People with diabetes are already in primary care pretty often—for blood tests, prescription refills, blood pressure checks, and regular follow-up. If the retinal photo can be done while they are there, that is one less visit to arrange.

A 2025 Boston study looked at more than 10,000 patients at community health centers. After teleretinal screening was added, yearly screening went up by 7.2 percentage points. Some people still missed eye care because of work, transportation, childcare, or just having too much to deal with.

A clinic in Madison, Wisconsin saw screening rise from 14.4% to 40.3% during its teleophthalmology program. Hispanic/Latino patients and patients without insurance saw some of the biggest increases.

An eye clinic can be close by and still be hard to get to. For some patients, the problem is not the distance. It is having to make one more appointment.

What Equipment Does a Primary Care Program Need?

There is no one camera that works for every screening program.

Some clinics keep the camera in one room. Others move it around during the day or take it outside the clinic. If the camera needs to go from room to room, or out to a community site, a handheld model may simply be easier to use.

But size is only part of it. The camera still has to work well with the patients the clinic sees. Can it get a good photo without dilation? What happens with a small pupil? Is focusing easy? Can staff tell right away if the picture needs to be taken again? Battery life and getting the images off the camera matter too.

Out in the field, small things can become a problem fast. There may be nowhere to plug in the camera, no desk to work from, and the internet may be spotty. If a photo comes out bad, it is much easier to take it again before the patient leaves.

So the camera is only one part of the job. The photo still has to be checked, sent out, read, reported, and followed up.

Healthcare professional using a handheld fundus camera for retinal screening in a mobile community health clinic.

Where Teleretinal Screening Programs Usually Run Into Trouble

A lot can go wrong after the camera is already in use. Maybe no one is checking who still needs screening. Maybe the person who was good at taking the photos leaves, and the next person never gets much training. Sometimes the pictures are too poor to read. Sometimes the result sits in the chart and nobody notices it. A referral may even be made without anyone checking whether the patient ever went.

None of that is fixed by buying a better camera. The clinic still has to see where things are getting stuck.

That might mean looking at how many patients actually get screened, how many photos have to be taken again, how long results take, and whether referred patients make it to an eye doctor. Those numbers can show where the problem is.

The VA has used tele-eye programs in a similar way. The photo can be taken closer to the patient, then looked at somewhere else. If the patient needs more care, they can be sent on for follow-up.

What Teleretinal Screening Does Not Replace

Teleretinal screening can be useful, but it is still only part of eye care.

A retinal photo shows what the back of the eye looks like. OCT shows the layers inside the retina. Some cameras can see farther out toward the edges than others. A full eye exam can also check things a photo cannot, such as vision, eye pressure, symptoms, and the front of the eye.

With diabetic screening, the photo is not the end of the visit. Some people can simply come back for their next routine screening. Others may need to see an eye doctor.

In the NHS program, the photos are checked after the screening visit. If something needs another look, the patient is called back or sent on for more care.

Clinics also need to decide this stuff before they start. What counts as a good photo? When do you take it again? When does the patient need to see an eye doctor? Staff should not have to figure that out on the spot.

Frequently Asked Questions

What is teleretinal screening used for?
Most often, diabetic eye screening. Retinal photos are taken locally and reviewed later so patients who need further eye care can be identified.

Is teleretinal screening the same as teleophthalmology?
No. It is one use of teleophthalmology, focused mainly on retinal imaging and screening.

Does it require pupil dilation?
Not in every program. Non-mydriatic cameras can often be used without routine dilation, although some patients still need another approach.

Can primary care staff capture the images?
Yes. Nurses, medical assistants, and technicians can do the imaging after appropriate training.

Can a handheld fundus camera be used?
Yes, particularly when screening moves between rooms, clinics, or community locations.

The Camera Is Only One Part of the Screening Program

The photo can be taken while the patient is already at the clinic. Someone looks at it later. If something shows up, the patient may need to see an eye doctor.

So choosing the camera is not the whole job. The clinic also needs to know who reads the photo and what happens when the result comes back.