Utilisation of Telemedicine for Diabetic Retinopathy Screening in Rural Plateau State

Telemedicine offers a promising solution for extending diabetic retinopathy screening services to rural populations who lack regular access to ophthalmologists. This study evaluates the utilisation and feasibility of a telemedicine-based diabetic retinopathy screening programme implemented in rural primary health centres in Plateau State, North Central Nigeria. A mixed-methods study will be conducted in 10 rural primary health centres in Mangu and Shendam local government areas. Non-mydriatic fundus cameras operated by trained primary care nurses will capture retinal images that are transmitted to a remote grading centre at Jos University Teaching Hospital via a cloud-based platform. Grading turnaround time, image quality, proportion of gradable images, retinopathy detection rates, referral outcomes, and patient acceptance will be measured. In-depth interviews with nurses, grading ophthalmologists, patients, and programme managers will explore implementation experiences and sustainability considerations. Telemedicine retinopathy screening programmes in comparable African settings demonstrate high clinical sensitivity and cost-effectiveness compared to traditional in-person examination, but sustainability challenges related to power supply, connectivity, and equipment maintenance persist. This study contributes Plateau State-specific evidence on telemedicine feasibility in a challenging operational environment. Recommendations will address infrastructure requirements, training standardisation for nurse photographers, reimbursement models for telemedicine services, and data privacy governance frameworks. Scaling telemedicine retinopathy screening across rural Nigeria represents a high-impact opportunity to reduce preventable diabetes-related blindness. Keywords: telemedicine, diabetic retinopathy, rural screening, Plateau State, fundus photography