Delivery models of diabetic retinopathy services in low- and middle-income countries: a scoping review

Abstract Background Diabetic retinopathy (DR) is a leading cause of vision loss, and its burden is projected to increase disproportionately in low- and middle-income countries (LMICs). Although blindness from DR is preventable through screening and prompt treatment, most LMICs lack organised DR service delivery models due to resource constraints. This scoping review aimed to describe DR service delivery models that are implemented in LMICs and to report on the nature and scope of evidence on their effectiveness to inform policy and programme design in resource limited settings. Methods We conducted a scoping review using the Arksey and O’Malley framework and reported the findings in accordance with PRISMA-ScR guidelines. MEDLINE, Embase, Global Health, and CENTRAL were searched for studies published between 2000 and December 2025, supplemented by targeted grey literature. We included studies describing operational DR service delivery models in LMICs across the continuum of care, including screening, referral, and treatment. Data were synthesised descriptively and mapped to an adapted DR continuum of care framework comprising screening, management and referral mechanisms. Results A total of 129 reports from 58 LMICs were included of which most were conducted in lower-middle-income (50.4%) and upper-middle-income countries (42.6%). Screening was most commonly opportunistic (61.1%) and delivered at the primary level of care (50.9%). In most programmes, screening was offered along with routine diabetes services at various levels of the health system (77/94 reports, 81.9%) and physically delivered within diabetes or non-communicable disease clinic settings in 36/109 reports(33.0%). Task-sharing with non-eye health cadres (28.6%) and task-shifting (16.1%) models were common, supported by digital retinal imaging (75.5%), telemedicine (42.9%) and artificial intelligence-assisted grading (9.8%). Although referral pathways were described, few studies reported referral adherence ( n = 5), treatment uptake ( n = 7), or post-treatment visual outcomes ( n = 9). Conclusion DR service delivery in LMICs is increasingly characterised by decentralised screening through integration within diabetes care, task-sharing and technology-assisted approaches, while treatment services remain largely centralised. Organised screening and combined screening and treatment were reported as cost-effective, however evidence on the performance of referral pathways or treatment outcomes remains limited.