{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:18:56Z","timestamp":1787750336017,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract:<\/jats:title>\n                  <jats:p>Diabetic retinopathy (DR) is a leading cause of preventable blindness, with the highest burden falling on populations living in urban slums and peri-urban settlements in low- and middle-income countries. These communities often remain outside the reach of conventional health systems due to systemic neglect, migratory lifestyles, and fragile infrastructure. Traditional facility-based screening models are often inaccessible, underscoring the urgent need for decentralized, community-embedded solutions. This review synthesizes global evidence on community and allied health worker (CAHW)-led DR screening initiatives in urban slum contexts, drawing from 22 studies conducted across Asia, Africa, Latin America, and Oceania. In addition, field experience from a DR screening program in Dharavi, Mumbai, one of Asia\u2019s largest informal settlements, is included to illustrate operational realities. Findings highlight the transformative potential of task-shifting DR screening responsibilities to CAHWs, many of whom are recruited from the communities they serve. These workers effectively carried out tasks including health education, visual acuity screening, portable fundus photography, referral navigation, and digital data management. With structured training and supervision, CAHWs were found capable of taking on responsibilities conventionally reserved for ophthalmic professionals. Their cultural familiarity and embedded presence also enabled them to overcome key barriers such as distrust, mobility, and language, improving screening uptake and follow-through in underserved populations. Despite clear benefits, challenges persist. Programs often lack standardized competency frameworks, adequate incentives, digital tools, and integrated referral systems. Addressing these gaps is essential for sustaining impact.<\/jats:p>","DOI":"10.4103\/ojo.ojo_264_25","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T02:00:14Z","timestamp":1782266414000},"page":"183-189","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Reaching the unreached: Task-shifting diabetic retinopathy screening in urban slums of low- and middle-income countries"],"prefix":"10.4103","volume":"19","author":[{"given":"Sunita","family":"Mohan","sequence":"first","affiliation":[{"name":"Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands"},{"name":"Center for Medical Genetic Counseling, GenVams Trust, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Govindasamy","family":"Kumaramanickavel","sequence":"additional","affiliation":[{"name":"Center for Medical Genetic Counseling, GenVams Trust, Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Stevens","sequence":"additional","affiliation":[{"name":"Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Scherpbier","sequence":"additional","affiliation":[{"name":"Faculty of Health, Medicine and Life Sciences, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"R1-20260624","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1016\/j.ophtha.2021.04.027","article-title":"Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis","volume":"128","author":"Teo","year":"2021","journal-title":"Ophthalmology"},{"key":"R2-20260624","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000502387","article-title":"Strategies to tackle the global burden of diabetic retinopathy: From epidemiology to artificial intelligence","volume":"243","author":"Wong","year":"2020","journal-title":"Ophthalmologica"},{"key":"R3-20260624","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3109\/09286586.2013.867509","article-title":"Aditya jyot-diabetic retinopathy in urban Mumbai slums study (AJ-DRUMSS): Study design and methodology-report 1","volume":"21","author":"Sunita","year":"2014","journal-title":"Ophthalmic Epidemiol"},{"key":"R4-20260624","doi-asserted-by":"crossref","first-page":"350","DOI":"10.4103\/ijo.IJO_1231_22","article-title":"Impact of individual counseling on the knowledge and attitudes of type 2 diabetics regarding diabetic retinopathy: The Aditya Jyot diabetic retinopathy in urban Mumbai slums study-report 3","volume":"71","author":"Kim","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"R6-20260624","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s40814-020-00644-8","article-title":"Feasibility of a cluster randomized controlled trial on the effectiveness of peer-led health education interventions to increase uptake of retinal examination for diabetic retinopathy in Kirinyaga, Kenya: A pilot trial","volume":"6","author":"Mwangi","year":"2020","journal-title":"Pilot Feasibility Stud"},{"key":"R7-20260624","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2471\/BLT.22.288580","article-title":"Feasibility of screening for diabetic retinopathy using artificial intelligence, Brazil","volume":"100","author":"Malerbi","year":"2022","journal-title":"Bull World Health Organ"},{"key":"R8-20260624","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1001\/jamaophthalmol.2019.2923","article-title":"Diagnostic accuracy of community-based diabetic retinopathy screening with an offline artificial intelligence system on a smartphone","volume":"137","author":"Natarajan","year":"2019","journal-title":"JAMA Ophthalmol"},{"key":"R9-20260624","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1186\/s12889-024-17652-5","article-title":"The role of cadre in the community on diabetic retinopathy management and its challenges in low-middle income countries: A scoping review","volume":"24","author":"Sadikin","year":"2024","journal-title":"BMC Public Health"},{"key":"R11-20260624","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/1741-7015-11-157","article-title":"Diabetic retinopathy in Sub-Saharan Africa: Meeting the challenges of an emerging epidemic","volume":"11","author":"Burgess","year":"2013","journal-title":"BMC Med"},{"key":"R12-20260624","doi-asserted-by":"crossref","first-page":"e0198979","DOI":"10.1371\/journal.pone.0198979","article-title":"Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings","volume":"14","author":"Piyasena","year":"2019","journal-title":"PLoS One"},{"key":"R13-20260624","doi-asserted-by":"crossref","first-page":"e2023","DOI":"10.5935\/0004-2749.2023-0200","article-title":"Transition from an in-person to a telemedicine diabetic retinopathy screening program","volume":"87","author":"Barbieri","year":"2024","journal-title":"Arq Bras Oftalmol"},{"key":"R14-20260624","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1177\/1932296820985567","article-title":"Diabetic retinopathy screening using artificial intelligence and handheld smartphone-based retinal camera","volume":"16","author":"Malerbi","year":"2022","journal-title":"J Diabetes Sci Technol"},{"key":"R15-20260624","first-page":"6976","article-title":"Impact of diabetic retinopathy awareness training on community health workers'knowledge and referral practices in Fiji: A qualitative study","volume":"22","author":"Ram","year":"2022","journal-title":"Rural Remote Health"},{"key":"R16-20260624","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/tmi.13039","article-title":"Diabetic retinopathy screening programme utilising non-mydriatic fundus imaging in slum populations of New Delhi, India","volume":"23","author":"Wadhwani","year":"2018","journal-title":"Trop Med Int Health"},{"key":"R18-20260624","doi-asserted-by":"crossref","first-page":"e0260936","DOI":"10.1371\/journal.pone.0260936","article-title":"Diabetic retinopathy service delivery and integration into the health system in Pakistan-findings from a multicentre qualitative study","volume":"16","author":"Bechange","year":"2021","journal-title":"PLoS One"},{"key":"R19-20260624","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1038\/s41433-023-02673-y","article-title":"Assessing the barriers and facilitators of access to diabetic retinopathy screening in Sub- Saharan Africa: A literature review","volume":"38","author":"Achigbu","year":"2024","journal-title":"Eye (Lond)"},{"key":"R20-20260624","doi-asserted-by":"crossref","first-page":"674","DOI":"10.2471\/BLT.18.212613","article-title":"Implementation of a diabetic retinopathy referral network, Peru","volume":"96","author":"Salamanca","year":"2018","journal-title":"Bull World Health Organ"},{"key":"R21-20260624","first-page":"36","article-title":"Barriers to an effective diabetic retinopathy service in Ibadan, Nigeria (Sub -Saharan Africa) \u2013 A pilot qualitative study","volume":"13","author":"Ibrahim","year":"2015","journal-title":"Ann Ib Postgrad Med"},{"key":"R22-20260624","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1007\/s00592-020-01585-7","article-title":"Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera","volume":"57","author":"Queiroz","year":"2020","journal-title":"Acta Diabetol"},{"key":"R23-20260624","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1097\/HJH.0000000000003834","article-title":"Task-sharing with community health workers to treat hypertension: A scoping review","volume":"42","author":"Inagaki","year":"2024","journal-title":"J Hypertens"}],"container-title":["Oman Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ojo.ojo_264_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T12:25:48Z","timestamp":1787747148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ojo.ojo_264_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/ojo.ojo_264_25","relation":{},"ISSN":["0974-620X","0974-7842"],"issn-type":[{"value":"0974-620X","type":"print"},{"value":"0974-7842","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5]]},"assertion":[{"value":"2025-07-13","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}