Table 2.

Wilson-Jungner criteria applied to Queen's Trust Project

Criteria	Diabetic Retinopathy	Queen’s Trust Pilot Projects
Condition should be an important public health problem	Evidence shows that 10%-20% people with diabetes have DR and if not detected in time, it can lead to irreversible vision loss	Areas with higher prevalence of diabetes and therefore with risk of higher prevalence of DR identified compared to other areas
There should be an accepted treatment for patients with recognized disease	Effective treatment is available for DR though affordability can be an issue	An effective system for screening, referral, and management of DR was supported
Facilities for diagnosis and treatment should be available	Skills, infrastructure, and access are patchy and discriminate against people with diabetes in rural areas	Physicians from the identified districts and NCD Clinic Nurses/Female Health Workers along with ASHA sensitized; Paramedical Ophthalmic Assistants/Officers/NCD Clinic Nurses/Ophthalmologists were skilled and equipment including Fundus Cameras were provided at the district hospital and CHC
There should be a recognizable latent or early symptomatic stage	DR has a long latent window and takes 15-20 years to lead to vision loss in most cases	All persons with diabetes registered with NCD Clinics were offered fundus imaging to prevent VTDR
There should be a suitable test or examination process	Noninvasive screening tests are available	Nonmydriatic fundus cameras and skills to use the same were provided to all identified districts
The test should be acceptable to the people	Undilated fundus examination is acceptable to most people but there is more hesitancy for dilated fundus examination	High compliance rates for screening using nonmydriatic fundus imaging was seen.
The natural history of the condition, including development from latent to declared disease should be adequately understood	Available evidence supports knowledge of the natural history and rate of progression in most individuals. However, there may be rapid progression in proliferative DR or DME	Available evidence on progression of DR and VTDR was used to develop strategies under the project.
There should be an agreed policy on whom to treat as patients	National guidelines are available along with ICO guidelines on whom to treat	Guidelines were developed and shared with all mentoring partner institutes
The cost of case-finding (including diagnosis and treatment) should be economically balanced in relation to possible expenditure on medical care as a whole	Cost of case-finding is affordable; cost of treatment with some regimens is not affordable, unless covered by insurance schemes; treatment entails a high out-of-pocket expenditure	Screening and DR management services were provided at no cost to the patient
Case finding should be a continuous process and not a one-time intervention	Systematic screening is not yet established and many people are screened in temporary camps	Screening activities and referral services were in place from 2016/2017 to the end of the project