Inclusion Criteria:  At least 18 years of age Type 1 or type 2 diabetes as determined through linked provincial healthcare administrative datasets or primary care data using algorithms similar to provincial methods. Attended the primary health care setting, with at least 1 visit to the centre within the past 10 years  Exclusion Criteria:  1. Individuals identified as having received DRS (in the previous 425 days) by an ophthalmologist and/or optometrist or tele-ophthalmology/Tele-Retina.