The UK-Philippines Remote Retinal Evaluation Collaboration in Health: Diabetic Retinopathy (REACH-DR) One of the major complications of diabetes is vision loss due to a disease known as diabetic retinopathy (DR) that includes diabetic maculopathy affecting predominantly the centre part of the back of the eye, the place of high acuity vision. One of the greatest success stories in diabetes eye care is the United Kingdom's National Diabetic Retinopathy Screening Programme (UK-DRSP). In 2014, for the first time in 5 decades, DR was no longer the leading cause of legal blindness in the working-age population in England and Wales, likely due to the early detection of DR by screening, along with improved control of blood sugar levels. Later, similar results have been found in other populations. Therefore, the prevalence of diabetes-related blindness and visual impairment is lowest where continuous retinal evaluations for all persons with diabetes exist. Outside the UK, only 18-60% persons with diabetes undergo annual DR examinations, usually by dilated retinal examination by eye-care professionals. However, in the Philippines, in-person retinal evaluation is not always possible, due to lack of trained personnel and suitable equipment. Telemedicine uses telecommunication and information technology to provide clinical health care from a distance and provides an alternative to in-person examination. In the UK, over 2 million persons with diabetes mellitus are screened using telemedicine annually.   The Philippine telecommunication and health-care infrastructure is being developed to sustain centralized telemedicine programmes. The Philippine government showed significant interest and support for the development of such programmes by passing the National Telehealth Service Act of 2009. In 2012-2013, a hospital-based retinal imaging reading center and a limited scale DR specific tele-ophthalmology programme was established in collaboration with the Joslin Diabetes Center. However, deployment of a population based DRSP, for which the well-established UK-DRSP is the ideal partner, especially at remote locations is still lacking. Current conditions in the Philippine health-care setting are optimal for the development of such a programme and this application aims to fully develop this.  The objectives of this proposal will be to first establish a DRSP in the Philippines within a well characterized but underserved target population. This objective will be pursued in three phases: i) In the initial phase we will develop the necessary infrastructure jointly by the UK and the Philippine teams. The UK and Philippine principal investigators will perform analysis and validation of existing telemedicine technology with independent expert review from the Joslin Diabetes Center. ii) The second phase will involve adapting selected technologies into the Philippine setting, with the first DR screening being performed under the direct guidance and supervision of the UK team. iii) In the last phase there will be a complete technology transfer to the Philippine stakeholders. Long-term quality assurance and control (QA/QC) programmes will be based on UK-DRSP but will be carefully adapted to the Philippine environment to ensure standards and key performance indicators will be continually maintained and patients remain safe in the DRSP. The proposed teleophthalmology programme for DRSP will help to identify eyes at high risk for losing sight, and this will have direct benefit for individuals. An additional benefit will be the promotion of awareness for the need for eye evaluations which will significantly improve the overall level of eye care and reduce the risk of DR related visual loss in PwDM. The ultimate aim of this project will be the implementation of a national programme in the Philippines with a country-wide benefit. The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.