Diabetic eye screening: what Hong Kong's primary care reference framework says, how often to have it, and what retinal photography is

How often should people with diabetes have a diabetic eye examination?

People with diabetes must take special care of their feet and also have regular eye examinations (Centre for Health Protection, July 2026).

The Primary Healthcare Commission (Health Bureau) Hong Kong Reference Framework for Diabetes Care for Adults in Primary Care Settings (2023 revised edition; ‘the Reference Framework’ below) is written for primary care professionals, and the table below shows its recommendations on eye examinations for them. The frequency and arrangements for an individual patient are decided by the treating doctor.

What is retinal photography? What does a diabetic eye examination include?

Retinal photography is evidence-based best practice and should be done by experienced personnel in a systematic screening programme; the eye examination must check visual acuity, lens opacity and retinopathy (Reference Framework, 2023 revised edition).

Dilated direct ophthalmoscopy by an experienced doctor should be used only for opportunistic examination, cannot replace a systematic screening programme, and is an option only when screening by retinal photography is not possible or not available (Reference Framework, 2023 revised edition).

How common is diabetic retinopathy? What are the risk factors?

Diabetic retinopathy is one of the leading causes of blindness in adults; the main risk factors include longer duration of diabetes, poor glycaemic control, high blood pressure and dyslipidaemia, and other risk factors include pregnancy and diabetic kidney disease (Reference Framework, 2023 revised edition).

About 540,000 people with diabetes were treated at the Hospital Authority in 2022; at the time of the reply, about three in ten diabetic patients had been diagnosed with diabetic retinopathy (Government reply to the Legislative Council, February 2024).

Does the Primary Healthcare Co-care Network offer diabetic eye examinations?

District Health Centres/District Health Centre Expresses (DHC/DHCE) arrange retinal photography examinations for Chronic Disease Co-Care Scheme (CDCC Scheme) participants diagnosed with diabetes, to monitor eye complications of diabetes, and the examinations are done by optometrists (Primary Healthcare Commission CDCC Scheme frequently asked questions, accessed October 2026).

Participants with diabetes have one optometry assessment a year, including retinal photography, and newly diagnosed hypertension participants without diabetes have one in the first year (Operation Manual of Primary Healthcare Co-care Network for Family Doctor, Version 2.1, October 2026). Allied health services are arranged by the DHC/DHCE according to the Family Doctor's prescription and clinical needs, and participants pay the amount set by the Government; if the service provider participates in the Elderly Health Care Voucher Scheme and accepts vouchers as payment, participants can pay with Elderly Health Care Vouchers (Operation Manual for Family Doctor, Version 2.1, October 2026).

Scheme participants must hold a Hong Kong identity card or a certificate of exemption, be registered with eHealth and be members of a DHC/DHCE, and fall into one of the categories listed in the CDCC Scheme frequently asked questions, including: people aged 45 or above with no known diagnosis of diabetes or hypertension (who go through screening first); Hospital Authority Family Medicine Clinic patients who have been invited to join (who must have received at least 12 months of treatment for the relevant disease at that clinic) and General Outpatient Clinic Public-Private Partnership Programme patients; and, from 1 October 2026, people aged 65 or above who are receiving chronic follow-up services at the Department of Health's Elderly Health Centres (who go straight to the treatment phase). The latest eligibility is as stated on the Scheme's web page. For eHealth registration, see eHealth registration; for family doctors and Government-subsidised schemes, see How to choose a family doctor.

When is a referral to an ophthalmologist made?

Primary care professionals are advised to refer promptly to an ophthalmologist with knowledge of and experience in managing diabetic retinopathy any patient with macular oedema of any degree, severe non-proliferative diabetic retinopathy or any proliferative diabetic retinopathy (Reference Framework, 2023 revised edition). The Reference Framework's list ‘When to refer to an ophthalmologist’ (Table 2) also includes: a positive pregnancy test, pre-proliferative retinopathy, new-onset or worsening non-proliferative retinopathy, and unexplained visual impairment (Reference Framework, 2023 revised edition).

Ophthalmology deals with the diagnosis and management of visual disorders and diseases of the eye and its related structures (Hong Kong Academy of Medicine, Specialty Descriptions, April 2025). Whether and when an individual patient is referred to an ophthalmologist is decided by the treating doctor. For choosing an ophthalmologist, see How to choose an ophthalmologist; the specialty for diabetes is named ‘Endocrinology, Diabetes and Metabolism’ (Hong Kong Academy of Medicine, Specialty Descriptions, April 2025), and for choosing an endocrinologist, see How to choose an endocrinologist; for booking a new case at a public specialist clinic, see How to book a new case at a public specialist outpatient clinic; for the English name of diabetes, see Diabetes in English.

Frequently asked questions