We thank Martins and colleagues for their letter regarding our study on the estimates of ophthalmologists manpower to tackle the burden of vision-threatening diabetic retinopathy (VTDR) worldwide [1]. We agree that training primary care physicians and optometrists and the use of technology for diabetic retinopathy (DR) screening can reduce DR-related blindness.

In our earlier publication [2], we emphasized the need for a paradigm shift in focus from tertiary to secondary and primary care to effectively tackle the burden of DR. Improving awareness and accessibility to DR screening and management is key. The Global Diabetic Retinopathy Advocacy Initiative group recommends appropriate task sharing and task shifting among ophthalmologists, primary care physicians and other healthcare professionals to deliver DR care in a collaborative and cost-effective manner [3]. An evidence-based shared eye care model in Singapore called the Primary Eye Care (PEC), demonstrated the effectiveness of task shifting [3] where by 80% of patients managed in tertiary hospitals were decanted to primary eye clinics run by trained general physicians and optometrists [3].

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