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Saving sight in China and beyond: the Lifeline Express model
  1. Ian Yat Hin Wong1,
  2. Michael Yuxuan Ni2,
  3. Irene Oi Ling Wong2,
  4. Nellie Fong3,4,
  5. Gabriel M Leung2
  1. 1 Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  2. 2 School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
  3. 3 Lifeline Express, Lifeline Express Hong Kong Foundation, Hong Kong, China
  4. 4 Chinese Foundation for Lifeline Express, Beijing, China
  1. Correspondence to Dr Michael Yuxuan Ni; nimy{at}


Cataract and diabetic retinopathy are leading causes of blindness globally. Lifeline Express (LEX) has pioneered the provision of cataract surgery in rural China from custom-built trains and eye centres nationwide. Over the past two decades, LEX has provided free cataract surgery for over 180 000 patients in China. In China, half of the adult population has prediabetes and 113 million adults have diabetes. Recognising the rising threat of diabetic retinopathy, LEX has expanded to providing free diabetic retinopathy screening nationwide by establishing 29 Diabetic Retinopathy Screening Centres across China. Source of referrals included host hospitals, the community and out-reach mobile vans equipped with fundus cameras. Fundi photos taken in the mobile vans were electronically transferred to primary graders. LEX also leveraged the widespread smartphone use to provide electronic medical reports via WeChat, the most popular instant messenger app in China. From April 2014 to December 2016, 34 506 patients with diabetes underwent screening, of which 27.2% (9,396) were identified to have diabetic retinopathy. China’s latest national health strategy (‘Healthy China 2030 Plan’) has championed the ‘prevention first’ principle and early screening of chronic diseases. LEX has accordingly evolved to extend its services to save sight in China—from cataract surgery to diabetic retinopathy screening and most recently outreaching beyond its national borders in a pilot South–South collaboration. With health at the top of the China’s developmental agenda and the country’s growing role in global health—LEX’s large-scale telemedicine-enabled programme could represent a potentially scalable model for nationwide diabetic retinopathy screening elsewhere.

  • Health Services Research
  • Public Health
  • Screening
  • Diabetes
  • Eye Diseases

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  • Handling editor Seye Abimbola

  • Contributors NF founded the Lifeline Express and collected data. IYHW, MYN, GML designed the analytic plan. IYHW, MYN, IOLW, GML analysed and interpreted the data. MYN and IYHW wrote the first draft, and all authors contributed to revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data is available.

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