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Background: Screening for diabetic retinopathy (DR) through tele-ophthalmology using mobile screening imaging units in Canada and in isolated First Nation communities in Quebec with the goal of reaching unscreened diabetic persons.Methods: Image capture of both eyes of 3505 known diabetic individuals was performed with mobile imaging units located in pharmacies and traveling through urban communities throughout Canada as in 9 isolated First Nation communities located in northern Quebec.tele-ophthalmology, ophthalmologists proceeded provided reading and timely referral in ophthalmology when indicated.Dedicated sofware for DR screening (iVision Solution) insured safety and confidentiality for the communications, the organization, overview, management of the follow-up care of the screened patients and archiving.Results: Screening results and the impact of screening through teleophtalmology on betteraccess of screening to diabetics and on the efficiency of medical resources are reported.Interpretation: Tele-ophthalmology used for screening for DR through mobile imaging units efficiently lowers barriers to screening and provides better outreach to diabetic populations enabling diabetics to be assessed in their own communities.It identifies individuals truly in need ophthalmologic services while increasing the ability of ophthalmologists to treat patients effectively, efficiently, and expediently and limiting extensive and expensive traveling for patients.Significant incidental findings associated with screening highlight the need for experienced ophthalmologic competenees in exercising DR screening within a tele-ophthalmology approach.The use of special management software to enable safety and confidentiality, archiving, overview and management of the screened patients, monitor every step of the screening process up to follow-up with an ophthalmologist or yearly patient recall, automated medical quality control is found essential to enable comprehensive and safe screening.Such dedicated screening software coupled with any fundus camera could be used advantageously in any public health care screening program for DR.