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To investigate the clinical validity of using a handheld fundus camera to detect diabetic retinopathy (DR) in China. Prospective comparison study of the handheld fundus camera with a standard validated instrument in detection of DR in hospital and a community screening clinic in Guangdong Province, China. Participants aged 18 years and over with diabetes who were able to provide informed consent and agreed to attend the dilated eye examination with handheld tests and a standard desktop camera. Primary outcome was the proportion of those with referable DR (R