In the Methods, we describe in detail the training received by ophthalmologists in the CREST (Comprehensive Rural Eye Service and Training) program. As described there, only two doctors per hospital (not all of whom examined patients in the current study) could attend the didactic phase of training at the Zhongshan Ophthalmic Center (ZOC). This is due to the limited number of ophthalmologists at a typical rural Chinese county hospital, and the heavy load of clinical duties. For more doctors to have left their facilities for the two month didactic training would not have been practical. However, all ophthalmologists participating in the CREST network and in the current study received intensive hands on training by medical retina experts from ZOC at their own facilities, which included the diagnosis and laser treatment of diabetic retinopathy (DR) as well as the use of the United Kingdom National Health Service Diabetic Eye Screening Program (UK NHS DESP) DR grading system assessed in our study. The median number (inter quartile range) of hands on training sessions received in managing DR was 3 (1, 9).
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