Background. Diabetic retinopathy (DR) is the leading cause of acquired blindness in U.S. adults. Early detection prevents progression. Screening rates are only 10% in medically underserved populations. Methods. A statewide telemedicine-based program within primary care centers was implemented to improve DR screening, detection and referrals for underserved patients. Study design. Retrospective, descriptive study. Results. A total of 568 adults were screened during a comprehensive nurse visit from July 2009-June 2010 and had complete data available. Nearly 60% were minorities and 24% were uninsured. A total of 145 cases of DR were identified. The majority were recommended to return in one year for follow-up, while 75 were referred to a specialist. Conclusions. Telemedicine using digital imaging technology in the primary care office is a strategy that can be used to screen underserved and at-risk patients for DR, increase compliance with screening, and streamline specialist referrals.