Aim - To study the prevalence of diabetic retinopathy in the secondary hospital screening program in south India Methodology - Retrospective descriptive study. Patients who were diagnosed with diabetes mellitus, referred by the treating physician for an evaluation or those with visual complaints who presented to the eye clinic were included. A detailed evaluation was done for all patients with a slit lamp, condensing lenses and a dilated fundus examination by a trained ophthalmologist. The screening was done at 3 secondary level community hospitals catering to a population of 15 - 20 lakhs. The Low Cost Effective Care Unit (LCECU) caters to the urban slums and the Rural and Urban Health and Social Affairs Unit (RUHSA) and Community Health and Development (CHAD) Unit cater to semi-urban and rural population. The LCECU clinic was initiated in 2007 and then the other 2 units were added in 2013. Results - There were 6795 person visits between 2007 - 2015 from the 3 secondary hospitals.The prevalence of diabetic retinopathy was 12.19%. Proliferative diabetic retinopathy was seen in 0.54% and severe non-proliferative diabetic retinopathy in 0.55%. In the LCECU screening program the prevalence of retinopathy dropped from 23.61% (2007) to 5.23% (2015). Conclusions - Diabetic retinopathy affects all strata of society. The prevalence of diabetic retinopathy in this secondary hospital data is less than those reported by other large population based studies in India. Screening on a regular basis will help in decreasing the burden of sight threatening disease and health expenditure in a resource limited setting.