The study aims to assess the clinical and cost-effectiveness of a novel diabetic retinopathy care pathway across patient, clinician, and service levels while evaluating its implementation in a resource-limited setting. Using a type 2 hybrid effectiveness-implementation design, the evaluation will employ mixed methods. The study outlines the economic evaluation of the costs of the diabetic retinopathy care pathway. Implementation strategies will be guided by the Expert Recommendations for Implementing Change taxonomy.