Diabetic Retinopathy in India: Screening and Management

Diabetic retinopathy (DR) is a major public health concern in India, where the prevalence of diabetes is increasing rapidly. With over 77 million people living with diabetes in India, the burden of diabetic retinopathy is significant, leading to visual impairment and blindness if not properly managed.

Understanding Diabetic Retinopathy

Diabetic retinopathy is a complication of diabetes that affects the blood vessels in the retina, the light-sensitive tissue at the back of the eye. High blood sugar levels can damage these vessels, causing them to swell, leak, or close off, which can result in vision loss.

DR progresses through various stages:

1. Non-Proliferative Diabetic Retinopathy (NPDR):
   • Mild NPDR: Micro aneurysms occur.
   • Moderate NPDR: Blood vessels that nourish the retina are blocked.
   • Severe NPDR: More blood vessels are blocked, depriving areas of the retina of blood supply.
2. Proliferative Diabetic Retinopathy (PDR):
   • Growth of new, abnormal blood vessels on the retina, which can bleed and cause retinal detachment.

Screening for Diabetic Retinopathy

Early detection of diabetic retinopathy through regular screening is crucial in preventing vision loss. The following are key screening methods used in India:

1. Fundus Photography:
   • Non-invasive imaging of the retina to detect and document DR changes. Mobile fundus cameras are being increasingly utilized in remote and rural areas to improve access to screening.
2. Optical Coherence Tomography (OCT):
   • Provides detailed cross-sectional images of the retina, allowing for the detection of retinal thickness changes and macular edema.
3. Telemedicine:
   • Tele ophthalmology programs enable remote diagnosis by allowing trained technicians to capture retinal images and send them to ophthalmologists for evaluation. This is particularly useful in rural and underserved areas.
4. Screening Camps:
   • Periodic screening camps organized by government and non-governmental organizations (NGOs) help reach larger populations, especially in rural areas.

Management of Diabetic Retinopathy

Management strategies for diabetic retinopathy in India include medical, surgical, and lifestyle interventions aimed at controlling diabetes and preventing disease progression:

1. Blood Sugar Control:
   • Tight glycemic control through diet, exercise, and medication (oral hypoglycemics and insulin) is fundamental in preventing and slowing the progression of DR.
2. Medical Treatments:
   • Anti-VEGF Therapy: Injections of anti-vascular endothelial growth factor (VEGF) drugs (e.g., ranibizumab, aflibercept) help reduce macular edema and prevent the growth of abnormal blood vessels.
   • Steroid Injections: Intravitreal steroids (e.g., dexamethasone implants) are used to reduce inflammation and macular edema.
3. Laser Therapy:
   • Focal/ Grid Laser Photocoagulation: Used to treat macular edema by sealing leaking blood vessels.
   • Panretinal Photocoagulation (PRP): Aimed at reducing retinal ischemia and preventing neovascularization in PDR.
4. Surgical Interventions:
   • Vitrectomy: Removal of the vitreous gel and scar tissue from the eye is performed in cases of severe vitreous hemorrhage or retinal detachment.
5. Patient Education and Lifestyle Modifications:
   • Educating patients about the importance of regular eye examinations, blood sugar control, blood pressure management, and healthy lifestyle choices (diet, exercise, and smoking cessation) is essential for preventing DR progression.

Challenges and Future Directions

Despite the availability of effective screening and management options, several challenges remain in addressing diabetic retinopathy in India:

• Awareness: Low awareness levels about the importance of regular eye check-ups among diabetic patients.
• Accessibility: Limited access to screening and treatment facilities, especially in rural and remote areas.
• Affordability: High costs of advanced treatments like anti-VEGF therapy and laser surgery.

To overcome these challenges, it is essential to enhance public health initiatives, improve healthcare infrastructure, and promote affordable and accessible screening and treatment options. Continued efforts in research, technology, and community outreach are crucial to reducing the burden of diabetic retinopathy in India.