India fast emerging as world's diabetic retinopathy capital; experts unveil new national screening guidelines
NEW DELHI: India is not only the diabetes capital of the world but is also fast emerging as the diabetic retinopathy capital, experts warned, while attributing the rise in this vision-threatening condition to poor awareness among both doctors and the public. According to experts, currently, 85% of diabetic patients are unaware that diabetes can impact vision and have never undergone a retinal examination. Concerned about the rise in diabetic retinopathy (DR) cases, experts from across the country met to develop, in consultation, revised India-specific national guidelines for the early detection and management of DR, to combat this public health challenge. The new guidelines introduce a comprehensive, technology-enabled and system-integrated approach that can change the trajectory of eye care for diabetic patients in India and aims to achieve 80% DR screening coverage among the diabetic population. The updated guidelines announced by Vision 2020-The Right to Sight India, a national consortium of not-for-profit eye hospitals across the country, outline a tiered diagnostic and treatment pathway that ensures timely intervention at every level of care. Speaking with the TNIE , Dr Rajesh Saini, President, VISION 2020, India, said, Diabetic retinopathy is a growing public health concern, silently threatening the vision of millions. These new guidelines, rooted in expert consensus and enriched with the latest diagnostic and management protocols, will empower healthcare providers to detect and intervene earlier, especially in underserved communities. He said they have updated the 2015 manual on DR, a silent yet steadily rising cause of avoidable blindness, to align with current best practices. We want to drive nationwide awareness, strengthen clinical capacity, and reinforce the message that vision loss from diabetes is preventable with timely action, said Dr Saini. Dr Vishali Gupta, President at Vitreo Retinal Society India, PGI, Chandigarh, said, India is not only the diabetic capital of the world but also the world capital for diabetic retinopathy. But we are not doing anything about it. Diabetic retinopathy should be included in the National Diabetes Program. So far, the focus is on screening. Our focus should be on DR because it affects the economically productive age group, those in their forties and younger. By prioritising timely and systematic screening, we can identify the disease much earlier, significantly improving outcomes. Evidence shows that early intervention can halve the risk of severe vision loss, and these guidelines translate that evidence into actionable practice across all levels of care, she told this paper. According to Dr R Kim, CMO at Aravind Eye Hospital, Madurai, Every patient who has diabetes is at risk of developing diabetic retinopathy. The sheer number is huge. People with diabetes dont know when they will develop it. So that's why we insist that they should get their eyes screened at least once a year. The guidelines recommend screening right at the time of diagnosis for type 2 diabetes. If we start creating awareness on having a regular eye checkup for everyone, then I think we will be able to prevent DR and other eye diseases, which can cause people to go blind, said Dr Gupta. According to the 2023 Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, there are an estimated 101 million people in India with diabetes, 136 million pre-diabetics and 315 million people with hypertension in 2021. Experts said the number could exceed 125 million by 2045. Among them, nearly 6-7 per cent, or approximately four to six million individuals, are already at risk of sight-threatening diabetic retinopathy. The new guideline lists financial coverage for essential DR treatments (lasers, anti-VEGF and bispecific IVI injections, OCT monitoring) under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) to reduce out-of-pocket costs. It also highlights integration through ABHA IDs, strengthening referral chains and leveraging tele-ophthalmology hubs for continuity of care. It strongly pitches for developing National Diabetes and DR Registries to enable real-time monitoring and data-driven policy planning. In India, epidemiological data show that DR affects approximately 18% of urban and 10.4% of rural populations with diabetes, which means nearly one in five urban diabetics is at risk of vision impairment. While early detection and timely intervention can prevent blindness in most cases, awareness levels remain low, not only among patients but also among some healthcare practitioners. Experts said many non-ophthalmic providers, such as diabetologists, endocrinologists and primary care physicians, do not consistently refer patients for retinal screening, leading to late diagnosis and irreversible vision loss in many cases.
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