In India, diabetic retinopathy was the 17th cause of blindness 20 years ago. Today, diabetes related blindness has ascended to the 6th position.

Diabetes prevalence in India is expected to rise by 195% from 18 million in 1995 to 54 million in 2025. With better treatment modalities being available for the treatment of diabetes, the life expectancy of this population sub-group is also increasing.

With this, the prevalence of diabetic retinopathy is also likely to increase.

Approach

In India there is an inequitable distribution of wealth and resources; while 70% of the population live in villages, about 80% of ophthalmologists practice in the cities. India has 1 ophthalmologist per 100,000 population and this ratio is even more dismal for rural settings.

Screening for diabetic retinopathy can be either ophthalmologist based or ophthalmologist led. Given the ophthalmologist/population ratio, the ophthalmologist-based approach is not cost-effective.

Tele-ophthalmology, an ophthalmologist-led screening model, offers a cost-effective and feasible model for screening large groups of people in remote and often poor areas.

The Vision Research Foundation, Medical Research Foundation and the Indian Space Research Organisation collaborate to develop, test and implement this model.

Geographically, the project targets the districts of Bangalore, Kolar, Mandya, Mysore, Chamrajnagar and Tumkur in the state of Karnataka.

Mobile units will be equipped with the latest technology for screening and satellite communication and manned by optometrists. These units will be used to access rural, remote areas to conduct screening camps for diabetic retinopathy.

Before each of these camps, 2 screening camps for diabetes will be conducted to detect undiagnosed people with diabetes in the population.

The data and images for people consulted in the mobile unit will be transferred to the hub at Sankara Nethralaya in Bangalore, where a vitreoretinal surgeon will review the pictures and data and give advice regarding management.

All people detected to have diabetic retinopathy at the screening camps would undergo detailed clinical evaluation and ancillary investigations like ultrasound if required in the van itself by the optometrists. Appropriate treatment, either in the form of laser photocoagulation or surgical intervention will be advised by the ophthalmologist.

Once treatment is over, appropriate follow up schedules with fixed follow up date will be given to the patients.

Patients found to have advanced diabetic retinopathy, who are not amenable to any further treatment, will be provided with low visual aids in the van by the optometrist.

Treatment will be provided free to all patients with income less that USD 40 per month.