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Vision at Risk: Tackling Diabetic Retinopathy in Rural India

Keywords: Diabetic Retinopathy, CHW, Deep Learning, Rural, Eye Condition

According to National Library of Medicine, the prevalence of Diabetic Retinopathy (DR) is 14.0% (95% confidence interval [CI]) in rural India with a prevalence of 7.9% in males and 7.5% in females by 2321. There is no significant difference between the urban (19%) and rural (14%) population in India. But majorly the rural population have been suffering due to the lack of accessible and affordable healthcare services in India. 

High blood sugar from diabetes results in diabetic retinopathy. Blood sugar levels that are excessively high over time might harm the retina, the area of the eye that detects light and transmits information to the brain via the optic nerve, which is located at the back of the eye. Most often, there are no symptoms in the early stages of diabetic retinopathy. Some people experience vision changes that affect their ability to read or perceive objects in the distance. These adjustments could occur suddenly. Blood vessels in the retina begin to bleed into the vitreous, the gel-like fluid that fills the eye, as the condition progresses. 

Santen (Santen Pharmaceutical is a Japanese pharmaceutical company, specializing in ophthalmology) and iKure had intervened in three crucial locations mainly, in Hoskote, Bengaluru, Kankinara, and Domjur, West Bengal. In those rural locations, DR screening and complete body checkups for patients was adopted as part of the iKure-Santen partnership. Frontline health workers from iKure were actively checking for diabetic retinopathy and offering appropriate medication or medical advice to the patients. Screening of 94.5% of diabetic patients had been done. 100% of patients learned about their eye health condition and sought out an ophthalmologist. 92% of patients expressed a desire to get routine eye checkups. By preventing or considerably reducing vision loss and other health problems, early detection and management of diabetes and its consequences, including DR, significantly improved people’s quality of life. The success of the intervention in raising awareness and encouraging routine eye exams was a result of strong community involvement and teaching about the value of eye care in managing diabetes. 

A couple of the significant advancements that have influenced the DR landscape over the past few decades are the introduction of anti-vascular endothelial growth factor (VEGF) treatments and the accessibility of imaging with optical coherence tomography. Over the next ten years, deep learning (DL) and artificial intelligence (AI) algorithms will become more and more crucial in fields including medical diagnosis, screening, prognostication, and decision support for management or therapy. Utilising AI to conduct a thorough examination of retinal imaging, systemic parameter profile, and other blood biomarkers may yield more insightful, and possibly even more accurate, results than human intelligence alone. 

A sustainable strategy to improve diabetes and DR services at the primary level of care was seen by utilisation of Community Health Entrepreneurs (CHE) who are already part of the health system, especially if it involves community awareness, health education, and the facilitation of health services. iKure has been ensuring that the services are available at the last mile community’s doorstep through their Community Health Entrepreneur (CHE) model. 


  • Article: Rajiv Raman, MS, Joana C Vasconcelos, MSc, Ramachandran Rajalakshmi, PhD, Prof A Toby Prevost, PhD, Kim Ramasamy, MS, Viswanathan Mohan, PHD. (2022). Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban–rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. The Lancet Global Health, Volume 10 (Issue 12). 
  • Article: Praveen Vashist, Suraj S Senjam, Vivek Gupta, Souvik Manna, Noopur Gupta, B R Shamanna,Amit Bhardwaj, Atul Kumar, and Promila Gupta. (2021). Prevalence of diabetic retinopathy in India. Indian J Ophthalmol, Volume 69 (Issue 11). 
  • Article: Srikanta Kumar Padhy, Brijesh Takkar, Rohan Chawla, and Atul Kumar. (2019). Artificial intelligence in diabetic retinopathy: A natural step to the future, Indian J Ophthalmol, Volume 67 (Issue 7). 
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