Diabetes affects more than 101 million people in India today. The number is estimated to reach 125 million by the year 2045. There are several systemic health risks associated with diabetes, such as heart disease, chronic kidney disease and diabetic retinopathy (DR). While other risks often present with symptoms, DR is a sight-threatening complication of diabetes, often progressing silently, resulting in vision impairment and in some cases blindness. It’s the number one factor for loss of vision worldwide in middle-aged adults.
The SMART India Study conducted across multiple states and one union territory examined DR prevalence in over 6,000 people with diabetes and revealed that the prevalence of retinopathy is 12.5% in diabetic patients. Out of this, 4% have vision-threatening diabetic retinopathy (VTDR), which causes total vision loss. The small blood vessels of the retina can swell and leak due to prolonged high blood sugar causing DR, or they can close, stopping blood from passing through and causing progressive vision loss. DR often develops without early symptoms. As a result, majority of patients remain unaware of the condition, inadvertently allowing it to progress to an advanced stage.
Dr Nishikant Borse, Medical Director, Insight Eye Clinic, Mumbai says, “Diabetic retinopathy (DR) is a silent threat, affecting nearly one in three people with diabetes, often progressing without early symptoms. With India’s rising diabetes prevalence, the burden of DR will follow, posing risks to vision health. Prolonged high blood sugar levels damage the retina’s blood vessels, potentially leading to blindness if not detected early. Annual eye exams are essential for timely intervention, especially since vision loss from DR is irreversible. In my observation, 50% people are unaware of DR until it progresses to a more advanced stage. Hence, it is important for physicians to be proactive through regular screenings and prompt action to prevent vision loss.”
To address this risk, the Research Society for the Study of Diabetes in India (RSSDI) and the Vitreo Retinal Society of India (VRSI) have jointly developed guidelines, which recommend regular screening for all individuals with diabetes. They highlight the importance of annual eye exams, noting the significance of early detection and prompt intervention to prevent VTDR. Type 1 diabetes patients are advised to begin screening five years from the year of diagnosis and Type 2 patients should be screened when diagnosed. Additionally, pregnant women with diabetes require tailored screening schedules due to increased DR progression risk during pregnancy. Since the vision loss is irreversible, proactive DR screening is important like routine blood tests for diabetes monitoring.
Screening tools like non-mydriatic fundus cameras equipped with artificial intelligence (AI) algorithms enable quick and effective screenings, making it easier for physicians to identify patients needing ophthalmology referrals. Through early detection, public awareness, and integrated screening models, DR can be significantly managed. Collaboration among healthcare providers and their collaboration with patients will be instrumental in preserving the sight of millions threatened by this silent complication of diabetes.
