Dr explains: Why skipping eye checks could cost you your sight if you're diabetic

India is home to over 101 million people living with diabetes, earning it the grim title of the “Diabetes capital of the world.” With this vast population at risk, diabetic retinopathy (DR), a complication that can lead to irreversible vision loss has emerged as a significant public health concern.

Studies indicate that between 12% and 22% of Indian diabetics suffer from DR, with urban populations showing higher prevalence due to lifestyle factors, while rural patients often present with advanced disease because of low awareness and limited access to eye care services. Among those aged 50 and above, nationwide surveys suggest that nearly 17% are affected.

Firstpost talked to Dr. Vikas Jain, Group COO, ASG Eye Hospital to shed light on the current burden of diabetic retinopathy in India, effective screening and treatment strategies, the impact of coexisting conditions and what policy measures could help reduce diabetes-related blindness in the coming decade.

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Who in India is most affected by DR?

Dr Jain: Studies estimate that the prevalence of diabetic retinopathy among Indian diabetics ranges from 12% to 22%, with higher rates observed in urban populations due to lifestyle factors, while rural areas have lower awareness and limited access to eye care services so often present with more advanced disease. A nationwide study reported that the prevalence of diabetic retinopathy was as high as 16.9% among those aged 50 years and above.

Screening frequency and challenges

Dr Jain: Regular screening and early detection right from the time of diagnosis of Type 2 DM are crucial to preventing visual loss. Many diabetic patients go to an optical shop and change their spectacles. They are not seen by an Ophthalmologist and do not undergo a dilated fundus examination. Thus they are not routinely screened for diabetic retinopathy.

Many patients remain undiagnosed until advanced stages due to low levels of awareness and inadequate screening programs, especially in rural areas. All Ophthalmologists noted the impact of COVID 19 on diabetic retinopathy, patients missed their follow up as many routine OPDs were closed or due to fear of contracting the disease in the hospital. Many missed their doses of intravitreal Anti VEGF, an important treatment modality to vision threatening retinopathy. We noted that many of our diabetic patients worsened dramatically during the pandemic. There should be increasing awareness of the issues around diabetic retinopathy so people can go to the doctor and get themselves checked on time.

Urban and rural reasons for lack of checkups are also very varied. In rural India, the cost of travel and loss of daily wages to visit a tertiary eye care center are significant deterrents.In urban areas, the traditional need to dilate pupils (causing 4–6 hours of blurry vision) discourages working professionals and daily wage earners from undergoing screening.

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Effective DR screening in low-resource settings (telemedicine, AI, mobile screening vans)

Dr Jain: Timely identification and treatment of Diabetic Retinopathy are critical to preventing vision loss. Screening remains especially difficult in resource-limited regions of India, where there is a chronic shortage of trained ophthalmologists and limited access to regular eye care. In this context, artificial intelligence (AI)–based screening tools offer a promising alternative. International research, and several pilot studies in India, suggest that high-quality, context-adapted AI tools can approach human-grader accuracy while significantly reducing screening costs and turnaround time.

Treatments and access for advanced DR

Dr Jain: The good news is that all advanced VTDR treatments, such as new and more effective anti-VEGF molecules, laser photocoagulation, steroid implants, and vitrectomy for the complicated TRDs are available in India. The government sector (Ayushman Bharat) offers laser and vitrectomy and limited anti-VEGF treatments free of charge at hospitals empanelled under PM-JAY in some states. The private sector offers all options with rapid access in cities. With only ~3,500 retina specialists for 80+ million diabetes patients, rural areas face delayed and inadequate treatment. Despite significant advancements in the healthcare sector over the past few years, the screening process still needs significant improvement; this leads to many patients being late. Furthermore, access to healthcare is highly disparate in our country, with excellent urban private hospitals but not up to the mark in rural government hospitals.

How do comorbidities affect DR management?

Dr Jain: Duration of diabetes is the biggest issue. After 20 years of diabetes, nearly 80% of patients will have some form of retinopathy. Besides this, uncontrolled blood pressure damages the retinal capillaries, accelerating leakage and bleeding. There is a strong correlation between the kidney and the eye. If a patient has high creatinine or proteinuria, they almost certainly have retinopathy. Management of fluid retention (edema) in these patients is complex and requires careful selection of anti-VEGF agents that are safe for the kidneys.

Policy needed to reduce diabetes blindness?

Dr Jain: Fully integrating sight-saving injections into schemes like PM-JAY(Pradhan Mantri Jan Arogya Yojana) and state insurance programs is urgent. This would make the most effective treatment for Macular Edema accessible to the poor. Currently, Ayushman Bharat includes DR screenings in 12 states, but only upon submission of an OCT photograph. What happens is that this restricts its use by physicians who may not have an OCT machine.

In some states, the government has supplied physicians and dialectologists with non-mydriatic fundus cameras which help in the detection of diabetic retinopathy. The expansion of diabetic retinopathy screening under Ayushman Bharat to all states and the implementation of such scalable screening models can significantly help improve diabetic retinopathy detection. Another factor is lack of skilling. Currently, some estimates state retinal specialists range from 11,00 to 3500. There is major upskilling needed.