Vision loss due to Diabetic Retinopathy: A national crisis
diabetes
crisis, with 101 million
1
diagnosed and 136 million with pre-diabetes, the country is faced with an urgent but unrecognised public health threat from
Diabetic Retinopathy
(DR), Diabetic Macular Edema (DME) and Vision-Threatening Diabetic Retinopathy (VTDR).
A staggering 16.9% of people with diabetes suffer from DR, and 3.6% from VTDR
2
and face irreversible blindness. It strikes people in their most productive years, severely impacting their quality of life and creating profound economic and social ramifications. As India aims to become a developed economy by 2047 (Viksit Bharat), improving citizens' quality of life is a key government agenda.
Retinal diseases, often overlooked, demand the same urgency and national focus that transformed cataract care in the country. In response to this urgent challenge, Mission Vision has been launched to elevate retinal health to the forefront of India's public health agenda.
Mission Vision: A confluence of expertise
Mission Vision, a public health initiative by The Vitreo Retinal Society of India (VRSI) and Times of India, supported by Roche, has been launched to tackle preventable blindness and improve retinal health in India.
Under Mission Vision, the VIEW Council, a multi-stakeholder task force of retina experts, ophthalmology societies, policymakers, and industry partners has been formed to focus on reducing the burden of avoidable blindness due to DR. The inaugural meeting saw strong participation from the VRSI leadership, alongside other leading experts. The Council pledged to drive multi-stakeholder action, build awareness, advocate for early screening, and better access to treatment across India.
[L to R] Dr. Vinod Aggarwal (Professor of Vitreo Retina Services, AIIMS, New Delhi); Dr. Muna Bhende (Director Vitreo Retinal Services, Sankara Nethralaya, Chennai); and Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad)
Founding members of the VIEW council
Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai)
Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi)
Dr. Vishali Gupta (Chief of Retina and Uvea Services at Post Graduate Institute (PGI) of Medical Education and Research, Chandigarh)
Dr. Muna Bhende (Director Vitreo Retinal Services,
Sankara Nethralaya
, Chennai)
Dr. Vinod Agarwal (Professor of Vitreo Retina Services, AIIMS, New Delhi)
Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad)
Dr. Chaitra Jayadev (Senior Consultant- Vitreoretina Services, Narayana Nethralaya, Bengaluru)
Dr. Partha Biswas (President, AIOS and Medical Director at Netralayam and
Trenetralaya
, Kolkata)
Dr. Ajay Aurora (Executive Director
Vitreoretina Consultant
, Vision Plus Eye Centre, Noida)
Ms. Rajwinder (Rajji) Mehdwan (CEO and MD, Roche Pharma)
[L to R] Ms. Rajwinder (Rajji) Mehdwan (CEO and MD, Roche Pharma); Dr. Muna Bhende (Director Vitreo Retinal Services, Sankara Nethralaya, Chennai); Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad); Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi); and Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai)
The experts acknowledged the tremendous efforts taken by the government to combat blindness secondary to cataract; however, the tide of retinal disorders due to diabetes is a growing and urgent problem. A recurring theme was the critical need for a massive, nationwide awareness campaign. Nearly nine out of 10 patients with diabetes had never had a retinal examination
3
, showing the enormity of the problem. Driving focus on retinal disorders and making annual retinal examinations a national priority will ensure this growing disease burden is addressed.
[L to R] Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi) and Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai); Dr. Chaitra Jayadev (Senior Consultant- Vitreoretina Services, Narayana Nethralaya, Bengaluru); Dr. Vishali Gupta (Chief of Retina and Uvea Services at Post Graduate Institute (PGI) of Medical Education and Research, Chandigarh); and Dr. Partha Biswas (President, AIOS and Medical Director at Netralayam and Trenetralaya, Kolkata)
Dr. R Kim emphasised the need for a collaborative approach, stating, 'Several stakeholders must be involved to increase awareness. Not only the patients with diabetes, but even primary care physicians, diabetologists, chemists, and optometrists must be made aware of the dangers of retinal disorders like DR. It is about starting a national conversation where every patient asks for an eye exam. We cannot afford to lose another person's vision to silence.'
This sentiment was echoed with a call for making screening ubiquitous. Dr. Manisha Agarwal drew a powerful analogy for its ideal accessibility, 'Diabetes is silently stealing the sight of millions across urban and rural India, often without any warning. The real tragedy is that blindness due to DR is preventable. DR screening should be as accessible as the availability of a weighing machine at railway stations. On the other hand, the inclusion of intravitreal injections in
Ayushman Bharat
, with its need being assessed by OCT, can go a long way towards improving access to treatment.'
Experts also highlighted the need to leverage government schemes. Dr. Vishali Gupta pointed out, 'Ayushman Bharat has been a phenomenal effort to ensure that treatment reaches the most vulnerable. NGOs and strategic public-private partnerships can also help in improving awareness and DR screening at the grassroots level. However, a lot needs to be done towards upskilling the ophthalmologists to screen and evaluate patients with retinal disorders effectively.'
Creative strategies for awareness such as reaching out to schools and organizations with a large sedentary population were also discussed. Dr. Muna Bhende suggested a two-pronged approach for different demographics. 'School children can become your primary influencers, and sensitize their parents to the dangers of blindness due to DR. Also, awareness programmes can leverage the trust that NGOs have built with the local population to ensure the message reaches every corner of India.'
Setting a clear, ambitious goal was seen as crucial. Dr. Rajeev R Pappuru articulated a powerful vision for the future. 'By 2030, no diabetic should go without an eye check-up, including a retinal screening. From the first diagnosis of diabetes to annual follow-ups, DR screening should become an integral part of diabetes care, with access at the patient's doorstep.'
To achieve all of this, patient empowerment is key. Dr. Vinod Agarwal said, 'Our growth over the past few decades has been due to the demand in services. Raise awareness to the level that the patients demand DR screening and we can then offer it as a service. That will help in widespread adoption of screening and also help in mandating the availability of fundus cameras at all centres. Also, the inclusion of intravitreal injections in Ayushman Bharat can go a long way towards improving access to treatment for DR.'
Currently, Ayushman Bharat includes DR screening in 12 states but only upon submission of an OCT photograph, which restricts its use by physicians who may not have an OCT machine. In some states, the government has supplied physicians and diabetologists with non-mydriatic fundus cameras which help in detection of DR. Expansion of DR screening under Ayushman Bharat to all states and the implementation of such scalable screening models can improve DR detection significantly, the experts opined.
Dr. Chaitra Jayadev emphasised, 'Every physician who encounters a patient with diabetes must urge them to go for retinal screening. The outstanding success with the pulse polio program shows us that widespread awareness campaigns can yield results. Our country's technological prowess can be leveraged to develop low-cost screening devices that can help us reach every patient. Linking the Aadhar ID/digital health IDs to medical records can also help clinicians track the patient's progress and ensure adequate follow-up.'
Alongside awareness, building capacity is also important. With only 3500 retinal specialists available, striking a balance by finding innovative avenues to upskill the workforce is essential. Dr. Partha Biswas stressed, 'Academic enhancement and capacity building should go hand-in-hand with increasing awareness. Training postgraduate students in fundus screening and enhancing their ability to detect these disorders can help improve access to care.'
Addressing the infrastructure gap is another critical piece of the puzzle. Dr. Ajay Aurora provided a stark reality check. 'There are 806 districts in India but only 50% have district hospitals, and only two-thirds of those have ophthalmology services. Putting a hub-and-spoke model in place so that patients are referred to adequately equipped care centres is essential.'
Speaking on the need for urgent action, Roche Pharma's Rajwinder (Rajji) Mehdwan said, 'To millions suffering from retinal diseases, the gift of vision should be a guarantee, a right, supported by the very best of our science, our policy, and our collective will. The question is not if we can eliminate preventable vision loss, but how soon we act to build a future where sight is accessible for all. Vision health is not a luxury but a necessity for every individual to live a fulfilling life. By making it a national priority, we can ensure a world where everyone has the opportunity to see clearly and experience life to its fullest. Roche is committed to bringing its global healthcare ecosystem shaping expertise to make Mission Vision a reality.'
[L to R] Dr. Indu Bhushan (Former CEO, National Health Authority & Ayushman Bharat) and Dr. Rajni Kant Srivastava, ICMR- Chair for Disease Elimination
The discussion coalesced around the need for concrete policy action with contributions from eminent policymakers. Dr. Indu Bhushan (Former CEO, National Health Authority & Ayushman Bharat), drawing from his extensive experience, noted, 'Retina health is closely tied to the twin silent epidemics of Diabetes and Hypertension in India. Policy change can happen if there is enough evidence. A policy document that explains the scale of the problem, its economic and social impact, existing gaps in the ophthalmology space, and how they can be plugged can help put things in perspective.'
Providing an update on current government efforts, Dr. K Madan Gopal (Advisor, Public Health Administration, NHSRC, Ministry of Health & Family Welfare) said, 'We have defined norms through the Indian Public Health Standards for all levels of care. Furthermore, at our 1,70,000 Ayushman Arogya Mandirs, we are already equipping our Community Health Officers for the basic screening of eye disorders, including the use of an ophthalmoscope.'
Talking about best practices that can be replicated, Dr.
Rajni Kant Srivastava
, ICMR- Chair for Disease Elimination said, 'Though India is a land of vast disparities, states like Kerala have prioritized eye health. For instance, the
Nayan Amritham
initiative was a successful and scalable programme in which ASHA workers identified diabetic patients for retinopathy screening using handheld non-mydriatic cameras. The images were sent to a central hub for evaluation and treatment advice. Telemedicine can also help in ensuring care reaches remote areas.'
The VIEW Council charter: A roadmap to help India see better
The culmination of these deliberations was a comprehensive charter, a clear and actionable roadmap designed to make retinal screening a fundamental right in India and aiming to decrease VTDR to less than 1%. Mission Vision will focus on driving large-scale public awareness about DR, integrate retinal screening with existing NCD screening programmes, design protocols for every patient to undergo retinal screening, build capacity for widespread screening and diagnosis, and ensure advanced treatment options, like intravitreal injections, are made available through programmes like Ayushman Bharat.
The VIEW Council's inaugural meeting marks a decisive and powerful step towards safeguarding the vision of millions. With a clear charter, the journey to make retinal health a national priority has officially begun.
References -
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(23)00119-5/fulltext
https://pmc.ncbi.nlm.nih.gov/articles/PMC8725073/
https://pmc.ncbi.nlm.nih.gov/articles/PMC11883894/
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