In India diabetes mellitus is fast gaining the status of an epidemic, with 62 million people diagnosed with the disease and this number is likely to go up to 79.4 million by 2030 as per WHO reports.
Diabetic Retinopathy (DR) is one of the complications of diabetes mellitus (incidence ranging from 6-30%),and is a leading cause of visual impairment and avoidable blindness. The manifestations of DR may vary from mild background retinopathy to severe sight threatening proliferative retinopathy/macular edema. The early stages of DR, which are symptomless, are treatable, if detected and managed in time. The sad fact is that by the time the diabetic patient reaches the ophthalmologist, DR is already in an advanced stage, and the visual prognosis is bleak. This is due to lack of awareness and sensitisation not only among patients but also among medical professionals and the treating physicians/endocrinologists.
These operational guidelines for management of Diabetic Retinopathy have thus come at a very opportune moment. They provide a broad framework for the policy makers and planners for integration between two National Health Programmes viz, the NPCDCS (National Programme for Cancer, Diabetes, Cardiac diseases and Stroke) and NPCBVI(National Programme for Control of Blindness & Visual Impairment) through opportunistic screening of diabetic patients attending NCD clinics which have been set up in all district and sub district Hospitals. The use of teleophthalmology as an important tool (to be used by specially trained PMOAs/ Nurses) at health & wellness centers for opportunistic screening of diabetics attending the NCD clinics and sending the doubtful images to the Ophthalmologists for confirmation of DR Grading has been well conceptualised. This would help in minimising the drop outs among diabetics and a better utilization of the already crunched manpower of ophthalmologists. The guidelines also illustrate the set of interventions required at various levels of health care that need to be taken for prevention, early detection and treatment of DR cases.
These guidelines will benefit the patients, medical experts and ophthalmologists and go a long way in reducing the burden of avoidable blindness due to DR in our Country.