Impact of the first guided Diabetic Retinopathy screening to care continuum program within the Indian public health system

BANGALORE, India, Feb. 28, 2022 /PRNewswire/ -- Diabetic Retinopathy (DR), an eye condition causing vision loss and blindness, affects nearly 16.9% of patients with diabetes and 3.6% of whom are most likely to lose their vision because of sight-threatening DR (STDR), stated India's first National Diabetes and Diabetic Retinopathy Survey in 2019. Hence, stressing the need for screening for ocular diseases in patients with diabetes is as critical as screening for diabetes.

In 2019, Remidio began working with the Directorate of Health Services (DHS), Government of Kerala on project Nayanamritham, the brainchild of Dr. Sobha Sivaprasad, Professor and Consultant Ophthalmologist at Moorfields Eye Hospital, London, UK, who worked under the aegis of the ORNATE India, a project funded by Global Challenges Research Fund (GCRF) and UK Research and Innovation (UKRI) to implement the program. The partnership between the DHS, Government of Kerala, the ORNATE India, and Remidio created a care pathway from DR screening to treatment in Kerala, spanning primary, secondary, and tertiary touchpoints. 

Remidio's Fundus on Phone, the world's first non-mydriatic smartphone-based portable fundus camera, powered the DR screening at the 16 Family Health Centres (FHCs) across Thiruvananthapuram district. Remidio imparted extensive training to the FHC healthcare workers to capture retinal images, many of whom did not have prior experience.

The FHCs then transferred the retinal images to a picture archiving and communication system (PACS) at the Regional Institute of Ophthalmology (RIO), a tertiary ophthalmic centre in Thiruvananthapuram. The retinal specialists at RIO graded the images into the four categories of DR staging using teleophthalmology.

To document the program's impact, a detailed analysis was conducted to ascertain the number of patients with diabetes screened, duration of diabetes, behavioural risk factors, the number of patients detected with DR, and the number of patients referred to a specialist. A December 2021 paper published in the Journal of Clinical Medicine, found the prevalence of DR to be 17.4% (age – and gender–adjusted prevalence) among the 4,527 patients with diabetes screened in Kerala. If DR is left unchecked, it may often be, then the condition may lead to vision loss, including blindness. Another alarming observation was that nearly 99% of the patients detected with DR were unaware of the fact that they had DR. This finding stresses the urgent need for improving public awareness towards DR and associated vision loss.                  

"The Nayanamritham program has shown great promise in bringing affordable DR screening to the grassroots. Such FHC driven chronic eye disease screening models can significantly impact preventable blindness in India," said Dr. Sobha Sivaprasad. 

At Kerala, the sub-population that is more at risk of DR are patients with diabetes aged between 40–70 years. With most of the population being in the working-age group, visual impairment risk is likely to impact the individual and their family and society significantly. With a current prevalence of diabetes at 20%, Kerala has the highest prevalence amongst all the states of India. If DR were to be left unchecked, the impact on the economy would be tragic.

"Kerala expanded the focus of its robust NCD program to include health conditions that impact the quality of life severely. DR is one such condition that causes vision loss, but it is preventable through screening programs. Moreover, when medical technology is increasingly bringing healthcare closer to the patient. We should focus on bringing the technology to improve the quality of life of our citizens," said Dr. Bipin K Gopal, Assistant Director, Directorate of Health Services, Thiruvananthapuram.

The Government of Kerala is actively working to curb the effects of DR and has expanded the program to 172 FHCs across the state based on the initial impact of the pilot screening program.

With ~30% of India dependent on public health paired with the rising levels of diabetes, a need has arisen to implement preventative care strategies designed to spread awareness, detect, and treat diabetic retinopathy as many lives may depend on it.

"Programs like Nayanamritham help empower patients with diabetes, especially in rural areas, by making it convenient to get an annual eye screening within the comfort of an accessible FHC. The success of this pilot program, wherein 1 in 3 patients with Diabetes were detected to have Retinopathy, and moved to the care pathway, paves the way for other states to implement similar cost-effective and accessible models for screening chronic eye diseases like DR," said Dr. Anand Sivaraman, Founder & CEO of Remidio. 

About Remidio Innovative Solutions

Remidio is an innovative ISO 13485 certified medical device company that seeks to impact preventable blindness by creating accessible technologies that are smart and simple to use. Remidio's CE marked and FDA 510k registered retinal imaging devices have helped screen and impact more than 7.5 million patients in 15 countries globally, because of increased access provided by the ease of use and affordability of Remidio's patented optics on the smartphone platform.

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