Stronger Together: Collaborative Strategies in Blindness Prevention from Diabetic Retinopathy (DR)

Insights from the APA-AIO Session, April 5, 2025

At the 83rd All India Ophthalmological Society (AIOS) Conference, held from April 3rd to 6th at Yashobhoomi, Delhi, jointly with the 40th Asia-Pacific Academy of Ophthalmology (APAO), on 5th April, VISION 2020 INDIA organised a unique and impactful session to address one of the most pressing issues in eye care today—Diabetic Retinopathy (DR).

Titled—Stronger Together: Collaborative Strategies in Blindness Prevention from Diabetic Retinopathy, the session brought together eminent ophthalmologists, public health experts, and eye care leaders to delve deep into the DR crisis and forge pathways for collaborative action. It was chaired by Prof Taraprasad Das, co-chaired by Prof GVS Murthy and Moderated by Prof Rupali Chopra. The session aimed to chart the path forward through a blend of expert presentations and a panel discussion, encouraging actionable solutions and multi-sectoral partnerships. It began with an overview of the current landscape of Diabetic Retinopathy (DR) in India, along with global comparisons that highlighted the seriousness of the issue

Diabetic Retinopathy in India and Globally: Understanding the Gravity of the Problem

Diabetic Retinopathy, a leading cause of blindness in diabetic patients, stems from prolonged high blood sugar levels that damage the delicate blood vessels in the retina. It is a preventable yet growing concern in India, especially given the rising prevalence of diabetes.

India is witnessing an alarming trend with a Diabetic Retinopathy (DR) prevalence of 16.G% among individuals aged 50 and above, according to the National Diabetes and Diabetic Retinopathy Survey (2015–201S) conducted by the R.P. Centre for Ophthalmic Sciences, New Delhi. Globally, nearly 1 in 5 people living with diabetes develop some degree of Diabetic

Retinopathy (DR), though prevalence varies across different populations, according to the IAPB Joint Policy Brief on Early Diagnosis and Treatment of DR.

In contrast:

• Spain has seen a rise in diabetes cases but a decline in DR prevalence, signalling progress in effective screening and management.
• Japan, although it has a lower rate of diabetes, reports higher instances of DR, pointing to possible gaps in early detection or care pathways.

As per WHO-SEARO (Southeast Asia Region) DR indicators, the growing burden of DR presents a significant public health challenge, necessitating urgent action and strategic planning.

Dr. G.V.S. Murthy, President of Pragyaan Sustainable Health Outcomes (PRASHO), emphasized that while diabetes cases may continue to rise, Diabetic Retinopathy (DR) can be effectively controlled—and even reduced—as evidenced by Spain’s success in this area. He highlighted the importance of task-sharing, suggesting that screening for DR can be effectively conducted by trained pharmacists and lab technicians. He also stressed that awareness about DR remains critically low.

The Need for a Comprehensive DR Management Approach

Undoubtedly with the rising number of diabetes cases, the incidence of Diabetic Retinopathy (DR) will increase manifold, significantly impacting the population. A key message that resonated throughout the session was the urgent need for early screening and integrated care. Emphasis was placed on the pivotal role of physicians as in identifying Diabetic Retinopathy. The "One Ophthalmologist-One Physician, (one hub and spoke model with Single Point of Contact was advocated to improve screening coverage across the country was introduced by Dr. (Prof.) Padma Paul, Professor of Outreach Services, Department of Ophthalmology at Christian Medical College, Vellore.

She emphasized the need for a Diabetic Registry, referring to the importance and urgency of creating and maintaining a systematic database of all individuals with diabetes being cared for at the physician's office being partnered with, providing screening with imaging performed at the physician’s office, either powered by AI or read by ophthalmologist or a clinical fundus examination. This needed to be followed up by a well chartered referral pathway for medical and surgical management of referable DR not to forget low vision rehabilitation in appropriate patients. Every Diabetes care facility will thus be responsible for their own registry of patients at least.

Multidisciplinary involvement is crucial:

• It was discussed that DR screening can be conducted by diabetes educators, lab technicians, pharmacists, and nurses—provided they are properly educated and trained in every physician's facility.
• Patient awareness remains low, and it is essential to sensitize not only the patients but also their families, especially patients’ spouses about the risk of blindness due to diabetes.

As the discussions progressed, the need for a pyramid-level screening model emerged. Inspired by the CMC Vellore approach, this model aims to ensure that even the most peripheral health systems are equipped to detect DR effectively all the way to that at quaternary care in Nephrology clinics.

Dr. (Prof.) Anika Amritanand from CMC Vellore moderated an excellent discussion on ‘What will it take to recruit every single practicing ophthalmologist in this war against DR related blindness: Recommendations for Action and Implementation across cross cutting themes.

Dr. Kim Ramasamy, Chief Medical Officer at Aravind Eye Care System, shared his insights on the existing screening guidelines for physicians, and stressed the importance of advocacy and physician engagement. He also shared how AI tripled DR detection efficiency compared to conventional diabetic clinics and described how integrating screenings with medicine distribution at PHCs in Tamil Nadu significantly improved coverage. He further highlighted the value of leveraging print media to raise public awareness on Diabetic Retinopathy.

The panel stressed the importance of empowering patients and their families, especially spouses, to understand and demand DR screenings. Patient advocacy emerged as another critical theme.

Dr. Shalinder Sabharwal, Director of Public Health and Projects at Dr. Shroff’s Charity Eye Hospital, advocated for AI-driven screening at PHCs and vision centres and highlighted the importance of informed consent and data privacy. 

Dr. Taraprasad Das, Vice-Chair Emeritus, L V Prasad Eye Institute emphasized that diabetes has the potential to cause blindness. He noted, “If you warn people that diabetes can lead to blindness, it acts as a wake-up call.” He stressed the importance of raising awareness to prevent vision loss, advocating for clear communication with patients about the risks. Dr. Das also highlighted the crucial role of government engagement in successfully addressing the growing burden of diabetic retinopathy (DR).

Dr. Sobha Sivaprasad from Moorfields Eye Hospital (NHS Trust) called for risk-based, targeted screening models using automated AI tools. Drawing from the UK’s incentivization model, she explained how general practitioners there are encouraged—through financial incentives—to prioritize DR screening, a strategy that could be adapted in India. She also advocated for incentivizing physicians for referrals, to strengthen the DR care pathway.

From the optometry perspective, Dr. Prema Chande, Professor at Lotus College of Optometry, emphasized the pivotal role optometrists play as frontline screeners for Diabetic Retinopathy (DR). 

She advocated for:

1. Enhanced training to strengthen screening capabilities
2. Adoption of co-management models for better coordination between care providers
3. Integration of AI-based reminder systems to ensure timely follow-ups and continuity of care

She strongly recommended incorporating routine retinal and glaucoma screenings into general eye care and reiterated the need to educate both patients and optometrists alike.

Ms. Anusha Purushottam, Head of Health Systems and Policy at Remedio, underlined the vital role of AI in DR screening, while also emphasizing that technology is not a substitute for a qualified doctor. She encouraged the integration of AI as a tool to support—not replace— clinical expertise in eye care.

The APA-AIO session made it abundantly clear that India’s fight against Diabetic Retinopathy needs a shift from isolated interventions to powerful collaborations of every ophthalmologist with at least one physician to make cohesive, technology-driven strategies. By embracing AI tools, building cross-disciplinary teams, and focusing on patient education, the eye care community can significantly reduce the burden of DR-related blindness. As the prevalence of DR continues to rise, the time for action is now. From this high-level dialogue, the roadmap ahead is evident: a united, innovative, and patient-centred approach is not just ideal—it is essential.