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This infographics on the burden of diabetes in India is developed from the International Diabetes Federation Atlas highlighting the expected near doubling of prevalence of diabetes from 2019 to 2045.
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Introduction The ORNATE India project is funded by the UK Research and Innovation (UKRI) through the Global Challenges Research Fund. The aim is to build research capacity and capability in India and the UK to tackle global burden of diabetes-related visual impairment. As there are over 77 million people with diabetes in India, it is challenging to...
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Context 1
... with diabetes in India and this number is predicted to increase to 100.95 million in 2030 and 134.23 million in 2045 [4]. The age-adjusted prevalence of diabetes in India is projected to increase from current 10.4% to 11.2% in year 2030 and to 11.5% in year 2045. In addition, an estimated further 43.9 million people have undiagnosed diabetes (Fig. 1) ...
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Background
There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings....
Citations
... Additionally, it seeks to better understand specific risk factors and disease patterns in the population context. The article provides details on the research methodology, advances achieved to date, and the significance of this international collaboration in addressing a significant visual health issue in the context of diabetes in India [51]. ...
The field of healthcare holds significant global importance due to its profound impacts on both individual well-being and the broader healthcare system. It plays a pivotal role in the economic landscape, with far-reaching effects at the local, national, and global levels. Moreover, healthcare stands as a vital source of employment, supporting countless individuals across the world. It is a sector characterized by persistent challenges that have been met with innovation and technological advancements. In this literature review, our goal is to explore the key contributions in the healthcare domain, specifically in the diagnosis of diabetic and hypertensive retinopathy using advanced technologies such as Machine Learning and Artificial Intelligence (AI). The use of these technologies is instrumental in enhancing diagnostic accuracy and patient care. The wealth of research in this field is dispersed across various scholarly databases, presenting an opportunity for an extensive and focused investigation. By combining scientometric analysis with the metaphorical "tree of science," we can gain two valuable perspectives on this domain. The first perspective delves into scientometric statistics, shedding light on countries, authors, academic institutions, and research centers that are at the forefront of developing innovative solutions for diagnosing retinopathy using AI and Machine Learning. The second perspective employs an evolutionary analysis, exploring the origins of seminal research contributions and how they have evolved over time. This literature review underscores the ongoing relevance of leveraging Machine Learning and AI in healthcare, particularly in the diagnosis of retinopathy. Furthermore, the COVID-19 pandemic has accelerated the development of technologies that enable remote diagnosis and care, revolutionizing the healthcare landscape. As we navigate the intricate web of healthcare innovation, this literature review aims to provide a comprehensive understanding of the current state of research and its trajectory in the realm of diabetic and hypertensive retinopathy diagnosis through advanced technologies.
... The Ornate India project and the related Nayanamritham study include collaborations between researchers from the UK and India, and the Government of Kerala. [29][30][31][32] The Ornate study aimed to build research capacity and capability in India to tackle diabetes-related visual impairment. The Nayanamritham study aimed to pilot a DR care pathway in the Thiruvananthapuram district, spanning primary, secondary, and tertiary care. ...
India has been witnessing an epidemic of diabetes for several years now. A large proportion of patients with undiagnosed and poorly controlled diabetes are at great risk of developing diabetic retinopathy (DR) and irreversible blindness. The goal of DR screening is to identify people with sight-threatening DR early so that prompt treatment can be initiated, and blindness can be prevented. Systematic DR screening is essential to identify disease early, and a national effort for the same is required. We adopt a health system approach to outline the actions that need to take place for effective DR screening in the public sector in India. We discuss the role of national leadership, needs assessment, finalization of DR screening and referral pathway, trainings, strategies to improve the uptake, allocation of roles and responsibilities, public-private partnerships, quality control, and financing.
... We hope the multicenter SMART-India (Statistical Modelling And Risk assessment of Type 2 diabetes in India) study currently underway in 11 states and one union territory would bridge this knowledge gap. [30] ...
Purpose:
There is an exponential rise in the prevalence of diabetes mellitus (DM) in India. Ideally all people with DM should be periodically screened for diabetic retinopathy (DR) but is not practical with current infrastructure. An alternate strategy is to identify high-risk individuals with vision-threatening diabetic retinopathy (VTDR) for priority screening and treatment.
Methods:
We reanalyzed four population-based studies, conducted in South India between 2001 and 2010, and reclassified individuals above 40 years into known and newly diagnosed diabetes. Multiple regression analysis was done to identify risk factors in people with known and new DM.
Results:
The prevalence of DR in 44,599 subjects aged ≥40 years was 14.8% (18.4 and 4.7% in known and new DM, respectively), and the prevalence of VTDR was 5.1%. Higher risk factors of VTDR were older age >50 years, diabetes duration >5 years, and systolic blood pressure >140 mm Hg. Targeted screening of people with diabetes using high-risk criteria obtained from this study was able to detect 93.5% of all individuals with VTDR.
Conclusion:
In a limited resource country like India, a high-risk group-based targeted screening of individuals with DM could be prioritized while continuing the current opportunistic screening till India adopts universal screening of all people with DM.
... Generous grants first from the Queen Elizabeth Diamond Jubilee Trust, UK and then the UK Research and Innovation (UKRI) through the Global Challenges Research Fund have facilitated the thinking on Screening activities and referral services were in place from 2016/2017 to the end of the project systematic screening programs embedded in a comprehensive diabetic care model. [16,25] The Queen's Trust initiative developed potential models were mapped against the Wilson-Jungner criteria for screening, to see if there was a good fit with the criteria [18] [ Table 2]. ...
Of all the eye conditions in the contemporary Indian context, diabetic retinopathy (DR) attracts the maximum attention not just of the eye care fraternity but the entire medical fraternity. Countries are at different stages of evolution in structured DR screening services. In most low and middle income countries, screening is opportunistic, while in most of the high income countries structured population-based DR screening is the established norm. To reduce inequities in access, it is important that all persons with diabetes are provided equal access to DR screening and management services. Such programs have been proven to reverse the magnitude of vision-threatening diabetic retinopathy in countries like England and Scotland. DR screening should not be considered an endpoint in itself but the starting point in a continuum of services for effective management of DR services so that the risk of vision loss can be mitigated. Till recently all DR screening programs in India were opportunistic models where persons with diabetes visiting an eye care facility were screened. Since 2016, with support from International funders, demonstration models integrating DR screening services in the public health system were initiated. These pilots showed that a systematic integrated structured DR screening program is possible in India and need to be scaled up across the country. Many DR screening and referral initiatives have been adversely impacted by the COVID-19 pandemic and advocacy with the government is critical to facilitate continuous sustainable services.
... The Ornate India project and the related Nayanamritham study include collaborations between researchers from the UK and India, and the Government of Kerala. [29][30][31][32] The Ornate study aimed to build research capacity and capability in India to tackle diabetes-related visual impairment. The Nayanamritham study aimed to pilot a DR care pathway in the Thiruvananthapuram district, spanning primary, secondary, and tertiary care. ...
Purpose:
Diabetes mellitus (DM) and diabetic retinopathy (DR) contribute to ocular morbidity and are emerging as diseases with significant public health impact. Our aim was to assess the countrywide prevalence of DR and sight-threatening DR (STDR) among persons with diabetes and to evaluate the coverage of DR examinations among them.
Methods:
The present survey was planned to estimate the burden of DR in the population aged ≥50 years for assisting in the planning and prioritization of diabetic eye services. For this survey, 21 districts with a high prevalence of DM were selected among the 31 districts where the national blindness and visual impairment survey was conducted. The total sample size was 63,000 people aged 50 years and above. DR was assessed by dilated fundus examination with indirect ophthalmoscope and was graded according to Scottish DR grading. STDR included severe nonproliferative DR, proliferative DR, and clinically significant macular edema.
Results:
The prevalence of diabetes in the surveyed population was 11.8%. Among them, one-third were newly diagnosed DM, that is, diagnosed at the time of the survey. The study revealed that the prevalence of DR among persons with diabetes was 16.9%, the prevalence of STDR was 3.6%, and the prevalence of mild retinopathy was 11.8%. Risk factors for DR in the current study were duration of diabetes (>10 years, OR 4.8, 95% CI: 3.3-6.9), poor glycemic control (≥200 mg/dL, OR: 1.5, 95% CI: 1.2-1.7) and insulin treatment (OR: 2.6, 95% CI: 1.7-4.1).
Conclusion:
The current study highlights the substantial burden of DM and DR in India and the critical need to adopt a coordinated and multisectoral approach to reduce their prevalence. There is a need for early identification of persons with diabetes and their routine screening for DR along with availability of treatment facilities.
... We present key issues and potential solutions for scalability and sustainability of systematic DR care pathway in LMICs borne out of the lessons learned from our conducting research in India, funded by the Global Challenges Research Fund and UK Research and Innovation. [5] The Complexity of Diabetic Retinopathy Screening Screening for DR is complex and costly, unlike many other screening programs. People with diabetes have to be screened regularly during their lifetime. ...
Translating research findings to routine clinical practice is fraught with obstacles. The gap between the end of a research project and the implementation of its results is often termed the "valley of death." In this perspective, we highlight the barriers and potential solutions in translating research on diabetic retinopathy care pathways to implementation in the clinic. This gap analysis applies to all countries around the world, though it predominantly applies to low- and middle-income countries.
... Diabetes mellitus is a global pandemic, with India having a lion's share of 77 million cases among its adult population (20-79 years), a number that is likely to double over the next 25 years. [1] Since the discovery of insulin, the prolonged lifespan of diabetic subjects has ironically opened the Pandora's box of diabetic retinopathy (DR), nephropathy, and neuropathy, with their multiple attendant complications, including diabetic blindness. [2] The Early Treatment Diabetic Retinopathy Study (ETDRS) showed that with regular follow-ups and adequate treatment, up to 98% of diabetic blindness can be prevented. ...
Purpose:
"Featureless retina" (FLR) has been only briefly mentioned in textbooks; this deceptively benign appearance of diabetic retinopathy (DR) merits a detailed description. Here we report the clinical profile, diagnosis, and management of FLR.
Methods:
The case records of consecutive type 2 diabetic patients clinically diagnosed as FLR were reviewed. The case selection was based on suggestive signs (white thread-like arterioles and atrophic retina), asymmetric presentation of DR, and fluorescein angiographic (FA) demonstration of retinal capillary nonperfusion (CNP) with/without proliferative disease (PDR). Panretinal photocoagulation (PRP) was performed as needed. The extent of CNP was correlated with diabetic macular ischemia (DMI) and neovascularization on FA, and DMI was correlated with best-corrected visual acuity using Pearson Chi-square test (P < 0.05). IBM SPSS Statistics 26 was used for analysis.
Results:
Out of 46 patients, 21 (46%) patients had bilateral and 25 (54%) had unilateral involvement (67 eyes with FLR). PDR was clinically discernible in two (3%) eyes; 65 (97%) eyes had clinical features of mild-moderate NPDR. However, FA revealed extensive CNP areas in 49 (73%) and PDR in 59 (88%) eyes. DMI was found in 83% of the eyes which had best-corrected visual acuity <6/12; this association was statistically significant (P = 0.024). Fifty-seven (85%) eyes underwent panretinal photocoagulation (PRP) for extensive CNP or PDR.
Conclusion:
Behind the mild-moderate clinical profile of FLR lay extensive CNP and PDR, which were unmasked by FA, with a complete overhaul of the treatment and follow-up.
... The ORNATE India project, funded by GCRF and United Kingdom Research and Innovation (UKRI) in 2017, is a UK-India collaboration to build research capacity and capability to tackle the burden of diabetes-related visual impairment. [1] Six institutions in the UK and seven in India collaborated on this project, including the Government of Kerala. ...
The ORNATE India project is an interdisciplinary, multifaceted United Kingdom (UK)-India collaborative study aimed to build research capacity and capability in India and the UK to tackle the burden of diabetes-related visual impairment. For 51 months (October 2017-December 2021), this project built collaboration between six institutions in the UK and seven in India, including the Government of Kerala. Diabetic retinopathy (DR) screening models were evaluated in the public system in Kerala. An epidemiological study of diabetes and its complications was conducted through 20 centers across India covering 10 states and one union territory. The statistical analysis is not yet complete. In the UK, risk models for diabetes and its complications and artificial intelligence-aided tools are being developed. These were complemented by joint studies on various aspects of diabetes between collaborators in the UK and India. This interdisciplinary team enabled increased capability in several workstreams, resulting in an increased number of publications, development of cost-effective risk models, algorithms for risk-based screening, and policy for state-wide implementation of sustainable DR screening and treatment programs in primary care in Kerala. The increase in research capacity included multiple disciplines from field workers, administrators, project managers, project leads, screeners, graders, optometrists, nurses, general practitioners, and research associates in various disciplines. Cross-fertilization of these disciplines enabled the development of several collaborations external to this project. This collaborative project has made a significant impact on research capacity development in both India and the UK.
... year 2045, the numbers are projected to increase to 160.50 million, and 44.82 million [12]. In addition, in developing countries where there is a shortage of ophthalmologist [13,14] as well as access to standard clinical facilities. This problem also exists in underserved areas of the developed world. ...
Diabetic Retinopathy (DR) is a leading cause of vision loss in the world,. In the past few Diabetic Retinopathy (DR) is a leading cause of vision loss in the world. In the past few years, Artificial Intelligence (AI) based approaches have been used to detect and grade DR. Early detection enables appropriate treatment and thus prevents vision loss, Both fundus and optical coherence tomography (OCT) images are used to image the retina. With deep learning/machine learning apprroaches it is possible to extract features from the images and detect the presence of DR. Multiple strategies are implemented to detect and grade the presence of DR using classification, segmentation, and hybrid techniques. This review covers the literature dealing with AI approaches to DR that have been published in the open literature over a five year span (2016-2021). In addition a comprehensive list of available DR datasets is reported. Both the PICO (P-patient, I-intervention, C-control O-outcome) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)2009 search strategies were employed. We summarize a total of 114 published articles which conformed to the scope of the review. In addition a list of 43 major datasets is presented.
... Diabetes mellitus is a global pandemic, with India having a lion's share of 77 million cases among its adult population (20-79 years), a number that is likely to double over the next 25 years. [1] Since the discovery of insulin, the prolonged lifespan of diabetic subjects has ironically opened the Pandora's box of diabetic retinopathy (DR), nephropathy, and neuropathy, with their multiple attendant complications, including diabetic blindness. [2] The Early Treatment Diabetic Retinopathy Study (ETDRS) showed that with regular follow-ups and adequate treatment, up to 98% of diabetic blindness can be prevented. ...
