Controlling diabetic retinopathy in India – a major challenge ThePipaNews

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ThePipaNews

Mumbai, September 21: India’s steady economic growth has greatly improved the standard of living of the people of the country. Cities in particular have become more affluent and lifestyles of city dwellers have become similar to those in Western countries. This prosperity and development has resulted in elimination of many diseases caused by malnutrition, unsanitary conditions, unhealthy food and unclean water. But, there is another side to this development. Growing affluence, increased urbanization, sedentary lifestyles and rich diets are leading to many lifestyle diseases – such as obesity, especially among children. Obesity also causes high blood pressure and diabetes. In India, the total number of people with diabetes is estimated to be 77 million in 2019, of which 43.9 million are undiagnosed. Diabetes (type 2 diabetes, aged 20-79) One in two adults in the world do not know they have diabetes. This number is expected to increase further. According to the International Diabetes Federation Atlas 2019, the number of people with diabetes will increase to 101 million in 2030 and 134 million in 2045. This could be a huge crisis for a country where medical services are already scarce Diabetes brings with it many complications, as it affects almost every organ in the body – people with diabetes are at increased risk of kidney, lower leg and even eye problems. Diabetes has become the fifth leading cause of blindness worldwide. DR has become the leading cause of visual impairment and blindness in people with diabetes worldwide. DR is also a leading cause of blindness in the working age population. It greatly affects personal and socio-economic aspects. This is known as an invisible visual disturbance: one that does not cause pain. Vision does not change. Which takes no hint. In fact, Dr. According to Manisha Agarwal, joint secretary of the Retina Society of India, one of the early symptoms is persistent difficulty reading, which does not go away even with a change of glasses. This means that by the time you start experiencing symptoms, irreversible vision loss has already occurred. However, once diagnosed, vision loss caused by DR can be stopped with the right measures. Diagnosis is accompanied by a DR eye examination by an ophthalmologist. Diabetic patients should have a DR test every year.
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About 18% of people with diabetes in India are affected by DR. It affects 1 in 5 people with diabetes. In a roundtable discussion on Season 1 of the Eye Safety Initiative, Dr. Dinesh Talwar, Director of Vertoretinal and Uveal Disorders at the Center for Sight in New Delhi, pointed out that people don’t know they need to be screened for DR regularly. . And lack of awareness poses a challenge in addressing DR at the societal level. Consider someone in your family and friends with diabetes – have you ever discussed diabetic retinopathy? This is thought provoking. DR mostly affects working people aged 20-70. This means that when the primary breadwinner of a family suffers from DR, that family also becomes financially vulnerable. But the good news is that vision loss from DR is largely preventable. If this disease is detected early and they contact the doctor in time, this damage is preventable. Network 18 launched ‘Netra Suraksha’ – India Against Diabetes initiative in collaboration with Novartis. Through which awareness will be created about DR. The initiative aims to spread awareness about DR through informative articles and personal screening camps. We hope that once people with diabetes become aware of this vulnerability, they will take steps to routinely screen themselves and their loved ones for DR and diabetes.

Lack of doctors
However, the next hurdle in the fight against DR in India is the lack of trained ophthalmologists. Currently, there are about 12000 ophthalmologists (about 3500 retina specialists) in India. The shortage of retina specialists is particularly high – there is only 1 retina specialist per 1.26 million people. When we compare the number of ophthalmologists (12000) with the number of diabetic patients (more than 100 million people will be diabetic by 2030), this number reaches 1 ophthalmologist for every 8,333 diabetic patients. Considering that people with diabetes need to have their eyes checked for DR every year, there is a shortage of doctors in India. This is an issue that needs to be addressed at the policy level. Because, here the demand and supply gap is going to increase with time. It can also screen for DR using an AI powered fundus camera. Increasing adoption of this technology will help bridge the gap.

The economics of illness
DR is increasing in young people, as diabetes (especially type 2) is increasing in the younger population. Vision loss can affect a person’s earnings at any age. When the disease occurs early, it impairs their ability to build retirement funds. Those whose families are young (and whose children are still learning), earn even less. Loss of sight also has many unexpected costs – hospital costs, rehabilitation and training costs, reskilling costs, etc. However, the most important expense is medical expenses. When one is diagnosed with DR, it is hard to ignore. This is followed by several doctor visits, tests and medication. Costs can increase depending on where the person is. If located in a metropolitan area, medical costs may be higher. If in a small town or rural area of ​​the country, the person may have to travel to a larger city and their medical bills when combined with travel and accommodation costs become very high. Insurance can come in handy in such cases. But most insurers have long waiting periods (often years) for diabetes-related problems. Diabetes specific insurance policies do not have a waiting period, but they also have some exceptions. This means that even if a person has an insurance product designed for diabetics, it may not cover all costs. Insurance costs continue to rise for people with diabetes. The number of diabetes-related claims increased by 120% between 2016 and 2019. Peak growth occurs between the ages of 20-30. So obviously where we see this trend, insurance premiums become more expensive.

Prevention is better than cure
With all these challenges, what can a person with diabetes do to take better care of their vision? For starters: Check your blood sugar and consult your doctor for better metabolic control. This means paying attention to many things – your blood pressure, serum lipid levels, mineral and vitamin deficiencies, and of course diet, exercise and weight management. Secondly, get yourself an insurance policy that is geared towards helping diabetics. Then, educate yourself about inclusions and exclusions. Understand the waiting period and read all policies thoroughly. The more information you gather now, the better it will help you make decisions when you need them. Third, schedule your annual eye doctor appointment for a DR checkup and don’t miss it. DR is asymptomatic in its early stages, and the sooner you catch it, the better your prognosis. Finally, learn about everything related to DR. A good platform for this is the Eye Safety Initiative website. Here you can find in-depth panel discussions, videos and informative articles. Be your own champion and encourage others you interact with to be champions for their vision. https://www.news18.com/netrasuraksha/

References:https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002968 [Accessed 8 Sep 2022]Patel SA, Ali MK, Alam D, Yan LL, Levitt NS, Bernabe-Ortiz A, Checkley W, Wu Y, Irazola V, Gutierrez L, Rubinstein A, Sivashankar R, Li X, Miranda JJ, Chowdhury MA, Siddiqui AT. Gaziano TA, Kadir MM, Prabhakaran D. Obesity and its association with diabetes and hypertension: a cross-sectional study across 4 geographic regions. Globe heart. 2016 Mar;11(1):71-79.e4. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843822/#:~:text=Every%20standard%20deviation%20higher%20of,%2C%20aged%2040%E2%80% 9369%20 years. [Accessed 25 Aug 2022]IDF Atlas, International Diabetes Federation, 9th Edition, 2019. Available at: https://diabetesatlas.org/atlas/ninth-edition/ [Accessed 5 Aug 2022]Pandey SK, Sharma V. World Diabetes Day 2018: Combating the Emerging Epidemic of Diabetic Retinopathy. Indian J Ophthalmol. 2018 Nov;66(11):1652-1653. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213704/ [Accessed 5 Aug 2022]Complications of diabetes. Available at: https://www.diabetes.org.uk/guide-to-diabetes/complications [Accessed 3 Aug 2022]Raman R, Ramasamy K, Rajalakshmi R, Sivaprasad S, Natarajan S. Diabetic retinopathy screening guidelines in India: All India Ophthalmological Society Diabetic Retinopathy Task Force and Vitreoretinal Society of India consensus statement. Indian J Ophthalmol [serial online] 2021;69:678-88. Available at: https://www.ijo.in/text.asp?2021/69/3/678/301576 [Accessed 6 Sep 2022]Vasisht P, Senjam SS, Gupta V, Manna S, Gupta N, Shamanna BR, Bharadwaj A, Kumar A, Gupta P. Prevalence of diabetic retinopathy in India: findings from national survey 2015-19. Indian J Ophthalmol. 2021 Nov;69(11):3087-3094. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725073/ [Accessed 5 Aug 2022]Diabetes health insurance is expensive. Here’s a 4-point guide to managing related costs: https://economictimes.indiatimes.com/wealth/insure/health-insurance/diabetes-health-insurance-is-expensive-heres-a-4-point- guide-to-manage-related-cost/articleshow/71982198.cms?utm_source=contentofinterest&utm_medium=text&utm_campaign=cppst [Accessed on 5th, August, 2022]

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