Screening for diabetic retinopathy—is the use of artificial intelligence and cost-effective fundus imaging the answer?

Abstract

Vision loss among people with diabetes is a major problem. While most know the importance of evaluating a patient for complications, retinopathy screening gets left out by most treating physicians for want of expertise and training needed. IDF atlas of 2017 [1] estimates that India has 72.9 million people with diabetes. Twenty percent of 24.4 million IGTadd up to this number each year and along with 42.2 million undiagnosed cases quoted in the Atlas, takes the total close to 120 million. This figure is likely to double by 2045 as per experts. Really an epidemic that can be called the tsunami of diabetes! IDFAtlas of 2017 also goes on to say that diabetic retinopathy (DR) is the leading cause of blindness and 1 out of every 3 patients has DR, and 1 out of 10 go on to develop Bvision threatening’ DR. International Association for Prevention of Blindness (IAPB) estimates 45 million to have vision threatening DR. Meta-analysis published in diabetes care [2] mentions that 1 out of 39 blind people had blindness due to DR and 1 out of 52 visually impaired persons has impaired vision due to DR. Figures are truly Beye opening^ and frightening! In India, prevalence of DR is close to 35.12% in people with diabetes after 5 years of duration of diabetes [3]. CINDI (chronic complications in newly diagnosed patients with type 2 diabetes in India) [4] published in 2014 reported that 6.1% of newly diagnosed type 2 patients have established DR at diagnosis. CINDI 2 in 2016 [5] looked at complications in newly detected T2 DM patients below the age of 40 years (young onset type 2 diabetes) and reported that 5.1% as the study population had established DR at diagnosis. These figures coming from national level survey data clearly tell us that India has a huge problem in terms of prevention of blindness due to DR. Who should screen for DR?