Retinopathy refers to damage to the light-sensitive tissue in the back of the eye, which can lead to vision problems and blindness. People with diabetes are at high risk for retinopathy due to prolonged exposure to excess blood glucose. Retinopathy screening is the assessment of damage to vessels supplying blood to the retina. Timely screening can prevent progression of vision loss in people at risk. Early diabetic retinopathy is identified by tiny bulges (microaneurysm) and leaky blood vessels (haemorrhages). Progression of diabetic retinopathy involves formation of new blood vessels (neovascularization), rupture of these new blood vessels, and detachment of retina from underlying layer of blood vessels. Retinopathy is sometimes accompanied by swelling of the macula, the part of the retina responsible for sharp, detailed central vision.
The main stakeholders are individuals with poor access to screening and monitoring services by formal ophthalmologists. Rural and low-income populations, the elderly, and individuals with long-standing diabetes are at highest risk.
Individuals with detected retinopathy should receive at least annual dilated retinal examination. Dilated retinal examinations using eye drops enable clear views of the retina, macula, and the optic nerve. Fundus photography can be done with (myadriatic) and without (non-myadriatic) dilation.
Currently, screening is predominantly done at hospitals using fundus photography and led by ophthalmologists. Occasional screenings are also completed at mobile eye clinics. Artificial intelligence algorithms, such as those developed from Google’s partnership with Aravind Eye Hospital in Chennai, have already received regulatory approval in the USA (IDx-DR, EyeArt, AEYE-DS, Retmarker, SELENA). Current practices assume that screening will be provider-driven and facility-based, which is impractical for a country with a vast diabetic population and poor health infrastructure in many regions. Specific challenges include high cost of equipment (₹10–50 lakhs per fundus camera), requirement of trained personnel to conduct the screenings, limited access in resource-limited regions, and low patient compliance for routine monitoring due to travel and time constraints.
Looking into Your Eyes: Affordable and easy-to-use retinal screening systems for patients and their caregivers.
Additional Considerations:
The solution should cost less than ₹1000 per patient per year and require minimal training for patients to capture high quality images.
Images should be easily and securely transmissible to clinical providers, even in rural settings and enable artificial intelligence-based or clinician-based retinopathy grading.
The solution should be easy to integrate with government and private electronic health record systems.
