Abstract
Purpose :
India endures an extraordinary burden of Diabetes Mellitus (DM) with ~70 million diabetics as of 2015 with an expected increase to 100 million by 2030. Hence diabetic retinopathy (DR) presents an expanding burden of avoidable blindness in this population. A combination of lack of awareness and low ophthalmologist to population ratio, makes early detection of DR and timely intervention impossible. Currently no established system of DR screening exists in the public health system in India. We trained semi skilled workers (SSW) for 2 weeks to use a smart phone based non mydriatic fundus camera (NmFoP) and an offline AI system to screen for DR in the Municipal Dispensaries of Mumbai, India
Methods :
174 dispensaries run by the Municipal Corporation of Greater Mumbai, cater to the 12 million population of the city. In addition to other ailments, patients with DM are monitored and anti diabetics are dispensed here. Over a period of 10 months, 1378 DM consenting evaluation were screened in 20 dispensaries by SSW and AI results were used to triage subjects and refer those needing treatment to the ophthalmologist. Images were further evaluated by ophthalmologist at base hospital to confirm diagnosis. The program costs included salaries of 2 SSW & 1 coordinator, NmFoP and travel to the dispensaries.
Results :
Of the 1378 DM screened 117 were detected with any DR, 50 were referred for further treatment & 67 were advised follow up for monitoring. Total program cost for screening and AI based triaging was INR 8,15,900 translating to per patient cost of INR 592 ie approximately 8 USD. Program resulted in 1378 DM who would otherwise have not been screened for DR till onset of symptoms, being screened and referred for treatment at an early stage.
Conclusions :
The global burden of disease report showed that 0.8 million were blind and 3.7 million visually impaired due to DR globally. The risk of DR increases with increasing duration of DM and the risk can be reduced by good control of blood glucose levels and by screening for retinal changes at regular intervals. Compared to Singapore & UK NHS, the per patient cost in our pilot is 10 times lower and can further be reduced by increasing throughput. Now with technology in place,focus must move to public health awareness measures to increase throughput for early detection of DR to prevent irreversible vision loss.
This is a 2020 ARVO Annual Meeting abstract.