NEW DELHI: As India is dubbed the diabetic capital of the world, there is a growing concern that diabetic retinopathy (DR), an eye condition that can cause vision loss and blindness in people who have diabetes, will increase in the next two decades in the country.
With approximately 1 in 3 people with diabetes said to develop diabetic retinopathy (DR), which usually impacts visual impairment in the working age group, and 10% of vision-threatening Diabetic Macular Edema (DME), experts said there is an urgent need for the union government to include its treatments under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (Ab-PM-JAY).
Speaking to TNIE, Dr Rupak Kanti Biswas, Director and Consultant VR surgeon at Netralayam Eye Hospital, Kolkata, said that if a person has had type 2 diabetes for more than 20 years, then 70% of those individuals will be affected by diabetic retinopathy.
“The majority of diabetes cases are now in people below 50 years. So, in their lifetime, they will develop diabetic retinopathy. Seventy to eighty per cent of them will develop it. That’s huge,” he said.
Biswas, who was here to attend the just concluded 40th Asia-Pacific Academy of Ophthalmology (APAO) Congress, emphasised that treating the disease at an early stage is key.
“The most important aspect of treatment is preventing blindness. Preventable blindness is a key focus, and time is a critical factor. The earlier the intervention, the better the outcomes. Once a preventable condition progresses to an irreversible stage, it can no longer be classified as preventable blindness. This is why timely intervention is crucial in managing diabetic retinopathy,” he said.
According to the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study, an estimated 101.3 million people in India have diabetes, and 136 million are prediabetics. Alarmingly, over 57% remain undiagnosed, increasing risks of complications like diabetic retinopathy (DR) - affecting 12.5% of adults over 40 years.
Initially, laser treatment was the only option. However, Dr Biswas said that introducing intravitreal injections has been a game-changer.
Currently, only the Central Government Health Scheme (CGHS) and some states provide insurance coverage to treat DR. The cost of treatment varies widely, depending on the drug used. Currently, the price of a single injection can range from Rs. 6,000 to Rs. 60,000, depending on the medication.
Though its diagnosis is covered under PM-JAY, its treatment is not included, said Dr Raja Narayanan, Director of Anant Bajaj Retina Institute at L V Prasad Eye Institute (LVPEI), Hyderabad, who also attended the two-day Congress.
“These injections are very common, and every patient has to get about five to six injections per year in one eye. Since diabetes affects the blood vessels, both eyes are generally affected. So, if you calculate for both eyes, ten to twelve injections per person. Now, imagine the burden if one crore people have this problem and ten to twelve injections each - that’s mind-boggling,” Dr Narayanan told TNIE.
According to Dr Parveen Sen, Senior Consultant and Head of Retina Services at Dr Agarwals Eye Hospital, Chandigarh, Ayushman Bharat covers eye surgeries, which addresses only the most advanced cases.
“The majority of patients - nearly 30% of diabetics who develop DR or DME - require laser therapy or injections, which remain excluded from the PM-JAY scheme,” he said.
DME occurs when fluid builds up under the macula, the centre of one’s retina. Injections are often the only effective treatment for DME, and 90% of patients need them.
“This creates a critical gap in care, leaving countless individuals without access to affordable treatment. There is an urgent need to include these sight-saving injections under Ayushman Bharat,” Dr Sen said, adding that expanding insurance coverage would not only bridge this treatment gap but also strengthen the continuum of care.
While laser treatment helps stabilize vision, intravitreal injections help not only stabilise but also reverse the disease process and improve vision.
‘If a patient has lost 30% of their vision due to central involvement, receiving an injection can help restore vision to near 90% or even 100% in some cases. The improvement can be maintained with continued injections, sometimes in combination with laser treatment,” Dr Biswas added.
AB-PM-JAY is the largest health assurance scheme in the world, which aims at providing a health cover of Rs. 5 lakhs per family per year for secondary and tertiary care hospitalisation to over 12 crore poor and vulnerable families (approximately 55 crore beneficiaries) that form the bottom 40% of the Indian population. The Union Government expanded the flagship programme by including all senior citizens aged 70 years and above, irrespective of their socio-economic status.