Abstract
Diabetes mellitus now affects 65 million adults in India, which is likely to increase to over 130 million by 2045. Vision impairment and blindness from diabetic retinopathy (DR) and diabetic macular edema (DME) will increase unless systems and services are put in place to reduce the incidence of DR and DME, and to increase access to diagnosis and effective treatment. In India, sight-threatening DR (STDR) affects 5%-7% of people with diabetes, i.e., 3-4.5 million. This will increase as the number of people with diabetes increases and they live longer. The main risk factors for DR and DME are increasing duration of disease and poor control of hyperglycemia and hypertension. There is strong evidence that good control of hyperglycemia and hypertension reduce the incidence of STDR: interventions which lead to better self-management, i.e., a healthier diet and regular exercise, are required as well as taking medication as advised. There are highly effective and cost-effective treatments for STDR and up to 98% of blindness can be prevented by timely laser treatment and/or vitreous surgery. Given this increasing threat, the Queen Elizabeth Diamond Jubilee Trust endorsed the development of evidence-based guidelines for the prevention, detection, and management of DR and DME, and for cataract surgery in people with diabetes, specific to India as a component of the national DR project it has supported.