Diabetes affects the eyes and causes blindness at an age when an individual is most productive (40-60 years). In the early stages, diabetic retinopathy does not cause any symptoms, and most patients are unaware of the problems in their eyes. Once it reaches an advanced stage, it causes a combination of oedema (swelling of the retina), hypoxia (irreversible damage to the retina due to poor blood supply) and bleeding. Untreated, these changes lead to irreparable damage and blindness. The key to prevention is to examine every diabetic regularly to assess their retinas, and signs of disease that could threaten vision should be identified and treated early.
While working at Moorfields Eye Hospital, London in 2010, Nishant Kumar, an ophthalmologist by training with a super-specialisation in retina and uveitis, saw first-hand how the UK’s National Diabetes Eye Screening programme, initiated in 2008, greatly helped in reducing loss of vision due to diabetes. Dr. Kumar says, “As soon as someone is diagnosed with diabetes in countries like the UK and the USA, they are automatically registered into the diabetes eye programme, where their vision and eyes are examined annually, life-long, for changes due to diabetes. Any changes are immediately referred to a specialist for further treatment.”
When Dr. Kumar returned to India in 2014, he realised that despite being a nation with at least 100 million diabetics, there was no such diabetic retinopathy screening programme here. “Diabetes and blindness is preventable if changes in diabetes are diagnosed and treated in the early stages,” he says.
So, in 2016, he started the Eyebetes Foundation, a non-profit which aims to fill that gap and establish the relationship between diabetes and some eye problems. The foundation’s three main activities are: providing free screening through camps, spreading awareness through educational leaflets, print and digital media and social media sites, and research to better understand the Indian diabetic.
Detection and prevention
At Eyebetes camps, participants get free checks for blood pressure, random blood sugar and vision, and fundus (retinal) examination. These are conducted by doctors, nurses and vision assessment-trained optometry students. The participants only have to provide a mobile phone number, age and sex to register. “The mobile number is their unique ID for the screening process. All results are sent to the participant by text, so it is important we have a correct mobile number,” says Anup Sakharkar, an Eyebetes volunteer.
The fundus examination using a non-mydriatic camera helps diagnose common blinding conditions like diabetic changes in the eye, glaucoma and aging changes in the retina. The images are uploaded to a machine with grading software. “50 to 60 doctors from across the world help in grading the retinal images by viewing them remotely using the specially designed software,” Dr. Kumar says. Once the images are reviewed, the software automatically generates a text message for each participant with their blood pressure, blood sugar, visual acuity and fundus photograph results. The messages are sent twice to each participant. The results can also be accessed by each participant on the Eyebetes’ website. A month later, an Eyebetes representative follows up with a reminder phone call to those with abnormal results, to ask if they have seen a doctor of their choice for further review investigations.
Eyebetes works through collaborations with other organisations, including government agencies.
The foundation conducted it first programme with Mumbai’s Lalbaugcha Raja Sarvajanik Ganeshotsav Mandal during the Ganpati festival in 2016. “Lalbaugcha Raja is an iconic Ganpati mandal, where more than a lakh devotees visit every day during the festival,” says Tushar Jadhav, who has volunteered with Eyebetes since its inception. “It is an ideal opportunity to spread awareness and provide free diabetes and eye screening.” Last year, during the Ganpati festival, Eyebetes also conducted a camp outside the Siddhivinayak temple in Prabhadevi.
Their next collaboration was with the Government of Maharashtra and the Thane Collector, to conduct free screening programmes for people from the rural and tribal areas of Thane. On March 4, it organised a camp with the Haji Ali Dargah Trust, its fourth so far.
Vision for the future
“We generally use research data from Western countries to establish prevention and treatment plans,” says Dr. Kumar. “But the Indian diabetic is very different from diabetics from other parts of the world in terms of genetics, diet, food habits and perspectives on exercise, health and treatments, and so on.” The Foundation plans to utilise the data it has collected to better understand the Indian diabetic, and eventually customise preventative measures, screening activities and treatment plans.
With the help of donations and CSR funds, Eyebetes has screened 50,000 people and has distributed 8,50,000 educational leaflets in Mumbai over the last year-and-a-half. Next, Dr. Kumar wants to set up small Eyebetes centres across India. “We have 100 million people at risk of diabetes in India. We want to screen more than a million people in 10 years across the country.”
