Diabetic retinopathy hamstrung by expensive treatment, few training centres

Shardul Nautiyal - Mumbai

Even as around 19 to 25 per cent of diabetics suffer from diabetic retinopathy, the speciality is marred by expensive treatment, dearth of specialists, lack of public awareness and training centres offering vitreoretinal fellowships.

Explains Dr Preetam Samant, vitreoretinal specialist and consultant eye surgeon, Hinduja Hospital and honorary associate professor J J Hospital, “Diabetic retinopathy is an abnormality affecting the retinal microvasculature as a result of pathophysiological changes in the blood stemming from diabetes. The implications of diabetic retinopathy is complete loss of vision. ”

With advanced laser treatment costing Rs 6, 000 to Rs 8, 000 and surgery around Rs 20, 000 to Rs 40,000 in a private hospital, many patients find treatment for diabetic retinopathy expensive. According to Dr Ramesh Shanbhag, professor, ophthalmology, Grant Medical College, Mumbai, “Due to lack of public awareness, patient approach the ophthalmologist late and get diagnosed with diabetic retinopathy at a stage when the chances of complications are more, recovery of vision is less and surgery is the only resort. Sometimes, patients approach the optometrist for any eye problem because of the cost factor.”

While there are more than six lakh patients suffering from diabetic retinopathy, there are only 600 retina specialists in the country, says Dr Hitendra Mehta, viteroretinal surgeon, Aditya Jyot Eye Hospital, Mumbai.

Expensive treatment compel patients to flock to government hospitals, where free treatment is provided. However, government hospitals face long waiting list, which affect the productivity of the doctor and the treatment of the patient. A study at J J Hospital’s retina centre, revealed that the authorities found it unmanagable at times to attend to the huge patient load due to shortage of manpower.

Says Dr N Kasinathan, vitreoretinal surgeon, Sankar Nethralaya, Chennai, “The government healthcare institutions do not have the infrastructure to conduct advanced eye surgery due to financial constraints.” The infrastructure of a retina centre requires an angiography machine costing 15 to 35 lakh, green laser costing Rs 15 to 20 lakh, viterectomy machine costing 15 to 30 lakh, operating microscopes costing Rs 15 to 30 lakh and ultrasound diagnosis to diagnose vitreous haemorrhages costing another Rs 10 lakh.

Informs Dr Pradeep Venkatesh, assistant professor, Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, “There are instances wherein the government has provided the infrastructure to the retina centres, but these are no longer functional due to poor maintenance and declining interest from the caretakers.”

The specialty is further plagued by the lack of centres offering training in retinal disorders. As of now, only centres in Mumbai, Chennai, Hyderabad, Madurai, and Ahmedabad offer training in retinal disorders. Most importantly, MS training programmes offered in government teaching institutions do not have specialised training curriculum in retinal disorders.

The two year fellowship in vitreoretinal surgery is offered in a few institutes like L V Prasad Eye Institute, Hyderabad, Sankar Nethralaya, Chennai, Arvind Eye Hospital, Madurai, Aso-Palov Eye Hospital, Ahmedabad and Aditya Jyot Eye Hospital, Mumbai. Aditya Jyot Eye Hospital currently offers one year vitreo-retinal fellowship to post graduate students of ophthalmology.

“The post-graduate students in ophthalmology have to avail the limited seats on vitreoretinal fellowship in the very few centres offering training in medical retina and vitreo-retinal surgery, across the country,” says Dr Kasinathan

To improve the situation, experts suggest setting up of more diabetic clinics, which have a dedicated team of ophthalmologists, general physicians, endocrinologists and neurologists. “The treatment for diabetic retinopathy would be cost effective, when offered through a diabetic clinic. Hinduja Hospital is in the process of starting up a diabetic clinic very soon,” informs Dr Samant. Cases of diabetic retinopathy can be addressed if general physicians encourage diabetic patients to have annual eye check-up and regular check-up of blood sugar level," informs Dr Shanbhag. To address the shortage of vitreoretinal specialist, experts suggest that every government and municipal teaching eye hospitals should have a vitreoretinal specialist.

According to Dr Rajiv Raman, associate consultant, department of vitreo-retinal surgery, Sankar Nethralaya, Chennai, the dearth of vitreoretinal specialists can also be addressed through tele-ophthalmology. “The set-up constitutes a van, which has a fundus camera for retinal evaluation, para-medical staff and a set up for satellite connectivity, thus offering connectivity on a minimum of 150 km radius,” says he.

Other say more centres on the lines of Sankar Nethralaya, which works as tertiary and referral eye care service and training centre, are required. “Poor patients could also benefit, if private set ups are provided soft loans and lesser import duties for equipment are imposed,” says Dr Venkatesh.

shardul@expresshealthcaremgmt.com