Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban–rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study
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Background National and subnational estimates of the prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy (VTDR) are needed to inform the stepwise implementation of systematic retinal screening for people with diabetes in India to decrease the rate of blindness. We aimed to assess these national and subnational estimates and to stratify the prevalence of diabetic retinopathy and VTDR on the basis of people with known versus undiagnosed diabetes, urban versus rural residence, and epidemiological transition level (ETL) and Socio-demographic Index (SDI) categories of states. Methods We did a multicentre cross-sectional screening study for diabetic retinopathy using a complex cluster sampling design in people aged 40 years or older in ten Indian states and one union territory between Dec 20, 2018, and March 20, 2020. We did non-mydriatic retinal screening and assessed risk factor burden for people with diabetes. We estimated nationally weighted prevalence of diabetic retinopathy and VTDR for individuals with known and undiagnosed diabetes by urban versus rural residence, and by state categorisation by ETL and SDI. We also assessed adjusted risk factors. Findings From 42 146 participants screened, 7910 (18·8%) were identified to have diabetes. Of these, 6133 (77·5%; 4350 with known diabetes and 1783 with undiagnosed diabetes) had gradable retinal images. 3411 (56%) participants were women and 2722 (44%) were men, and the median age was 56 years (IQR 49-65…
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Sight-threatening diabetic retinopathy is most commonly defined as severe non-proliferative DR, proliferative DR, or clinically significant macular edema.
“Sight-threatening diabetic retinopathy (STDR) is most commonly defined as severe non-proliferative DR (NPDR), proliferative DR (PDR), or clinically significant macular edema (CSME) [8, 10, 11, 13, 14, 21, 33]”
From Diabetic retinopathy screening model in low and middle-income countries: a scoping review (2025) · cites this paper as [33]
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Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045
Teo, Z. L., Tham, Y.-C., Yu, M., Chee, M. L., Rim, T. H., Cheung, N., Bikbov, M. M., Wang, Y. X., Tang, Y., Lu, Y., et al. (2021) · Ophthalmology · doi:10.1016/j.ophtha.2021.04.027 · Cited by 2,420 · see citing works
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Diabetic retinopathy screening model in low and middle-income countries: a scoping review
Lestari, Y. D., Sitompul, R., Widyahening, I. S., Tahapary, D. L., Yusuf, P. A., Sasongko, M. B., Riono, P., Nursakina, Y., & Alexandra, G. (2025) · BMC Public Health · doi:10.1186/s12889-025-25543-6 · Cited by 11 · see citing works
Chauhan, A., Goyal, A., Masih, R., Kaur, G., Kumar, L., Neha, ., Rastogi, H., Kumar, S., Singh, B. L., Syal, P., et al. (2025) · JMIR Formative Research · doi:10.2196/67047 · Cited by 3 · see citing works
- Authors
- Raman, R., Vasconcelos, J. C., Rajalakshmi, R., Prevost, A. T., Ramasamy, K., Mohan, V., Mohan, D., Rani, P. K., Conroy, D., Das, T., Sivaprasad, S., Bhende, P., Surya, J., Gopal, L., Ramakrishnan, R., Roy, R., Das, S., Manayath, G., Pooleeswaran, V. T., Anantharaman, G., Gopalakrishnan, M., Natarajan, S., Krishnan, R., Mani, S. L., Agarwal, M., Behera, U., Bhattacharjee, H., Barman, M., Sen, A., Saxena, M., Sil, A. K., Chakrabarty, S., Cherian, T., Jitesh, R., Naigaonkar, R., Desai, A., & Kulkarni, S.
- Affiliations
- Sankara Nethralaya (IN)
- King's College London (GB)
- Madras Diabetes Research Foundation (IN)
- L V Prasad Eye Institute (IN)
- University College London (GB)
- Moorfields Eye Hospital NHS Foundation Trust (GB)
- Corresponding author
- Sivaprasad, Sobha
- ORCID
- Venue
- The Lancet Global Health
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 10
- Issue
- 12
- Pages
- e1764-e1773
- ISSN
- 2214-109X (ISSN-L)
- OpenAlex
- W4307906703
- Cited by
- 106
- References
- 1
- Citations by year
- 2026: 20 · 2025: 37 · 2024: 32 · 2023: 17
- FWCI
- 19.20
- Type
- journal article
- Language
- en
- Update notices
- erratum (2023-02-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Global Health (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- UK Research and Innovation
- Medical Research Council (MR/P027881/1)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal Imaging and Analysis
- Health Sciences › Medicine › Epidemiology › Ophthalmology and Visual Impairment Studies
- Keywords
- diabetic retinopathy, vision-threatening diabetic retinopathy, prevalence, undiagnosed diabetes, diabetic retinopathy screening, retinal screening, urban-rural differences, socioeconomic status, socio-demographic index, India, blindness prevention, risk factors, subnational estimates, diabetes risk factors, diabetic nephropathy, diabetic retinopathy severity, diabetic retinopathy progression
- MeSH terms
- Cross-Sectional Studies, Diabetes Mellitus, Diabetic Retinopathy, Female, Humans, India, Male, Middle Aged, Socioeconomic Factors, Prevalence
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