Growing Threat Of Retinal Disorders: India Faces Alarming Rise In Vision Loss

Global rates of vision loss are increasing at a worrying pace, with millions affected by retinal conditions like diabetic retinopathy (DR), diabetic macular edema (DME), and neovascular age-related macular degeneration (nAMD). These conditions are leading causes of blindness, with India, home to 1/3rd of the world’s blind population, seeing a sharp rise in retinal-related vision loss.   

Globally, 90per cent of blindness is preventable or treatable, yet over 1 billion people are living with some form of vision loss. The global economic burden of vision impairment was estimated at $410.9 billion (about $1,300 per person in the US) in 2020 alone. Retinal disorders like DR, DME, and nAMD are particularly concerning as they can cause irreversible sight loss if left untreated.  Currently, 21 million people (about the population of New York) are living with DME, a leading cause of vision loss among working-age adults, while 20 million people (about the population of New York) globally are affected by nAMD, a major cause of vision impairment in those aged 60 and older.  

In India, over 11 million people (about twice the population of Arizona) are affected by retinal conditions, with 3.88 million suffering from DME and nAMD. The contribution of retinal disorders to blindness in India has increased from 4.7per cent in 2010 to 8per cent in 2019. With a population exceeding 100 million diabetics and an aging population, prioritising retinal health is crucial.  

Socio-economic Impact of Vision Loss    

Vision loss ranks as the third-largest global impairment, following anemia and hearing loss. While awareness around conditions like cataracts, glaucoma, and refractive errors exists, there is an alarming rise in blindness caused by retinal disorders. Retinal diseases account for about 6per cent of blindness worldwide, and conditions linked to uncontrolled diabetes (DR and DME) and aging (nAMD) are particularly dangerous as they can cause permanent sight loss.  

India has made progress in reducing blindness related to cataracts and glaucoma through initiatives like the National Program for Control of Blindness & Visual Impairment (NPCBVI). However, a greater focus on retinal health is urgently needed. Retinal damage can cause central vision loss, severely impacting quality of life and increasing the risk of injury. As the Indian population ages and more people develop diabetes and hypertension, the rate of retinal disorders is expected to continue rising.  

Key Challenges in Diagnosis and Treatment  

Despite the growing need, India's healthcare system faces several barriers when it comes to diagnosing and treating retinal disorders:  

• Shortage of Retina Specialists: Around 80per cent of ophthalmologists in India specialise in the front part of the eye (anterior segment), with only 5-8per cent focusing on retinal conditions, mostly in Tier 1 cities.  
• Lack of Standardised Treatment Guidelines: Inconsistent treatment protocols across regions impact patient outcomes, often delaying access to newer treatments that could save vision.
• Poorly Integrated Healthcare Systems: Many diabetic patients are referred to retina specialists only after their conditions have progressed to advanced stages.  
•  Burden of Current Treatments: Existing therapies, such as frequent eye injections, can lead to treatment gaps due to patient reluctance, which results in further retinal damage.
•  Low Public Awareness: Eye health, especially related to the retina, is often neglected in routine health checkups. Many people are unaware that conditions like diabetes can affect their vision.    

Need for Advanced Treatment Options    

Current treatments for retinal disorders primarily involve intravitreal (IVT) injections of anti-VEGF (vascular endothelial growth factors), which block the pathways that cause retinal blood vessels to leak and grow abnormally. However, these treatments only partially address the complex biological processes involved in conditions like DME and nAMD.  

Newer therapies target both the VEGF and Ang-2 pathways, which contribute to vascular instability and inflammation in the retina. By stabilising blood vessels, reducing inflammation, and controlling abnormal growth, these treatments aim to provide better outcomes while reducing the treatment burden on patients. Early intervention with these innovative therapies can prevent long-term, irreversible damage.  

Expert Insights  

“More than 90per cent of blindness is treatable or preventable, yet vision loss affects over 1 billion people worldwide,” says Dr Bhuvan Chanana, Senior VR Consultant and Surgeon at Bharti Eye Institute in New Delhi. “Retinal diseases like age-related macular degeneration and diabetic retinopathy are becoming increasingly common, and urgent action is needed to address this silent epidemic.”  

Dr Nikhil Pal, Principal Vitreoretinal Consultant at Max Healthcare, emphasises the broader impacts of vision loss. “Loss of sight affects not just health but also economic productivity and overall well-being. Retinal conditions are complex, and with a shortage of ophthalmologists in India, longer-lasting therapies could be a game-changer in reducing the treatment burden and preserving vision.”  

As retinal disorders continue to rise in India, there is an urgent need for better infrastructure, more specialists, and access to advanced treatments that can reduce the burden on patients and improve outcomes. Public awareness about retinal health must increase, and investment in eye care services and innovative therapies will be critical to tackling this growing public health challenge.