Kerala is the most advanced state in India in terms of literacy, economic progress, social uplift and demographic transition but is known as the diabetes capital of India. The prevalence of diabetes can be as high as 20% ─ double the national average of 8%. The prevalence of diabetic retinopathy among the diabetic population is ~ 18%. Currently, there is no systematic diabetic retinopathy screening programme in the public sector.

The overarching objective of the Kerala Study, planned in collaboration with the Government of Kerala, is to reduce the risk of visual impairment due to diabetes by developing a diabetic retinopathy care pathway.

We aim to evaluate the effectiveness of introducing screening and treatment pathways for diabetic retinopathy in the public system in Kerala by adapting care pathways in developed countries to local needs and resources. The researchers intend to introduce a complex intervention of screening for diabetic retinopathy at the primary care level, laser treatment at district hospitals and complex referrals to the tertiary centres by increasing research and service capacity and capability. The quality and delivery of the intervention is also assessed at each sector of the care pathway to evaluate whether the study is delivered as intended.

This pilot study will take place within the public health system in Thiruvananthapuram and will inform the roll-out of the diabetic retinopathy care pathway throughout the Kerala State.