Research

By increasing research capacity and capability through ORNATE India, we aim to develop a clinically cost-effective diabetic retinopathy care pathway in India using smartphone technology and evaluate innovative technologies based on machine learning and circulating biomarkers that may accurately identify patients at risk of blindness due to diabetic retinopathy. These technologies can be applied to all low middle income countries with prospects of reverse innovation in the UK. In addition, risk modelling of diabetes and its complications in ethnic groups globally will be developed and validated.

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ORNATE-India has five integrated work-packages developed to address all aspects of diabetic retinopathy care in India, led by a multidisciplinary team of researchers in the UK and India. By increasing research capacity and capability ORNATE India will answer the following research questions

Research questions	Research plan
1. Kerala study Can a clinically and cost-effective diabetic retinopathy care pathway using smart phone cameras and telemedicine be initiated in a public health system in India?	Development of a diabetic retinopathy care pathway for people with diabetes registered in the non communicable disease registers in the public system in Thiruvananthapuram district in Kerala to report process evaluation, clinical and cost-effectiveness of the care pathway to enable scalability and sustainability and translation to other regions in India.
2. SMART-India study: What is the regional prevalence of diabetic retinopathy and vision impairment in people with diabetes in India?	The regional prevalence of diabetic retinopathy and visual impairment in people with diabetes in pre-defined rural and urban clusters in 12 regions in India. This will inform whether DR screening should be a priority for all states in India.
3. SMART-India study: Can a cost-effective multistate telemedicine programme incorporating a house-to-house survey be employed in India to screen for diabetes and its complications?	Can a holistic diabetes complications telemedicine project be introduced in India using a minimal dataset.
4. AI study: How to use artificial intelligence (AI) for detecting diabetic retinopathy and other complications?	Quality assessment of retinal images captured with low cost non-mydriatic retinal cameras and development and validation of AI on these images.
5. Biomarker/Biosensor study: Can systemic biomarkers be used to accurately identify people with diabetes at risk of diabetic retinopathy and can a biosensor be developed to detect candidate biomarkers in blood	Diagnostic accuracy of 12 circulating biomarkers will be done to identify a pane of markers that may be used in a biosensor to detect sight threatening diabetic retinopathy.
6. Predictive modelling study: Can we develop predictive models for diabetes complications that can be applied to low middle income countries?	By creating predictive tools, all clinical specialists will be able to predict the risk of developing other complications of diabetes and ensure timely referral.
7. National diabetic retinopathy research network: Can we develop a national diabetic retinopathy research network in India that can help guide clinical practices there?	Setting up a national diabetic retinopathy research network will enable joint efforts in developing clinical standards appropriate to India using data from retrospective and longitudinal studies.
8. Global translation/reverse innovation: What aspects of the findings of this project can be translated globally or can be used to model a reverse innovation of diabetic retinopathy screening in the UK?	Different innovative diabetic retinopathy care models using outputs from various work packages such as AI incorporated into low cost cameras, predictive models and biosensors.

Research questions	Research plan
1. Kerala study Can a clinically and cost-effective diabetic retinopathy care pathway using smart phone cameras and telemedicine be initiated in a public health system in India?	Development of a diabetic retinopathy care pathway for people with diabetes registered in the NCD registers in the public system in Thiruvananthapuram district in Kerala to report process evaluation, clinical and cost-effectiveness of the care pathway to enable scalability and sustainability and translation to other regions in India.	1,4
2. SMART-India study: What is the regional prevalence of diabetic retinopathy and vision impairment in people with diabetes in India?	The regional prevalence of diabetic retinopathy and visual impairment in people with diabetes in pre-defined rural and urban clusters in 12 regions in India. This will inform whether DR screening should be a priority for all states in India.	1
3. SMART-India study: Can a cost-effective multistate telemedicine programme incorporating a house-to-house survey be employed in India to screen for diabetes and its complications?	Can a holistic diabetes complications telemedicine project be introduced in India using a minimal dataset.	1,4
4. AI study How to use artificial intelligence (AI) for detecting diabetic retinopathy and other complications?	Quality assessment of retinal images captured with low cost non-mydriatic retinal cameras and development and validation of AI on these images.	2
5. Biomarker/Biosensor study Can systemic biomarkers be used to accurately identify people with diabetes at risk of diabetic retinopathy and can a biosensor be developed to detect candidate biomarkers in blood	Diagnostic accuracy of 12 circulating biomarkers will be done to identify a pane of markers that may be used in a biosensor to detect sight threatening diabetic retinopathy.	3
6. Predictive modelling study Can we develop predictive models for diabetes complications that can be applied to low middle income countries?	By creating predictive tools, all clinical specialists will be able to predict the risk of developing other complications of diabetes and ensure timely referral.	5
7. National diabetic retinopathy research network Can we develop a national diabetic retinopathy research network in India that can help guide clinical practices there?	Setting up a national diabetic retinopathy research network will enable joint efforts in developing clinical standards appropriate to India using data from retrospective and longitudinal studies.	5
8. Global translation/reverse innovation What aspects of the findings of this project can be translated globally or can be used to model a reverse innovation of diabetic retinopathy screening in the UK?	Different innovative diabetic retinopathy care models using outputs from various work packages such as AI incorporated into low cost cameras, predictive models and biosensors.	5