Increasing eye research capacity and capabilities to tackle the burden of blindness in India: a research-based UK-India Collaboration (ORNATE INDIA)

印度有超过1500万盲人。糖尿病是一种全球流行病，但印度是受影响最严重的三个国家之一，有6900万人被诊断患有糖尿病。糖尿病视网膜病变是糖尿病最常见的并发症，视网膜中的血管渗漏或死亡，如果不治疗，这会导致视力丧失。威胁视力的糖尿病视网膜病变（STDR）是工作年龄组失明的主要原因，导致生产力损失，影响个人家庭和国民经济。尽管印度经济增长迅速，但仍有10亿人生活在贫困线以下。糖尿病可能导致贫困，贫困与糖尿病有关。因此，除非糖尿病并发症得到早期发现和治疗，否则失明对印度人口生活质量和生产力的影响将继续对国家经济产生负面影响。在英国，每年对所有糖尿病患者进行视网膜摄影筛查和及时治疗STDR已被证明可以降低失明率。然而，所涉及的技术费用昂贵，需要训练有素的人力，而且作为每年对印度6 900万人进行筛查的方法是不切实际的，因为大部分保健费用必须由病人承担。通过该计划提高研究能力和能力，我们的目标是通过研究和评估创新技术在印度启动系统的糖尿病视网膜病变筛查，这些技术可以准确识别因STDR而面临失明风险的患者。这些技术可以应用于所有DAC列出的国家，并在英国有反向创新的前景。印度的研究能力活动（可持续发展目标4）和能力建设的范围旨在改善患者的治疗效果（可持续发展目标3），培养具有优质教育的劳动力（可持续发展目标4），加强可持续生计（可持续发展目标8），并为印度和英国的工作做出贡献。首先，我们将在印度引入基于人群的糖尿病视网膜病变筛查，并评估采用智能手机技术和自动分级的手持摄像机在印度和英国是否可行，而不是目前英国采用的标准昂贵的摄像机和训练有素的人力。我们希望这项技术能覆盖更多的人群，并有更多的患者接受治疗。转诊医院的研究能力也将从该方案中得到提高，为治疗制定了新的质量标准。其次，我们将开发和验证一组已建立的标志物的血液测试，这些标志物可以检测STDR和糖尿病的其他并发症，目的是转化为临床实践。这将使患者能够监测自己的STDR血液测试。这有可能彻底改变全球糖尿病患者STDR和其他并发症的监测方式，为患者和医护人员提供新知识，提高印度和英国的研究能力，提高印度的研究能力并改善全球经济在持续健康、工业和创新以及减少医疗保健获取方面的不平等方面。该方案有可能改变全球性的性病预防和治疗的诊断和分类情况。此外，印度糖尿病视网膜病变研究网络的发展将确保印度世界级研究的可扩展性和可持续性。这些研究项目将在提高研究能力和反向创新方面为英国带来次要利益。此外，该方案还将提供现行护理标准与这些新技术的成本效益比较数据，以向全球的国家指导委员会和决策者提供信息。

India is home to over 15 million blind people. Diabetes is a global epidemic but India is one of the top 3 countries most affected with 69 million people diagnosed with diabetes. Diabetic retinopathy is the most common complication of diabetes, whereby blood vessels in the retina leak or die and, if left untreated, this leads to visual loss. Sight threatening diabetic retinopathy (STDR) is the leading cause of blindness in the working age group causing loss of productivity, affecting individual households and the national economy. Despite a fast growing economy, a billion people in India live below the poverty line. Diabetes may result in poverty and poverty is associated with diabetes. Therefore, unless the complications of diabetes are identified early and treated, the impact of blindness on the quality of life and productivity of the Indian population will continue to have a negative impact on the nation's economy. Annual screening of all people with diabetes with retinal photography and prompt treatment of STDR has been shown to decrease the rate of blindness in the UK. However, the technology involved is costly, requires trained manpower and is impractical as a method for screening 69 million people in India annually, when the major proportion of health expenses have to borne by the patients. By increasing research capacity and capability through this programme, we aim to initiate systematic diabetic retinopathy screening in India through research and evaluate innovative technologies that can accurately identify patients at risk of blindness due to STDR close to home. These technologies can be applied in all DAC listed countries with prospects of reverse innovation in the UK. The range of research capability activities (SDG Goal 4) and capacity building in India is aimed at better patient outcomes (SDG Goal 3), developing a workforce with quality education (SDG 4), enhancing sustainable livelihoods (SDG Goal 8) and contributing to India's and the UK's work towards an efficient value based healthcare. Firstly, we will introduce population based diabetic retinopathy screening in India and evaluate whether a hand-held camera with smartphone technology and automated grading is feasible in both India and the UK instead of the standard costly cameras and trained manpower employed in the UK currently. We expect more population coverage of retinal screening with this technology and more patients to be referred for treatment. The research capability at the referral hospitals will also improve from this programme with new quality standards being set for treatment. Secondly, we will develop and validate a blood test of a panel of established markers that can detect STDR and other complications of diabetes with the aim to translate into clinical practice. This will allow patients to monitor their own blood tests for STDR. This has the potential to revolutionise the way people with diabetes are monitored for STDR and other complications globally, empower patients and health care workers with new knowledge, improve research capability in India and the UK, improve research capacity in India and improve the global economy in terms of sustained health, industry and innovation and decreasing inequality in terms of access to healthcare. The programme has the potential to change the landscape of diagnosing and triaging STDR globally. In addition, development of a diabetic retinopathy research network of researchers in India will ensure scalability and sustainability of world-class research in India. These research projects will have secondary benefits to the UK in terms of increasing research capability and reverse innovation. Moreover, the programme will also provide comparative cost-effectiveness data of current standard of care versus these newer technologies to inform national guidelines committees and policy makers globally.