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，视网膜血管渗漏或死亡，如果不及时治疗，会导致视力丧失。威胁视力的糖尿病视网膜病变（STDR）是导致工作年龄组失明的主要原因，造成生产力损失，影响个人家庭和国民经济。尽管经济快速增长，但印度仍有10亿人生活在贫困线以下。糖尿病可能导致贫困，而贫困与糖尿病有关。因此，除非糖尿病的并发症得到早期发现和治疗，否则失明对印度人口的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检查和及时治疗STDR已被证明可以降低失明率。然而，所涉及的技术成本高昂，需要经过培训的人力，而且在印度每年筛查6900万人的情况下，作为一种方法是不切实际的，因为大部分医疗费用必须由患者承担。通过这一项目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，在印度启动系统性糖尿病视网膜病变筛查，这些技术可以准确识别在家附近因性传播疾病而有失明风险的患者。这些技术可以应用于所有DAC上市国家，在英国有反向创新的前景。印度的一系列研究能力活动（可持续发展目标4）和能力建设旨在改善患者的治疗效果（可持续发展目标3），发展一支拥有优质教育的劳动力队伍（可持续发展目标4），增强可持续生计（可持续发展目标8），并为印度和英国实现高效的基于价值的医疗保健做出贡献。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，并评估具有智能手机技术和自动分级的手持相机在印度和英国是否可行，而不是目前在英国使用的标准昂贵的相机和训练有素的人力。我们期待更多的人口覆盖率视网膜筛查与这项技术和更多的患者转介治疗。该方案还将提高转诊医院的研究能力，为治疗制定新的质量标准。其次，我们将开发和验证一组已建立的标记物的血液测试，这些标记物可以检测STDR和其他糖尿病并发症，目的是转化为临床实践。这将使患者能够监测自己的血液检测是否存在性传染病。这有可能彻底改变全球糖尿病患者监测性传染疾病和其他并发症的方式，为患者和卫生保健工作者提供新知识，提高印度和英国的研究能力，提高印度的研究能力，并在持续健康、工业和创新方面改善全球经济，减少获得医疗保健方面的不平等。该规划有可能改变全球STDR的诊断和分诊情况。此外，在印度发展一个由研究人员组成的糖尿病视网膜病变研究网络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逆向创新方面给英国带来二次好处。此外，该规划还将提供当前护理标准与这些新技术的成本效益比较数据，以便为全球国家准则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.