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1500多万盲人。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6900万人被诊断为糖尿病。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，如果不治疗，就会导致视力丧失。威胁视力的糖尿病视网膜病变(STDR)是导致劳动年龄组失明的主要原因，导致生产力下降，影响个人家庭和国民经济。尽管印度经济快速增长，但仍有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，除非及早发现和治疗糖尿病并发症，否则失明对印度人民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，通过视网膜照相和及时治疗STDR对所有糖尿病患者进行年度筛查已被证明可以降低失盲率。然而，涉及的技术成本高昂，需要训练有素的人力，作为一种每年在印度对6900万人进行筛查的方法是不切实际的，因为大部分医疗费用必须由患者承担。通过这项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，这些技术可以准确地识别离家很近的STDR致盲风险的患者。这些技术可以应用于所有在英国有反向创新前景的DAC上市国家。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结果(可持续发展目标3)，培养一支接受优质教育的劳动力队伍(可持续发展目标4)，提高可持续生计(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，并评估配备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，以取代目前在英国雇用的标准昂贵的相机和训练有素的人力。我们预计使用这项技术进行视网膜筛查的人口覆盖率会更高，更多的患者将被转介接受治疗。转介医院的研究能力也将从这一方案中得到改善，为治疗设定新的质量标准。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。这将允许患者监测他们自己的STDR血液测试。这有可能在全球范围内彻底改变对糖尿病患者进行STDR和其他并发症监测的方式，赋予患者和医护人员以新知识，提高印度和英国的研究能力，提高印度的研究能力，并在可持续健康、工业和创新以及减少获得医疗保健方面的不平等方面改善全球经济。该方案有可能改变对STDR进行全球诊断和分类的格局。此外，在印度发展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反向创新方面对英国产生次要好处。此外，该方案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，以便为全球的国家准则委员会和政策制定者提供信息。

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.