Prevalence of Diabetic Retinopathy in India

Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study Report 2
Published:December 12, 2008DOI:


      The aim of the study was to estimate the prevalence of diabetic retinopathy in an urban Indian population older than 40 years.


      A population-based cross-sectional study.


      Five thousand nine hundred ninety-nine subjects residing in Chennai, India, were enumerated.


      A multistage random sampling, based on socioeconomic criteria, was followed. Identified subjects with diabetes mellitus (based on the World Health Organization criteria) underwent detailed examination at the base hospital. The fundi of all patients were photographed using 45°, 4-field stereoscopic digital photography. The diagnosis of diabetic retinopathy was based on Klein's classification of the Early Treatment Diabetic Retinopathy Study scale.

      Main Outcome Measures

      These included age- and gender-adjusted prevalence of diabetes and diabetic retinopathy, and correlation of prevalence with history-based risk factors.


      The age- and gender-adjusted prevalence rate of diabetes in an urban Chennai population was 28.2% (95% confidence interval [CI], 27.0–29.3), and the prevalence of diabetic retinopathy in general population was 3.5% (95% CI, 3.49–3.54). The prevalence of diabetic retinopathy in the population with diabetes mellitus was 18.0% (95% CI, 16.0–20.1). History-based variables that were significantly associated with increased risk of diabetic retinopathy included gender (men at greater risk; odds ratio [OR], 1.41; 95% CI, 1.04–1.91); use of insulin (OR, 3.52; 95% CI, 2.05–6.02); longer duration of diabetes (>15 years; OR, 6.43; 95% CI, 3.18–12.90); and subjects with known diabetes mellitus (OR, 2.98; 95% CI, 1.72–5.17). Differences in the socioeconomic status did not influence the occurrence of diabetic retinopathy.


      The prevalence of diabetic retinopathy was 18% in an urban population with diabetes mellitus in India. The duration of diabetes is the strongest predictor for diabetic retinopathy.

      Financial Disclosure(s)

      The author(s) have no proprietary or commercial interest in any materials discussed in this article.
      To read this article in full you will need to make a payment


      Subscribe to Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Eye Diseases Prevalence Research Group
        Causes and prevalence of visual impairment among adults in the United States.
        Arch Ophthalmol. 2004; 122: 477-485
        • Eye Diseases Prevalence Research Group
        The prevalence of diabetic retinopathy among adults in the United States.
        Arch Ophthalmol. 2004; 122: 552-563
        • Wild S.
        • Roglic G.
        • Green A.
        • et al.
        Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.
        Diabetes Care. 2004; 27: 1047-1053
        • Ramachandran A.
        • Jali M.V.
        • Mohan V.
        • et al.
        High prevalence of diabetes in an urban population in South India.
        BMJ. 1988; 297: 587-590
        • Rema M.
        • Premkumar S.
        • Anitha B.
        • et al.
        Prevalence of diabetic retinopathy in urban India: the Chennai Urban Rural Epidemiology Study (CURES) Eye Study, I.
        Invest Ophthalmol Vis Sci. 2005; 46: 2328-2333
        • Nirmalan P.K.
        • Katz J.
        • Robin A.L.
        • et al.
        Prevalence of vitreoretinal disorders in a rural population of southern India: the Aravind Comprehensive Eye Study.
        Arch Ophthalmol. 2004; 122: 581-586
        • Agarwal S.
        • Raman R.
        • Paul P.G.
        • et al.
        Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS 1): study design and research methodology.
        Ophthalmic Epidemiol. 2005; 12: 143-153
        • Oakes J.M.
        • Rossi P.H.
        The measurement of SES in health research: current practice and steps towards a new approach.
        Soc Sci Med. 2003; 56: 769-784
        • Sharma T.
        How necessary is the second estimation of fasting plasma glucose level by laboratory venous blood to diagnose type 2 diabetes, particularly in epidemiological studies [letter]?.
        Ophthalmic Epidemiol. 2006; 13: 281-282
        • Expert Committee on the Diagnosis and Classification of Diabetes Mellitus
        Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.
        Diabetes Care. 2003; 26: S5-S20
        • Klein R.
        • Klein B.E.
        • Magli Y.L.
        • et al.
        An alternative method of grading diabetic retinopathy.
        Ophthalmology. 1986; 93: 1183-1187
        • Raman Kutty V.
        • Joseph A.
        • Soman C.R.
        High prevalence of type 2 diabetes in an urban settlement in Kerala, India.
        Ethn Health. 1999; 4: 231-239
        • Gupta A.
        • Gupta R.
        • Sarna M.
        • et al.
        Prevalence of diabetes, impaired fasting glucose and insulin resistance syndrome in an urban Indian population.
        Diabetes Res Clin Pract. 2003; 61: 69-76
        • Zargar A.H.
        • Khan A.K.
        • Masoodi S.R.
        • et al.
        Prevalence of type 2 diabetes mellitus and impaired glucose tolerance in the Kashmir Valley of the Indian subcontinent.
        Diabetes Res Clin Pract. 2000; 47: 135-146
        • Ramachandran A.
        • Snehalatha C.
        • Kapur A.
        • et al.
        • Diabetes Epidemiology Study Group in India (DESI)
        High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.
        Diabetologia. 2001; 44: 1094-1101
        • Mohan V.
        • Deepa M.
        • Deepa R.
        • et al.
        Secular trends in the prevalence of diabetes and glucose tolerance in urban South India—the Chennai Urban Rural Epidemiology Study (CURES-17).
        Diabetologia. 2006; 49: 1175-1178
        • Census of Indian 2001
        Total population, population of Tamil Nadu, urban and rural and their proportions to the total population.
        (Accessed: August 24, 2008)
        • Hu Y.H.
        • Pan X.R.
        • Liu P.A.
        • et al.
        Coronary heart disease and diabetic retinopathy in newly diagnosed diabetes in Da Qing, China: the Da Qing IGT and Diabetes Study.
        Acta Diabetol. 1991; 28: 169-173
        • Kuzuya T.
        • Akanuma Y.
        • Akazawa Y.
        • Uehata T.
        Prevalence of chronic complications in Japanese diabetic patients.
        Diabetes Res Clin Pract. 1994; 24: S159-S164
        • Weerasuriya N.
        • Siribaddana S.
        • Dissanayake A.
        • et al.
        Long-term complications in newly diagnosed Sri Lankan patients with type 2 diabetes mellitus.
        QJM. 1998; 91: 439-443
        • Jamal-u-Din
        • Qureshi M.B.
        • Khan A.J.
        • et al.
        Prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan.
        J Ayub Med Coll Abbottabad. 2006; 18: 40-43
        • Dandona L.
        • Dandona R.
        • Naduvilath T.J.
        • et al.
        Population based assessment of diabetic retinopathy in an urban population in southern India.
        Br J Ophthalmol. 1999; 83: 937-940
        • Ramachandran A.
        • Snehalatha C.
        • Vijay V.
        • King H.
        Impact of poverty on the prevalence of diabetes and its complications in urban southern India.
        Diabet Med. 2002; 19: 130-135
        • Narendran V.
        • John R.K.
        • Raghuram A.
        • et al.
        Diabetic retinopathy among self reported diabetics in southern India: a population based assessment.
        Br J Ophthalmol. 2002; 86: 1014-1018
        • Lau H.C.
        • Voo Y.O.
        • Yeo K.T.
        • et al.
        Mass screening for diabetic retinopathy—report on diabetic retinal screening in primary care clinics in Singapore.
        Singapore Med J. 1995; 36: 510-513
        • Dowse G.K.
        • Humphrey A.R.
        • Collins V.R.
        • et al.
        Prevalence and risk factors for diabetic retinopathy in the multiethnic population of Mauritius.
        Am J Epidemiol. 1998; 147: 448-457
        • Klein R.
        • Klein B.E.
        • Moss S.E.
        The Wisconsin Epidemiologic Study of Diabetic Retinopathy: a review.
        Diabetes Metab Rev. 1989; 5: 559-570
        • Kohner E.M.
        • Aldington S.J.
        • Stratton I.M.
        • et al.
        • United Kingdom Prospective Diabetes Study
        United Kingdom Prospective Diabetes Study, 30: diabetic retinopathy at diagnosis of non-insulin-dependent diabetes mellitus and associated risk factors.
        Arch Ophthalmol. 1998; 116: 297-303
        • Cugati S.
        • Kifley A.
        • Mitchell P.
        • Wang J.J.
        Temporal trends in the age-specific prevalence of diabetes and diabetic retinopathy in older persons: population-based survey findings.
        Diabetes Res Clin Pract. 2006; 74: 301-308
        • Leske M.C.
        • Wu S.Y.
        • Hyman L.
        • et al.
        • Barbados Eye Studies Group
        Diabetic retinopathy in a black population: the Barbados Eye Study.
        Ophthalmology. 1999; 106: 1893-1899
        • Kumaramanickavel G.
        • Sripriya S.
        • Ramprasad V.L.
        • et al.
        Z-2 aldose reductase allele and diabetic retinopathy in India.
        Ophthalmic Genet. 2003; 24: 41-48
        • Kumaramanickavel G.
        • Ramprasad V.L.
        • Sripriya S.
        • et al.
        Association of Gly82Ser polymorphism in the RAGE gene with diabetic retinopathy in type II diabetic Asian Indian patients.
        J Diabetes Complications. 2002; 16: 391-394
        • Kumaramanickavel G.
        • Sripriya S.
        • Vellanki R.N.
        • et al.
        Inducible nitric oxide synthase gene and diabetic retinopathy in Asian Indian patients.
        Clin Genet. 2002; 61: 344-348
        • Nagi D.K.
        • Pettitt D.J.
        • Bennett P.H.
        • et al.
        Diabetic retinopathy assessed by fundus photography in Pima Indians with impaired glucose tolerance and NIDDM.
        Diabet Med. 1997; 14: 449-456
        • Klein R.
        • Klein B.E.
        • Moss S.E.
        • Linton K.L.
        The Beaver Dam Eye Study: retinopathy in adults with newly discovered and previously diagnosed diabetes mellitus.
        Ophthalmology. 1992; 99: 58-62
        • Agarwal S.
        • Raman R.
        • Kumari R.P.
        • et al.
        Diabetic retinopathy in type II diabetics detected by targeted screening versus newly diagnosed in general practice.
        Ann Acad Med Singapore. 2006; 35: 531-535
        • Wang W.Q.
        • Ip T.P.
        • Lam K.S.
        Changing prevalence of retinopathy in newly diagnosed non-insulin dependent diabetes mellitus patients in Hong Kong.
        Diabetes Res Clin Pract. 1998; 39: 185-191
        • van Leiden H.A.
        • Dekker J.M.
        • Moll A.C.
        • et al.
        Blood pressure, lipids, and obesity are associated with retinopathy: the Hoorn Study.
        Diabetes Care. 2002; 25: 1320-1325
        • Perusicova J.
        Prevalence of dyslipidemia, hypertension and vascular complications in newly diagnosed diabetics (prospective study: part 2) [in Czech].
        Vnitr Lek. 2001; 47: 146-150
        • de Fine Olivarius N.
        • Nielsen N.V.
        • Andreasen A.H.
        Diabetic retinopathy in newly diagnosed middle-aged and elderly diabetic patients: prevalence and interrelationship with microalbuminuria and triglycerides.
        Graefes Arch Clin Exp Ophthalmol. 2001; 239: 664-672
        • West S.K.
        • Klein R.
        • Rodriguez J.
        • et al.
        Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER.
        Diabetes Care. 2001; 24: 1204-1209
        • Klein R.
        • Klein B.E.
        • Moss S.E.
        • et al.
        The Wisconsin Epidemiologic Study of Diabetic Retinopathy.
        Arch Ophthalmol. 1989; 107: 244-249
        • van Hecke M.V.
        • Dekker J.M.
        • Stehouwer C.D.
        • et al.
        Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB Prospective Complications Study.
        Diabetes Care. 2005; 28: 1383-1389
        • Rani P.K.
        • Raman R.
        • Agarwal S.
        • et al.
        Diabetic retinopathy screening model for rural population: awareness and screening methodology.
        Rural Remote Health [serial online]. 2005; 5 (Accessed: August 15, 2008): 350
        • Raman R.
        • Paul P.G.
        • Padmajakumari R.
        • Sharma T.
        Knowledge and attitude of general practitioners towards diabetic retinopathy practice in South India.
        Community Eye Health. 2006; 19 (Accessed: August 15, 2008): 13-14
        • Raman R.
        • Rani P.K.
        • Mahajan S.
        • et al.
        The tele-screening model for diabetic retinopathy: evaluating the influence of mydriasis on the gradability of a single-field 45 degrees digital fundus image.
        Telemed J E Health. 2007; 13: 597-602
        • Rani P.K.
        • Raman R.
        • Sharma T.
        • et al.
        Analysis of a comprehensive diabetic retinopathy screening model for rural and urban diabetics in developing countries.
        Br J Ophthalmol. 2007; 91: 1425-1429