Elevating Vitreo-retinal Care in India

by Brooke Herron

As one of the largest retina societies in the world, the Vitreo-Retinal Society of India (VRSI) has rightly earned its reputation as a thought leader in the field — thanks to its high-quality annual conferences, dedication to increasing public awareness for retinal diseases, and contributions to scientific literature.

VRSI as a society contributes to public health by taking various initiatives to avoid preventable blindness from different retinal pathologies.

The prime focus of the members of VRSI as a society is to avoid blindness secondary to diabetic retinopathy (DR). India is said to be the diabetes capital of the world and with the increase in the number of diabetics in the country, there is a parallel increase in the number of patients with DR — many of whom are in their working age group, which leads to a great economic burden on the country.

Currently, about 77 million people have diabetes in India, and this number is predicted to drastically increase to 125 million by 2045. Worryingly, at least three million people are at risk or already have vision loss due to vision-threatening diabetic retinopathy (VTDR) in India.1

With these numbers, it’s clear that intervention is needed to prevent avoidable blindness — and VRSI is actively working to increase public awareness through social media, diabetic retinopathy skill transfer workshops, and webinars, collaborating with online pharmacies and sending out awareness materials and conducting patient awareness workshops. VRSI is also collaborating with other ophthalmic societies, such as the All India Ophthalmic Society (AIOS), to educate general ophthalmologists in diagnosing and treating diabetic retinopathy.

Over the past three decades, VRSI has grown exponentially. Founded in 1992 by 20 dedicated vitreo-retinal specialists, the society has now more than 1,500 members across India — including 90% of the country’s actively practicing vitreoretinal specialists.

The society is managed by an elected executive committee: President Dr. N. S. Muralidhar, Vice President Dr. R.

Dr.

Dr.

Together, the executive committee and its members work to elevate the standard of vitreo-retinal care and resources in India, focusing on two main areas: Public health and continuing education.

Members of VRSI are also working with IHOPE International to formulate guidelines for diabetic retinopathy diagnosis and management. The Research Society for the Study of Diabetes in India (RSSDI) is the largest organization of all diabetologists and physicians in India with more than 10,000 members. And VRSI has joined hands with them to formulate the DR screening guidelines for diabetologists.

Furthermore, VRSI is working at various levels including the National Health Scheme to bring in diabetic retinopathy screening as a part of the national health scheme for the entire population of the country. VRSI also works with various insurance companies to ensure that coverage is given to the majority of diabetics for their intravitreal injections so that they remain compliant with their ongoing treatment and dropout is minimal.

Not only that, VRSI has also conducted DR screening camps to screen soldiers protecting the borders, as well as police personnel and military men, to help maintain their retina health despite being diabetic — thus preventing permanent loss of vision.

Retinopathy of prematurity (ROP) is another retinal pathology where VRSI focuses its resources. This is crucial because India has the highest number of premature births in the world — and further, the country is currently facing an ROP epidemic that has even penetrated its peripheral rural districts.

According to a 2019 paper,2 the incidence of ROP in different regions across India has been reported to range from 38% to 47%.

Creating opportunities for continued medical education is another primary objective of the VRSI. Members are informed of the latest developments in vitreo-retina through quarterly newsletters, each providing updated scientific information on a selected topic of the retina. Meanwhile, monthly Retina Roundups share new data and trial results to further add to the group’s collective knowledge and establish best practices.

Another valuable resource is the VRSI Study Group, which conducts collaborative research in retina. The recent paper from the group titled “Incidence of post vitrectomy endophthalmitis in India — A multicentric study by VRSI Study Group” was published in the prestigious journal Eye (London).3 This is a landmark original article highlighting the fact that the reuse of vitreo-retinal instruments as commonly done in the developing countries does not carry a higher risk of endophthalmitis, thereby reducing the cost of vitreo-retinal surgery.

In developing countries, it is a common practice to re-sterilize single-use instruments — this not only makes surgery more affordable for patients but also reduces the procedure’s environmental impact. However, these benefits aside, this reuse also raises concerns for postvitrectomy endophthalmitis (PVE), which is reported to be between 0.02% and 0.84%.

Nevertheless, this multicentric study done at 25 sites across India showed no such increase in the risk of endophthalmitis, and it also evaluated the existing sterilization practices of reused instruments in multiple vitreo-retinal centers in India. This study rationalized the use of single-use instruments, thereby making VR surgery more affordable with a lower carbon footprint.

VRSI ensures that the members remain updated with the latest happening in the field of retina by organizing its annual conference held in different parts of the country and attended by more than 700 delegates. Every year, an esteemed faculty both national and international participates to share their knowledge and experiences with all the delegates attending the conference. All the young and

budding vitreo-retinal specialists get an opportunity to showcase their work and learn from the experts.

Various awards are also given during the annual conference, including the Nataraja Pillai award to recognize an international retina specialist for his or her contribution in the field of retina at a global level. Several awards are given to Indian retina specialists for their contributions, such as the Lifetime Achievement Award given to a senior retina specialist who has worked for several decades and helped in bringing up the quality of retina practice in India. The Young Researcher Award, on the other hand, helps to encourage young researchers’ minds to come up with innovations and new techniques in the field. Not to mention, there are many travel grants given to students, encouraging them for their work and presentations.

Not only does the VRSI annual conference showcase the country’s best talents in the field, but it also provides a platform for knowledge exchange with collaborative research work mixed with fun and socializing.

This year’s meeting will be held from December 1 to 3 in Trivandrum, India. Registration is currently open.

For more information about VRSI or to register for the conference, visit www.vrsi.in.

1. Raman R, Vasconcelos JC, Rajalakshmi R, et al. Prevalence of diabetic retinopathy in India stratified by known and undiagnosed diabetes, urban-rural locations, and socioeconomic indices: results from the SMART India population-based cross-sectional screening study. Lancet Glob Health. 2022;10(12):e1764-e1773.

2. Bowe T, Nyamai L, Ademola-Popoola D, et al. The current state of retinopathy of prematurity in India, Kenya, Mexico, Nigeria, Philippines, Romania, Thailand, and Venezuela. Digit J Ophthalmol. 2019; 25(4): 49-58.

3. Shah PN, Mishra DK, Shanmugam MP, et al. Incidence of post vitrectomy endophthalmitis in IndiaA multicentric study by VRSI study Group. Eye (Lond). 2023 Feb 8. [Online ahead of print]