VISION 2020: The Right to Sight – India has released the revised National Guidelines for the Management of Diabetic Retinopathy (DR), 2025. The guidelines introduce a comprehensive, technology-enabled and system-integrated approach, with a target to achieve 80 per cent DR screening coverage among the diabetic population.
According to VISION 2020, 85 per cent of diabetic patients are unaware that diabetes can affect vision and have never undergone a retinal examination. Developed with national experts and key stakeholders, the updated guidelines provide a uniform, India-specific framework for prevention, early detection and management of DR.
Dr Vishali Gupta, President, Vitreo Retinal Society of India (VRSI) and Head- Retina, PGIMS said, “The revised screening guidelines mark a major strategic shift in the way we approach diabetic retinopathy. By prioritising timely and systematic screening, we can identify disease much earlier—significantly improving outcomes. Evidence shows that early intervention can halve the risk of severe vision loss, and these guidelines translate that evidence into actionable practice across all levels of care.”
The 2025 revision addresses gaps identified in the 2015 DR Manual. These include limited integration with NCD programmes, lack of monitoring indicators, inadequate awareness, the need for AI-based innovations, and limited adoption of emerging treatments.
Raman et al. (2022) estimate DR prevalence at 12.5 per cent and vision-threatening DR at 4.0 per cent among India’s diabetic population. According to the guidelines, 85 per cent of diabetic patients have never undergone a retinal examination, and inconsistent referrals from diabetologists, endocrinologists and primary care physicians continue to delay diagnosis.
The guidelines incorporate advances in retinal care from the past decade, including bispecific and anti-VEGF intravitreal injections, high-resolution imaging, tele-ophthalmology and AI-assisted screening. The updated framework integrates these developments into national clinical pathways.
Updated diagnosis and treatment protocols
The guidelines outline a tiered diagnostic pathway:
• Primary level: AI-enabled fundus imaging for early detection.
• Secondary level: Use of Optical Coherence Tomography (OCT), identified as the most sensitive method for detecting Diabetic Macular Edema (DME).
• Tertiary level: Access to advanced imaging, including wide-field imaging, FFA and OCTA.
The guidelines also include bispecific intravitreal injection that targets both VEGF and ANG-2.
Strengthening the ecosystem
The guidelines highlight mechanisms to support sustainability and accessibility. These include financial coverage for DR treatments such as lasers, anti-VEGF and bispecific injections and OCT monitoring under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). They also recommend integration through ABHA IDs, strengthened referral pathways, tele-ophthalmology hubs and the creation of National Diabetes and DR Registries for real-time monitoring.
Dr Vishal Agarwal, Member of VRSI and Director, Agrawal Hospital, Jaipur, said, “The updated Diabetic retinopathy national guidelines mark a turning point in India’s fight against this vision threatening disease .. By integrating technology, policy, and preventive care, they bring us closer to ensuring that no individual loses vision to a preventable cause. Vision is not a luxury—it is fundamental to one’s independence, dignity, and quality of life. The call to ‘Check yearly and See Clearly’ is a timely reminder that early detection and timely treatment can preserve sight and transform lives.”
Transforming the DR care pathway
The guidelines recommend the adoption of AI-assisted, digitally integrated screening using validated, CDSCO-cleared applications. These tools, along with non-mydriatic and smartphone-based fundus cameras, support faster and more accurate screening and triage.
Dr R. Kim, Chief Medical Officer, Aravind Eye Hospital, said: “The inclusion of AI-assisted screening in the updated guidelines is a game changer for diabetic eye care in India. By enabling fast and accurate grading, this innovation allows early referral of high-risk cases while ensuring safe, risk-based rescreening for mild disease. It not only enhances efficiency across the care pathway but also ensures that timely intervention reaches those who need it most—helping preserve vision and prevent avoidable blindness at scale.”
To expand access, the guidelines recommend training and certifying non-ophthalmologist personnel, including optometrists, ophthalmic assistants, nurses, paramedics, AYUSH staff and field volunteers to conduct DR screening.
Dr Vishali Gupta said, “One of the most impactful aspects of the updated guidelines is the focus on decentralising screening and empowering trained non-ophthalmologist personnel. This approach will enable early detection of diabetic retinopathy even at primary care and community levels, ensuring that timely intervention is no longer limited to specialised centers. It’s a crucial step toward making sight-saving care more accessible and equitable across the country.”