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Sankara Nethralaya Diabetic Retinopathy Project (SNDRP)

SNDRP was initiated in 2003 to combat rising prevalence of diabetes related-blindness. The six major components of SNDRP were rural diabetic retinopathy screening program, urban epidemiological & molecular genetic study, tele-screening, urban incidence study of DR and rural epidemiological study of prevalence of DR.

Rural Diabetic Retinopathy Screening Program

An important objective was to create a comprehensive diabetic retinopathy screening model for rural population. Between 2003 and 2006, 458 awareness meetings were conducted to spread the message on diabetes and diabetic retinopathy; over 150,000 people were benefited. In 77 diabetic screening camps, 25313 self-reported individuals were examined. The prevalence of diabetes was 5475/25,313 (21.63%).

Of those 26,519 persons with diabetes that underwent diabetic screening in 198 camps, the prevalence of diabetic retinopathy was 4671/26519 (17.6%).The prevalence of DR in persons with newly detected diabetes was 10.1%, and in known diabetes was 17.8%. SIght threatening Retinopathy was seen in 1407/26519 (5.3%)

Urban Epidemiological and Molecular Genetic Study

A population based study, designed to elucidate the prevalence of diabetes and diabetic retinopathy in urban Chennai, Tamilnadu, India. Using stratified random sampling, based on socioeconomic status, 5999individuals above the age of 40 years were enrolled. All known and newly diagnosed diabetics underwent comprehensive ophthalmic evaluation including 450 four field digital fundus photographs. Prevalence of DM was 28.2% Prevalence of diabetic retinopathy in population with diabetes mellitus was 18.0%.

Tele Diabetic Retinopathy Screening

Tele diabetic retinopathy screening model was initiated to reach remote rural areas in both Tamilnadu and Karnataka. A mobile van having a customized ophthalmic office with satellite connectivity to the base hospital was used. The fundus images were transmitted real time by satellite connectivity for interpretation and diagnosis and counseling. The procedure was found to be cost-effective; telescreening is an important tool for mass screening of diabetic population in the rural areas.

Urban Incidence Study of Diabetic Retinopathy is an ongoing study initiated in 2008 to to find the 4 year incidence of Diabetic Retinopathy in Urban Cohort. The clinical, genetic and biochemical risk factors for progression of retinopathy will be elucidated.

Rural epidemiological study of prevalence of DR: Based on findings of rising prevalence of DR from our self reported rural population screening program, a rural epidemiological study of DR is initiated in 2008 to find the prevalence of DR in rural areas. The study is conducted through a well equipped mobile van with laboratory and comprehensive eye examination setup.

Acknowledgements: Lions Club International Foundation, RD Tata Trust, Jamshetji Tata trust, World Diabetes Federation and Indian Space Research Organization

Sl.No Title Authors Journal


Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-Dreams 1): Study Design and Research Methodology

Agarwal S, Raman R, Paul PG, Rani PK, Uthra S, Gayathree R, MCcarty C, Kumaramanickavel G, Sharma T

Ophthalmic epidemiology 2005; 12: 143-53


A customized portable LogMAR chart with adjustable chart illumination for us as a mass screening device in the rural population

Gouthaman M, Raman R, Kadambi A, Padmajakumari R, Paul PG, Sharma T

Journal of Postgraduate Medicine 2005; 51: 112-114


Newly detected provisional diabetics in the rural South India

S Agarwal, P G Paul, S Mahajan, P R Kumari, R Raman, G Kumaramanickavel, Sharma T

British Medical Journal 2005; 328: 807-810


Use of eye care services by people with diabetes – South India Experience

Padmaja RK, Raman R, Paul PG, Agarwal A, Kumaramanickavel G,
Sharma T

British Journal of Ophthalmology 2005; 82: 410-414


How high is the non-response rate of patients referred by eye examination from diabetic screening camps?

Agarwal A, Mahajan S, Padmaja RK, Raman R, Paul PG, Kumaramanickavel, G Sharma T

Ophthalmic Epidemiology 2005; 12: 1-2


Diabetic Retinopathy – screening model for rural population: awareness and screening methodology

Padmaja RK, Raman R, Agarwal A, Uthra S, Margabandhu G, Senthilkumar D, Kumaramanickavel G, Sharma T

Rural and Remote Health 2005; 5: 1-11


Discordance among screening detected diabetics to attend a diabetic Retinopathy Screening camp

Sharma T, Agarwal S, Paul PG, Mahajan S, Padmaja RK, Raman R,
Kumaramanickavel G.

British Journal of Ophthalmology 2005; 330: 1250


Patient satisfaction with tele-ophthalmology versus ophthalmologist-based screening in diabetic retinopathy

Padmaja RK, Raman R, Manikandan M, Mahajan S, Paul GP, Sharma T

Journal of Telemedicine and Telecare 2006; 12: 159-160


How Necessary is the Second Estimation of Fasting Plasma Glucose Level by Laboratory Venous Blood to Diagnose Type 2 Diabetes, Particularly in Epidemiological Studies?

Sharma T, Rajiv Raman

Ophthalmic Epidemiology 2006; 13: 281-282


Mobile Teleophthalmology: A cost effective screening toll for diabetic retinopathy in rural south India

Sudhir RR, Kevin D Frick, Raman R, Padmaja RK, Murali V, Sharma T

E-health International Journal 2-8


Tele-health program for diabetic retinopathy in Rural South India: A Pilot Study

Raman R, Mahajan S, Padmaja RK, Agarwal S, Gnanamoorthy P, Paul PG, Krishna MS, Kumaramanickavel G,
Sharma T.

E-Health International 2005; 2: 13-18


The tele-screening model for diabetic retinopathy: evaluating the influence of mydriasis on the gradability of a single-field 45 degrees digital fundus image.

Raman R, Rani PK, Mahajan S, Paul P, Gnanamoorthy P, Krishna MS, Sharma T.

Telemed Journal and E Health. 2007 Oct;13(5):597-602.


Knowledge and attitude of general practitioners towards diabetic retinopathy Practice in South India

Raman R, Paul PG, Padmaja RK,
Sharma T

Community Eye Health Journal 2006; 19: 13-14


Diabetic Retinopathy in type II diabetics detected by targeted screening versus newly diagnosed in general practice

Agarwal S, Raman R, Padmaja RK, Deshmukh H, Paul PG, Gnanmoorthy P, Kumaramanickavel G, Sharma T

Annals Academy of Medicine Singapore 2006;35:531-535


Ocular complications of Diabetes Mellitus

Biswas J, Raman R

The journal of General Medicine, March 2002,
Vol 14


Patient satisfaction levels during tele-ophthalmology consultation in rural south India

Paul PG, Raman R, Padmaja RK, Deshmukh H, Sharma T

Telemedicine and e-Health 2006;12:571-578


Intron 4 VNTR of endothelial nitric Oxide synthase (eNOS) gene and diabetic retinopathy in type 2 patients in southern India

Uthra S, Raman R, Mukesh BN, Padmaja RK, Paul PG, Lakshmipathy P, Gnanamoorthy P,McCarty CA, Kumaramanickavel G, Sharma T

Ophthalmic Genetics 2007; 28(2):77-81


Analysis of comprehensive diabetic retinopathy screening model for rural and urban diabetics in developing countries

Padmaja RK, Raman R, Sharma V, Mahuli SV, Arokiasamy T, Sudhir RR, Kumaramanickavel G, Sharma T

British Journal of Ophthalmology 2007;91:1425-1429


The sensitivity and specificity of non-mydriatic digital stereoscopic retinal imaging in detecting diabetic retinopathy

Raman R, Padmaja RK, Sharma T

Diabetes Care 2007;30:1


Genetics of Diabetic Retinopathy

Uthra S, Raman R, Bickol MN, Padmaja RK, Catherine McCarty, Kumaramanickavel G, Sharma T

International Journal of Human Genetics 2007;1-5


Diabetic Retinopathy and IGF-1 Gene Polymorphic Cytosine – Adenine Repeats in southern Indian cohort

Uthra S, Raman R, Bickol NM, Rajkumar SA, Padmaja RK, Agarwal S, Paul PG, Praveen L, Gnanamoorthy P, Catherine Mc Carty, Kumaramanickavel G,
Sharma T

Ophthalmic Research 2007;1-6


Visual outcome after pars plana vitrectomy.

Agarwal R, Raman R

J Cataract Refract Surg. 2002 Aug;28(8):1310-1; author reply 1311.


Genetic epidemiology

Padeep P, Lingam Vijaya, Ronnie George,Rajiv Raman, Tarun Sharma

Br J Ophthalmol. 2005 May


Association of VEGF gene polymorphisms with diabetic retinopathy in a south Indian cohort.

Uthra S, Raman R, Mukesh BN, Rajkumar SA, Padmaja KR, Paul PG, Lakshmipathy P, Gnanamoorthy P, Sharma T, McCarty CA, Kumaramanickavel G.

Ophthalmic Genet. 2008 Mar;29(1):11-5.


Central retinal vein occlusion with non-arteritic ischemic optic neuropathy and cystoid macular edema.

Raman R, Choudhari NS.

Graefes Arch Clin Exp Ophthalmol. 2008 May 20. [Epub ahead of print]


Physicians, pharmacists, and people with diabetes in India.

Padmaja Kumari R, Raman R, Sharma T.

Pharm World Sci. 2008 Jun 13. [Epub ahead of print]


Combined retinal detachment in proliferative diabetic retinopathy

R Raman, Padmaja R

Can J Ophthalmol 2008;43:483


Knowledge of diabetes and diabetic retinopathy among rural populations in India, and the influence of knowledge of diabetic retinopathy on attitude and practice.

Rani PK, Raman R, Subramani S, Perumal G, Kumaramanickavel G, Sharma T.

Rural Remote Health. 2008 Jul-Sep;8(3):838. Epub 2008 Jul 24.


Prevalence of Diabetic Retinopathy in India Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study Report 2.

Raman R, Rani PK, Reddi Rachepalle S, Gnanamoorthy P, Uthra S, Kumaramanickavel G, Sharma T.

Ophthalmology. 2008 Dec 11. [Epub ahead of print]


Risk factors for diabetic retinopathy in self-reported rural population with diabetes.

Rani PK, Raman R, Chandrakantan A, Pal SS, Perumal GM, Sharma T.

J Postgrad Med. 2009 Apr-Jun;55(2):92-6.


Association of obesity with diabetic retinopathy: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetics Study (SN-DREAMS Report no. 8).

Raman R, Rani PK, Gnanamoorthy P, Sudhir RR, Kumaramanikavel G,
Sharma T.

Acta Diabetol. 2009 Mar 27. [Epub ahead of print]


Is neuronal dysfunction an early sign of diabetic retinopathy? Microperimetry and Spectral Domain Optical Coherence Tomography (SD-OCT) Study in individuals with diabetes, but no diabetic retinopathy.

Verma A, Rani PK, Raman R, Pal SS, Laxmi G, Gupta M, Sahu C, Vaitheeswaran K, Sharma T.

Eye. 2009 Jul 24. [Epub ahead of print]


Application of teleophthalmology in remote diagnosis of orbital and adenexal diseases

Maley Verma, Rajiv Raman, E. Ravindra Mohan

Indian journal of ophthalmology,2009,57: 381-84


Diagonal ear lobe crease in diabetic south Indian population: Is it associated with Diabetic Retinopathy? Sankara Nethralaya Diabetic Retinopathy Epidemiology And Molecular-genetics Study (SN-DREAMS, Report no. 3).

Raman R, Rani PK, Kulothungan V, Sharma T.

BMC Ophthalmol. 2009 Sep 29;9(1):11.


Influence of Serum Lipids on Clinically Significant versus Nonclinically Significant Macular Edema: Sankara Nethralaya-Diabetic Retinopathy Epidemiology and Molecular Genetic Study Report Number 13.

Raman R, Rani PK, Kulothungan V, Rachepalle SR, Kumaramanickavel G, Sharma T.

Ophthalmology. 2009 Dec 31. [Epubahead of print]


Protein Kinase C beta (PRKCB1) and pigment epithelium derived factor (PEDF) gene polymorphisms and
Diabetic Retinopathy in a south Indian cohort.

Uthra S, Raman R, Mukesh BN, Rajkumar SA, Kumari R P, Lakshmipathy P, Gnanamoorthy P, Sharma T, McCarty CA, Kumaramanickavel G.

Ophthalmic Genet. 2010 Mar;31(1):18-23.


Anemia and Diabetic Retinopathy in Type 2 Diabetes Mellitus

Padmaja Kumari Rani1, Rajiv Raman1, Sudhir R Rachepalli 2, Swakshyar Saumya Pal1, Vaitheeswaran kulothungan 2, Praveena Lakshmipathy 3, Uthra Satagopan 3, Govindasamy Kumaramanickavel 3, Tarun Sharma 1

Journal of Physicians of India, Vol 58, Jan 2010


Prevalence of Refractive Errors and Associated Risk Factors in Subjects with Type 2 Diabetes Mellitus SN-DREAMS, Report 18.

Rani PK, Raman R, Rachapalli SR, Kulothungan V, Kumaramanickavel G, Sharma T.

Ophthalmology. 2010 Feb 15. [Epub ahead of print]


Absence of diabetic retinopathy in a patient who has had diabetes mellitus for 69 years, and inadequate glycemic control: case presentation: Response.

Raman R, Gupta AG

Diabetol Metab Syndr. 2010 Mar 25;2(1):20.