Burden of Diabetic Retinopathy amongst People with Diabetes Attending Primary Care in Kerala: Nayanamritham Project
, Vasudeva Iyer Sahasranamam 2, Simon George 2, Rajeev Sadanandan 3, Bipin Gopal 4, Lakshmi Premnazir 4, Dolores Conroy 5, Jyotsna Srinath 6, Radha Ramakrishnan 5, Sundaramuthil Murukaiah Vijayanand 4, Raphael Wittenberg 7 and Gopalakrishnan Netuveli 6,â€
on behalf of the Nayanamritham Project CollaboratorsRound 1
Reviewer 1 Report
See file attached
Comments for author File: 
Comments.pdf
Author Response
Thank you for your useful comments.
We have tried our best to amend the manuscript in line with these comments.
Lines 44-49: Authors should provide a reference that reports statistical data related to this actual situation. Moreover, #7 (Parayil G., 1996), mentioned below (line 52), describe a model to improve the primary care, it is applicable even today?
Yes, this is the reference used for the Kerala Model but we have added a more recent reference too.
Lines 94-95: about technical details retinal cameras a parenthesis is missing? It is probably a spelling inaccuracy.
Corrected.
Lines 145 and lines 226: chapter Estimation of prevalence of DR and Prevalence of DR
Actually, there is a continuing rise in the numbers of patients with DM and DR needing care.
Moreover, recent literature data reported upward trends in the prevalence of diabetes mellitus (DM), diabetic retinopathy (DR) and sight-threatening retinopathy (STRD), most marked and accelerating in STRD in type 1 DM but slowing in type 2 DM, and in the overall prevalence of DR. Did the Author consider these differences for discussion of results?
For further details, Authors might take in consideration this reference: Haider S et al. Disease burden of diabetes, diabetic retinopathy and their future projections in the UK: cross-sectional analyses of a primary care database. BMJ Open. 2021 Jul 12;11(7):e050058. doi: 10.1136/bmjopen-2021-050058
Yes, we had over -estimated the prevalence in our sample size calculation to account for the rising numbers of DM and DR.
Lines 361-364: despite the difficulties encountered, the study succeeded in screening diabetic patients registered with the family health centres (FHCs), the future goal should be a DR screening program wich should involve as many subjects as possible to possibly counteract the limitations of the study.
This is already mentioned in the conclusion that the results should be used to upscale the program.
Reviewer 2 Report
The study is well written. In addition, the study has an exciting approach to DR screening using a teleophthalmology program.
The study is good since it used Cochran’s sample size formula to achieve the statistics and used certified retinal graders.
- Since the systematic screening for DR in India is in its infancy. It would be highly encouraged for future studies to include the insulin resistance data for a more elaborate screening program.
- Also, representative graded retinal images can go in the manuscript or supplemental for readers to check.
-However, this study or program can help developing countries screen DR, and it's an excellent initiative.
Author Response
Thank you for your comments.
- Since the systematic screening for DR in India is in its infancy. It would be highly encouraged for future studies to include the insulin resistance data for a more elaborate screening program. Thank you for your advice and we will pass this on to the Kerala Health Service Director.
- Also, representative graded retinal images can go in the manuscript or supplemental for readers to check. We have now added them. Thank you for the suggestion.
