Racial Background Impacts Diabetic Retinopathy in Young Patients

BOSTON, MA – MAY 9: Student Kelly Noisetle checks out the feel of her new glasses at the Washington Irving Middle School in Boston’s Roslindale neighborhood on May 9, 2017. Dr.Tricia Rose provided free vision screenings, glasses and repairs to students of the Boston Public School through her group Envision Boston. (Photo by David L. Ryan/The Boston Globe via Getty Images)
Researchers show that screening examinations are lacking for minority youths.

Non-White youths are less likely to undergo diabetic eye examinations, a report in JAMA Ophthalmology shows. However, that same group are actually more likely to develop diabetic retinopathy (DR) compared with White youths. 

Researchers conducted a cohort study at a single academic center to assess the health disparities in diabetic eye examination completion rates and to evaluate barriers in individuals not previously screened. The study enrolled youths with type 1 or type 2 diabetes who met criteria for DR screening in an observational trial which implemented point-of-care DR screening and asked about prior DR screenings.

The researchers compared and stratified demographic and clinical characteristics between those who did and did not have a previous diabetic eye examination according to race/ethnicity. Outcome measures included multivariate logistic regression to analyze the association between race/ethnicity, screening, and other social determinants of health. Participants were administered a questionnaire assessing barriers to screening adherence.

The study found that 34.2% (n=51) of the 149 participants had not had a prior diabetic eye examination, and that there was a higher likelihood that these participants were non-White youths than those who had undergone prior diabetic eye examinations (38 vs 31, P <.001) and have type 2 diabetes (38 vs 10, P <.001), Medicaid or public insurance (43 vs 31, P <.001), lower household income (<$25,000, 21 vs 9, P <.001), and parents with education levels of high school or less (29 vs 22, P <.001). 

Of questionnaire responses, the most common barriers to DR screenings were not recalling such a recommendation in the past (56%), difficulty finding time for an additional appointment (29%), and transportation issues (20%). Non-White youths were more likely to have DR than White youths (15% vs 3%, P =.008), and they were also less likely to get diabetic eye examinations after adjusting for insurance, household income, and parental education level (P =.02).

The study explains that type 2 diabetes disproportionately affects racial/ethnic minority youths and those of lower socioeconomic status, and that these youths are at higher risk for developing DR. 

“Similar to prior studies in adults, miscommunication was a factor, in that participants did not recall the eye examination being recommended, as well as confusion between routine eye care and the diabetic eye examination,” the researchers explain. “This reiterates the need to clearly recommend a diabetic eye examination and discuss differences from routine eye care.”

Study limitations include its single-site recruitment design, possibly barring it from generalizability to other cohorts.

Disclosure: Some study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  


Thomas CG, Channa R, Prichett L, Liu TYA, Abramoff MD, Wolf RM. Racial/ethnic disparities and barriers to diabetic retinopathy screening in youths. JAMA Ophthalmol. Published online May 27, 2021. doi:10.1001/jamaophthalmol.2021.1551.