Patients of racial and ethnic minority groups are disproportionately affected by both diabetes and diabetic complications, such as diabetic retinopathy (DR) and diabetic macular edema (DME), according to a review published in the Journal of the National Medical Association. Untreated, these complications can permanently impair vision and quality of life.
The prevalence of diabetic retinopathy is approximately 30% for all adults older than 40 years of age in the US. Studies show that patients who are Black or Latino are 2 to 3 times more likely than patients who are White to develop DR and DME, and yet they are less likely to receive appropriate screening.
Despite recommendations for diabetic retinopathy routine fundus screening, an estimated 33% to 68% of adults with diabetes undergo an annual dilated eye exam, and screening rates are lower among Black and Latino individuals than White individuals. Lack of screening has been attributed to a variety of factors, including patient, provider, and institutional barriers.
“The single most important prognostic factor for diabetic eye disease is the initial baseline severity level of DR at presentation,” investigators report. “Because of suboptimal screening, racial and ethnic minorities often present to the ophthalmologist with more advanced stages of diabetic eye disease or after they have already lost vision.”
The study highlights known barriers to recommended DR screening. Among the barriers is the lack of proper patient education, treatment cost to the patient, and lack of access to care. Provider-level and system-level factors in particular include a lack of awareness of screening guidelines, skills, or equipment to perform eye exams; limited patient-provider communication; time limitations; primary care provider referral patterns; insurance issues, understaffing of eye care personnel, and long-wait times for patient appointments.
It also highlights both patient-level and provider-level interventions to improve recommended diabetic retinopathy screening. Patient-level interventions include improved patient education about diabetic retinopathy, prevention, screening and treatment; reminders/personalized follow-up; and diabetes self-management programs. Provider-level interventions include provider education regarding diabetic retinopathy, screening guidelines, and performing exams; aids to increase guideline adherence; provider self-audit tools; training to improve provider-patient communication; cultural competency training; training in interpreter use; provider reminders such as prompts in electronic medical records; improved access for patients (such as using telehealth, mobile clinics, and retinal imaging technology in primary care providers’ offices); population-based screening programs and diabetes management programs; and community-based diabetes management and diabetic retinopathy screening programs.
“It is important to recognize and understand this disparity in eye care, because unlike other retinal diseases, the vision loss and blindness from [diabetic retinopathy] is largely preventable with early detection and prompt treatment,” researchers explain.
Coney JM, Scott AW. Racial disparities in the screening and treatment of diabetic retinopathy J Natl Med Assoc. Published online January 29, 2022. doi:10.1016/j.jnma.2021.12.011