Researchers target screening rates for diabetic retinopathy among low-income minority patients

(Image Credit: AdobeStock/meenon)

Researchers with the OhioHealth Grant Medical Center Family Medicine practice implemented diabetic retinopathy screening using in-clinic retinal photographs and automated software analysis to increase screening rates among low-income minority patients.

According to the American Academy of Family Physicians, about 33% of diabetic adults in the US do not receive annual eye exams. Additionally, lack of pupillary dilation before exams is associated with ungradable, or insufficient exams.^1,2

Nearly 2 years ago, the OhioHealth Grant Medical Center Family Medicine practice implemented on-site diabetic retinopathy screening using digital fundus photography and automated retinal imaging without dilation. The practice later introduced eye dilation for specific patients.³

The researchers noted they started to perform on-site diabetic retinopathy screening without eye dilation using the TRC-NW400 Non-Mydriatic Retinal Camera (Topcon Corp) and the IDx-DR program (Digital Diagnostics).

“We taught physicians and staff to ask patients about prior exams and obtain outside records, employ non-clinical medical assistant staff to perform eye exams, and refer patients with positive screens or uninterpretable results to ophthalmology,” they wrote in the study. “Successful processes included identifying patients due for retinopathy screening before appointments and using our electronic health record to remind physicians and staff to perform screening at the point of care.”

By identifying patients needing screening before appointments and using electronic health record reminders, the clinic increased the rate of interpretable exams from 20% in November 2022 to 35% in May 2023. That same month, the clinic started to offer eye dilation to patients older than 64 years of age and to those who failed non-dilated exams. According to the news release, the change reduced the insufficient exam rate from 36% to 22% over the following 8 months.³

Moreover, the clinic’s retinopathy detection rate increased from 11% to 18% between September 2022 and January 2024. By January 2024, the screening rate was 57% for patients not seen in a year and 65% for those seen within the year.

“Our efforts resulted in a substantial and sustainable increase in the number of patients who received diabetic retinopathy screening,” the researchers wrote. “The greatest increase in retinopathy screening came after clinic managers began reminding staff through electronic health record reminders to perform screening during appointments.”

The researchers concluded that offering dilated eye exams further reduced the rate of insufficient exams. Overall, the strategy of using in-clinic retinal photographs with software interpretation and selective eye dilation effectively increased screening rates for our patients from socially disadvantaged populations.

“Dilated diabetic retinopathy screening in the primary care setting using in-clinic retinal photographs and automated software interpretation resulted in a large, sustainable increase in diabetic retinopathy screening rates for our underserved patient population,” the researchers concluded.

References:

1. Gibson DM.Estimates of the percentage of US adults with diabetes who could be screened for diabetic retinopathy in primary care settings. JAMA Ophthalmol. 2019; 137(4): 440-444.doi:10.1001/jamaophthalmol.2018.6909

2. Sloan FA, Brown DS, Carlisle ES, Picone GA, Lee PP.Monitoring visual status: why patients do or do not comply with practice guidelines. Health Serv Res. 2004; 39(5): 1429-1448. doi:10.1111/j.1475-6773.2004.00297.x

3. Jonathan Yun, Spencer Schell, Kevin Gulley and Michael E. Johansen; Dilation Before Automated Diabetic Retinopathy Screening Performed in the Primary Care Setting. The Annals of Family Medicine July 2024, 22 (4) 356; Accessed July 29, 2024; DOI: https://doi.org/10.1370/afm.3133