Abstract
Purpose :
Pregnant patients with pre-existing diabetes mellitus (DM) are at increased risk for development or progression of existing diabetic retinopathy (DR). The county hospital population is at risk due to numerous barriers to healthcare access. A quality improvement project was initiated to improve DR screening during pregnancy and identify individuals requiring expedited referral to ophthalmology. We aim to evaluate the utility of this project and report our 6 month results.
Methods :
In April 2018, we implemented a photographic retinal screening system in the Maternal Fetal Medicine (MFM) clinic at Santa Clara Valley Medical Center (SCVMC). We queried electronic medical records at SCVMC to obtain a list of pregnant patients with pre-existing DM, type 1 or type 2, seen in the MFM clinic from 4/16/18 through 10/15/18. Our primary data point was completion of nonmydriatic photographic screening. We also collected data on age, ethnicity, hemoglobin A1C, type of DM, prior status of DR, retinal photo interpretation, and referral plan.
Results :
A total of 42 pregnant patients with pre-existing DM were seen in the MFM clinic during the study period. The average age was 32.7 years, and the population was predominantly Hispanic (69.1%). Thirty of 42 patients (71.43%) underwent nonmydriatic photo screening. Among the 12 who did not, six had already undergone screening elsewhere, yielding an overall screening rate of 85.7% (36/42). Among readable images for 60 eyes, all but one eye showed no DR. The one eye with mild-moderate DR was unchanged from pre-pregnancy status. Repeat photographic screening in the third trimester of pregnancy or postpartum was advised for most patients (23/30, 76.7%). One patient was referred to ophthalmology clinic for a retinal finding unrelated to DM. Six patients had unreadable quality images in one or both eyes, and have or will undergo repeat photography at next appointment.
Conclusions :
The new DR screening system for pregnant patients with limited access to healthcare may prevent unnecessary referrals, decrease clinic visits, and expedite those in need of emergent evaluation. This can prevent progression and offer timely treatment of vision-threatening DR, and provide a cost-effective framework for ophthalmic care in a county system.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.