Prevalence of Diabetic Retinopathy in Patients with Limited English Proficiency

Abstract

Purpose : This retrospective observational study compares the prevalence and severity of diabetic retinopathy (DR), and the likelihood of receiving anti-vascular endothelial growth factor (anti-VEGF) treatments in limited English proficiency (LEP) patients compared to English proficient (EP) patients.

Methods : We used the Cataract Surgery Outcomes Database to analyze the records of patients who underwent cataract surgery at the University of Colorado between 2014 and 2019. LEP was defined as a need or preference for an interpreter during medical encounters. Demographic and pre-operative characteristics analyzed included gender, race/ethnicity, age, prevalence of diabetes, history of macular edema, and history of DR. Comparisons between groups were made using logistic regression analysis with general estimating equations to account for patients with two eyes included in the study.

Results : A total of 868 LEP and 12,722 EP patients were analyzed. LEP patients had a significantly higher rate of type 2 diabetes (44.9% vs 21.5%, p<0.0001), macular edema (9.8% vs 2.9%, p<0.0001), and DR (18.1% vs 5.8%, p<0.0001). In patients with DR, LEP patients were more likely to receive anti-VEGF injections (34.4% vs 23.5%, p=0.028) and have more severe DR (severe non-proliferative DR 8.3% vs 6.5%, proliferative DR 58.6% vs 42.9%, p=0.023). LEP patients receiving anti-VEGF injections were less likely to receive >25 injections (2.3% vs 11.3%) and more likely to receive <10 injections as compared to EP patients (73.3% vs 65.5%, p = 0.111).

Conclusions : Our data suggests that LEP patients are at increased risk for DR and associated complications. Interestingly, we found that while a greater proportion of LEP patients receive anti-VEGF injections, they are less likely to receive as many injections overall compared to EP patients. This may suggest that LEP patients receive less consistent follow-up care. While this study represents a first step towards examining the relationship between EP status and DR, further studies are needed to better understand how language influences patient outcomes.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.