Abstract
Purpose :
Diabetic retinopathy (DR) is a complication of long-standing diabetes mellitus (DM) and one of the leading causes of blindness amongst working age adults in the United States. It has previously been shown that racial minority groups receive diabetic retinopathy screening at lower rates leading to higher morbidity and DR related blindness; however, racial disparities regarding DR referral by primary care and factors associated with subsequent follow up have yet to be fully elucidated.
Methods :
Adult patients diagnosed with DM and subsequently referred to the ophthalmologist from 2015-2023 were identified using CTP/ICD codes. Retrospective chart review (n= 3,270) was conducted to gather data on patient demographics, comorbid diseases, date of DM diagnosis, time to referral, time to ophthalmology follow-up, and presence or absence of DR at initial ophthalmology evaluation. Statistical analyses including unpaired student t-tests and chi-squared tests were performed, with a p value of less than 0.05 being considered statistically significant. Age, sex, ethnicity, insurance status, and presence of ocular or systemic comorbid disease were adjusted for when calculating the relative risk (RR).
Results :
930 black patients and 2,218 white patients were diagnosed with diabetes mellitus during the 8 year period, of which 69.46% and 69.93% were referred for ophthalmic evaluation, respectively (p> 0.05). At the time of referral, black and white patients were equally likely to have a hemoglobin A1C > 7.0% and use insulin for glycemic control. Of the patients referred, 68.88% of white patients compared to 62.19% of black patients were seen by an ophthalmologist within one month of referral (adjusted RR, 1.31 [95% CI: 1.04-1.64]; p=0.0124). 15.10% of white patients and 15.91% of black patients were diagnosed with DR at initial ophthalmic evaluation after referral (adjusted RR, 1.07 [95% CI: 0.83-1.37]; p=0.0812).
Conclusions :
Minority patients at risk for DR who are referred to ophthalmology had a similar rate of referral after a diagnosis of DM was established. Racial minorities experience significantly longer wait times to see an ophthalmologist after a referral has been placed but were equally likely to have DR at initial ophthalmic evaluation. Factors affecting the racial disparities in timely ophthalmic care needs to be further evaluated to ensure equitable eye care for all diabetic patients.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.