Sight-Saving Engagement and Evaluation in New Haven (SEEN) Program Engages Individuals with Excellent Vision at High-Risk for Blindness from Diabetic Retinopathy

Abstract

Purpose : It is unclear how best to address social determinants of health (SDH) of patients at high-risk for diabetic retinopathy (DR). We implemented an intervention that includes ophthalmic evaluation, DR education, SDH care coordination and patient navigation for participants at high-risk for DR.

Methods : We identified 35 participants at high risk for blindness from DR in the electronic health record (EHR) based on the SEEN risk calculator. Inclusion criteria included adults with diabetes without an eye exam within one year of outreach. We screened participants using the SEEN risk calculator that includes glycemic control (HbA1c) systemic co-morbidities (hypertension, stroke, heart attack, non-healing foot ulcers, renal failure, cholesterol). Participants in the highest quartile of risk 3- or 5- year risk for progression (range 18%-25%) were invited to participate via telephone or EHR outreach. Participants that met the criteria signed informed consent, underwent comprehensive eye examination with fundus photography and optical coherence tomography, viewed a co-designed informational video, and met with Project Access New Haven (PA-NH), our patient navigation and care coordination community partners. Each participant completed a questionnaire to identify adverse social determinants of health. PA-NH addressed determinants participants identified as important and engaged participants quarterly. We evaluated baseline cohort demographics using descriptive statistics.

Results : A total of 35 participants (women, 52%) participated in the SEEN Program. Mean age [SD] was 52.3 [13.7] years. Mean HbA1c [SD] was 10.3% [2.5]. Most participants identified as Black (42.9%) and non-Hispanic (73.5%). Most participants had public insurance (85.7%) and all had a primary care provider. Nearly 80% of participants reported a history of stroke and over a quarter reported acute myocardial infarction. Average 3- year risk of progression of DR was 22%; 5-year risk was 27%. Mean visual acuity was Snellen equivalent 20/25 (80[10] EDTRS). Mean IOP was 15[4]. Over 80% of participants did not have any retinopathy.

Conclusions : Most of the successfully enrolled high-risk participants not engaged in eye care did not have retinopathy. The SEEN Program is an effective intervention to identify and engage those at high-risk for DR with significant SDH and co-morbidities.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.