Prevalence of Diabetic Retinopathy and Self-reported barriers to Eye Care among Patients with Diabetes in the Emergency Department

Abstract

Background: Diabetic retinopathy (DR) is a sight-threatening condition that causes progressive retina damage. Screening for DR is suboptimal, and patients with diabetes who present to the emergency department (ED) may be at particularly high risk of undiagnosed DR. Although DR screening is a basic component of diabetes care, uptake of screening programs is less than optimal.  The aim of this study is: To determine the prevalence of DR among diabetic patients who present to the ED of our tertiary medical center using tele-ophthalmology and to assess self-reported barriers to eye care. Methods: A cross-sectional, single-institution study recruited clinically stable diabetic patients who presented to the ED during daytime hours over 29 total weekdays across 2 months from January to February 2022 in KSA. Participants had nonmydriatic, 45-degree, single-field digital retinal photographs taken on site (Digital Retinal System, Centervue). Following retinal imaging, participants then completed a survey about barriers to regular eye care and their acceptance of potential interventions to promote screening. Digital retinal photographs were [1]interpreted remotely by a board-certified ophthalmologist and communicated to participants’ primary care physician and/or endocrinologist. Results: Over the study period, 275 ED patients had a documented diagnosis of diabetes, of which 167 were deemed clinically stable for the study and 141 were invited to participate. Sixty-four were enrolled, of whom 50 had gradable-quality fundus images (78%). Of these 50 patients, almost all had type 2 diabetes (47, 94%), with an average disease duration of 12±9 years and mean hemoglobin A1c of 8.1±2.0% (mmol/mol). Based on fundus photography, 14 patients (28%) were diagnosed with DR, which was newly diagnosed for 10 (20% of the total study population). Severity was most commonly mild or moderate (12/14, 86%), with 1 case of severe non-proliferative DR and 1 proliferative DR. The majority (26, 52%) reported at least one barrier to routine eye care in our self-administered survey, of which having too many appointments (6, 12%) and cost (5, 10%) were frequently cited as most important. The majority were receptive to interventions to promote DR screening, including reminder phone calls (29, 58%) and text messages (28, 56%). Conclusions: Digital fundus photography in the ED detected a high rate of undiagnosed DR. Half of participants reported barriers to routine care, and most were receptive to messaging interventions to schedule an eye exam. Future studies are warranted to assess scalability of ED-based screening programs and their follow-through rates.