A Pragmatic Intervention to Increase Screening of High-Risk Individuals for Diabetic Retinopathy

Diabetic retinopathy (DR) is a leading cause of blindness among U.S. working-age adults. Hispanic and Black individuals with diabetes are disproportionately impacted. Early detection of DR can prevent vision loss; however, at least 30% of patients at risk are not screened. Data were collected in a primary care clinic from September 2023 - August 2024. People with diabetes overdue for an eye exam were referred for photo screening during a primary care visit. Referrals, screening completion, interpretation of results, and follow-up eye visits were recorded in the electronic health record (EHR). After screening, individuals were asked to complete an experience survey. Of the 124 individuals referred during their primary care visit, 78% (n=97) completed the screening. Of those screened, 77% (n=75) resulted in interpretable findings. Of these 75 screened patients, 9% (n=7) detected severe (vision threatening) DR and 24% (n=18) detected mild to moderate DR. 24% completed the experience survey. 22 respondents (96%) reported that it was very easy to get their eyes screened. Half reported that they would not have scheduled a separate screening visit if it hadn't been offered as part of their visit. All respondents recommend the intervention. We detected significant eye findings, including vision threatening retinopathy among a population likely to not have been otherwise screened. Patients reported positive experiences and recommended this approach. That we accomplished this at a primary care clinic location with a higher percent of patients of color than our general patient population indicates a contribution to equitable diabetes outcomes.