More Diabetic Retinopathy Screening? Primary Care May Be the Answer

Primary care may be an untapped resource for diabetic retinopathy screening, a new study suggested.

In a survey of over 3,200 adults with diabetes, nearly 88% visited a primary care physician within 12 months, reported Diane Gibson, PhD, of Baruch College at City University of New York, in JAMA Ophthalmology.

However, out of those who did not have a dilated eye exam within the previous year, 82.2% had a primary care visit — potentially serving as an underused resource for diabetic retinopathy screening.

“This report adds further evidence that screening for diabetic retinopathy in primary care settings could provide timely screening to a large portion of U.S. adults with diabetes, including those at high-risk of missing recommended eye examinations,” Gibson told MedPage Today, adding that this is particularly important “because timely screening increases the likelihood of the early detection and timely treatment of diabetic retinopathy.”

She explained that she looked at data from the 2016 National Health Interview Survey of adults with self-reported type 1 or type 2 diabetes and identified certain groups of people with diabetes who are at a higher risk for missing recommended eye exams. These include those who have type 2 diabetes, have a lower income and education level, lack insurance, are African American or Hispanic, and those who are not on insulin or oral medications to control their diabetes.

Gibson found that in addition to the uninsured group, over 78% of all these high-risk subgroups visited a primary care physician within the past 12 months.

Calling the analysis “very robust,” Avnish Deobhakta, MD, of New York Eye and Ear Infirmary of Mount Sinai in New York City, who was not involved with the study, praised it for its large sample size and said, “this is a useful way for primary care physicians and retina specialists to get a sense of whether diabetic patients are being appropriately screened for diabetic retinopathy.”

The findings underscore the need “for the medical community to be more vigilant about having patients receive appropriate eye care, while also being incredibly cognizant of the challenges that certain specific groups of patients may face in obtaining such care” — particularly for these high-risk subgroups, he told MedPage Today.

Gibson said that to address this issue and widen the scope of diabetic retinopathy screening, telemedicine screening should be added to primary care practices. Although a resourceful solution, however, this strategy has met with several barriers to implementation, she explained, including high equipment costs, primary care capacity constraints, varied insurance reimbursement, and the need for secure and confidential image acquisition, transfer, and storage systems.

Deobhakta said he also thinks telemedicine is an ideal solution for screening more patients: “Telemedicine is both increasingly useful and, ultimately, a necessary tool for delivering care, particularly for diabetic patients in rural areas or those for whom there exists access to a local primary care physician but limited access to a less local retinal specialist.”

He added that he also remains hopeful that the barriers to implementing this kind of screening will be addressed: “Some of the challenges at present, such as the outfitting of various primary care offices with the requisite equipment and the necessary staffing to ensure quality images for processing, will likely be solved in some capacity in the upcoming decade. In my estimation, the burgeoning application of artificial intelligence and deep learning algorithms to remotely take images, which increasingly can accurately flag patients with more severe disease for direct retina specialist care, will only serve to make telemedicine even more feasible in the long run.”