Overcoming health disparities in diabetic retinopathy


Image credit: AdobeStock/blackday

(Image credit: AdobeStock/blackday)

Reviewed by Kristen Nwanyanwu, MD, MBA, MHS

The subject of health disparities in eye care is not a new topic, but it is one that deserves the spotlight. Kristen Nwanyanwu, MD, MBA, MHS, the Department of Ophthalmology and Visual Science, Yale University School of Medicine, discussed how the gap is being closed at the Envision Summit in Puerto Rico.

Three following facts are clear. Black, Latino, and Indigenous people have a higher prevalence and more severe forms of disease, less privileged sociodemographic census tracts have increased diabetic retinopathy, and neighborhoods have increased hemoglobin A1c levels even after accounting for income, race, and education,1-6 Nwanyanwu said.

In the nutshell, marginalized groups have less access to diabetes screenings, are diagnosed later, treated less often, and as a result go blind more often.7-10

Programs underway

With the recognition of this scenario, the following groups have taken action.

The National Academy of Science developed a model centered on improved population eye and vision health and health equity.11 The components of the model include generation of evidence, expanded access to clinical care, enhanced public health capacity, promotion of community action, and increased public awareness.

A National Academy of Medicine model focuses on achieving health equity through transformed systems of health with efforts to strengthen partnerships and alliances, expand knowledge, improve health and health care programs and policies and achieve thriving communities.12

Yale’s Sight-saving Engagement and Evaluation in New Haven Lab approach embraces using Big Data, Community Engagement, and Implementation Science to advance equity in diabetic retinopathy screening and outcomes. The spotlight is on education, evaluation, and navigation.

“We’ve never seen health equity, but if we dream together, we can make it happen,” she concluded.

1. Wong TY, Klein R, Klein BEK. Epidemiology and risk factors of diabetic retinopathy. Diabetes and ocular disease. past present, and future therapies. Scott IU, Flynn HW, Smiddy WE, eds. New York: Oxford University Press, 2010;71-89
2. Harris MI, Klein R, Cowie CC, et al. Is the risk of diabetic retinopathy greater in non-Hispanic blacks and Mexican-Americans than in non-Hispanic white with type 2 diabetes? Diabetes Care. 1998;21:1250-1235.
3. Bachman MO, Eachus J, Hopper CD, et al. Socio-economic inequalities in diabetes complications, control, attitudes and health service use: a cross-sectional study. Diabet Med. 2003;20:921-929.
4. Spanakis EK, Hill Golden S. Race/ethnic difference in diabetes and diabetic complications. Curr Diabet Rep. 2013;13:814-823.
5. Bihan H, Laurent S, Sass C, et al. Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score. Diabet Care. 2005;28:2680-2685.
6. Geraghty EM, Balsbaugh T, Nuovo J, et al. Using geographic information systems to assess outcome disparities in patients with type 2 diabetes and hypertension. J Am Board Fam Med. 2010;23:88-96.
7. Lundeen EA, Andes LJ, Rein DB, et al. Trends in prevalence and treatment of diabetic macular edema and vision-threatening diabetic retinopathy among Medicare Part B Fee-for-Service Beneficiaries. JAMA Ophthalmol. 2022;140:345-353.
8. Lundeen EA, Wittenborn J, Benoit SR, Saaddine J. Disparities in receipt of eye exams among Medicare Part B fee-for-service beneficiaries with diabetes - United States, 2017. MMWR Morb Mortal Wkly Rep. 2019;68:1020-1023.
9. Malhotra NA, Greenlee TE, Iyer AI, et al. Racial, ethnic, and insurance-based disparities upon initiation of anti–vascular endothelial growth factor therapy for diabetic macular edema in the US. Ophthalmology. 2021;128:1438-1447.
10. Yusuf R, Chen EM, Nwanyanwu K, Richards B. Neighborhood deprivation and adherence to initial diabetic retinopathy screening. Ophthalmol Retina. 2020;4:550–552; published online 2020 Jan 28. doi:10.1016/j.oret.2020.01.016
11. National Academies of Sciences, Engineering, and Medicine. 2016. Making eye health a population health imperative:Vision for tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471
12. https://nam.edu/programs/value‐science‐driven‐health‐care/achieving‐health‐equity-and‐systems‐transformation‐through‐community‐engagement‐a‐conceptual‐model
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