What is Diabetic Retinopathy: How Primary Care Can Protect Patients with Diabetes

A simple description of diabetic retinopathy is; a complication of diabetes that can lead to preventable blindness and visual loss. However, considering the vast health implications for the 422 million people living with diabetes around the world, the reality of diabetic retinopathy is not so simple.¹,².

What is diabetic retinopathy? 

Diabetic retinopathy is the fifth leading cause of vision loss worldwide and is the number one cause of blindness in working-age Americans.³,⁴ 

The National Eye Institute describes diabetic retinopathy as a disease people with diabetes may develop that can cause vision loss and blindness. In diabetic retinopathy, blood vessels may break, close off, or new abnormal blood vessels may grow. The longer a person has lived with diabetes, the greater the chances they will develop some form of retinopathy, with studies showing an 8% chance of diabetic retinopathy development at 3 years from initial diabetes diagnosis to an 80% chance after 15 years.⁵ 

Diabetic retinopathy is a progressive disease that can advance over time from a very mild form of disease with no noticeable symptoms, to the most advanced stage of disease called proliferative diabetic retinopathy (including macular edema). In the later stages, abnormal blood vessels begin to grow in the retina, or blood vessels leak fluid into the retina, which can lead to visual loss and blindness. 

Early on, diabetic retinopathy is mostly symptomless, but in the late stages people may experience blurred vision, spots, and sudden loss of vision. If caught early, it is possible to avoid the symptoms that occur in the later stages.  

What about referrals to ophthalmologists and eye care specialists?  

After all, it is recommended that people with diabetes see their primary care provider every 3 months for diabetes management. At these appointments they will be reminded of the importance of caring for their vision and referred to an eye care specialist, when appropriate, as are part of their regular diabetes management.  

Unfortunately, even though patients hear about the referral to an eye care specialist at primary care, as low as 15% of people complete their regular recommended diabetic eye exam.⁶,⁷  

Why vision referrals don’t always work 

Even though most people with diabetes want to do the right thing for their eyesight, there are many challenging factors including appointments being far in the future, potential rescheduled appointments, fear of finding out they are going blind, or many other circumstances.  

Another reason can be a low perceived need for care. When a patient is not experiencing symptoms, scheduling a preventative appointment is not typically top of mind. Studies indicate 12% of the overall American population avoids medical care for that reason.⁵ Even more alarming are the 36% of Americans who avoid seeking care even if they suspect they should see a doctor.⁸ Patients with diabetes routinely miss eye exams despite blindness being their number one fear.⁹ This is illustrated by only 15% of patients with diabetes getting the regular eye exam they need.¹,¹⁰ 

In the US alone, 60,000 individuals go blind every year from diabetic retinopathy, which begs the question, what can be done to help facilitate timely follow up care with ophthalmologists after a patients’ annual checkup?¹⁰

Diagnose diabetic retinopathy early 

Early diagnosis is critical when it comes to identifying and managing diabetic retinopathy.¹¹ Vision loss or blindness can be minimized or possibly even prevented with early diagnosis and intervention.¹²

New technologies have been developed to target early diagnosis, and while you might think those technologies are reserved for specialists such as ophthalmologists and optometrists, fortunately there are now options to bring early diagnosis to the point-of-care. 

Diagnostic systems to identify diabetic retinopathy (including macular edema) have been perfected in recent years through the use of autonomous artificial intelligence (AI). A system utilizing autonomous AI, like IDx-DR, to detect and diagnose diabetic retinopathy (including macular edema) can image, identify, diagnose, and recommend next steps at the point-of-care, without the involvement of an eye care provider. Only if (sight threatening) disease is diagnosed, does the patient need to be seen by eye care provider to prevent visual loss or blindness. The autonomous AI exam requires an operator with minimal training, which means just about any tech or medical assistant can operate the system and there is no need for physician oversight or telemedicine overreads to provide a diagnosis at the point-of-care. 

As such, providers now have the ability to help patients with diabetes get their annual diabetic eye exam, right at the point-of-care. It also allows those providers to close the HEDIS and MIPS care gaps, as payors are incentivizing providers to get these diabetic eye exams done on their entire population with diabetes. This becomes particularly effective when you consider how many of those patients may have skipped out on their ophthalmologist or optometrist referral. Using AI technology allows for the referral of only those patients identified as most at risk and is backed with the weight of early disease identification. 

Eliminating vision loss caused by diabetic retinopathy and macular edema 

Is it possible to eliminate blindness caused by diabetic retinopathy and macular edema? Can you make a dramatic impact to those 30 million people each year who are at risk for blindness? Yes, you can. 

Offering the diabetic eye exam as part of a diabetes management visit enables point-of-care physicians to provide an eye exam on site for early diagnosis. This in turn supports proactive education opportunities, and a resulting referral to an ophthalmologist that is more likely to be successful.¹³

Diabetic retinopathy can steal vision from your patients. Now you can help stop the damage before it’s too late. 

References: 

  1. Diabetes. (n.d.). Retrieved March 24, 2021, from https://www.who.int/health-topics/diabetes#tab=tab_1National Eye Institute (2019). Diabetic retinopathy data and statistics. Accessed September 1, 2020. https://www.nei.nih.gov/learn-about-eye-health/resources- 
  2. for-health-educators/eye-health-data-and-statistics/diabetic-retinopathy-data-and-statistics 
  3. Economic Studies|Vision Health Initiative (VHI). (2017, April 11). Accessed September 01, 2020. https://www.cdc.gov/visionhealth/projects/economic_studies.htm 
  4. Fong, D., Aiello, L., Gardner, T., King, G., Blankenship, G., Cavallerano, J., . . . Klein, R. (2004, January 01). Retinopathy in diabetes. Retrieved March 24, 2021, from https://care.diabetesjournals.org/content/27/suppl_1/s84#:~:text=RISK%20FACTORS%20AND%20TREATMENTS&text=The%20duration%20of%20diabetes%20is,and%2080%25%20at%2015%20years. 
  5. OneSight – Top Leading Causes of Blindness Around The Globe. (n.d.). OneSight. Retrieved March 23, 2022, from https://onesight.org/news/top-leading-causes-of-blindness-around-the-globe/ 
  6. Taber, J et al (2015). Why do people avoid medical care? A qualitative study using national data. J Gen Intern Med. 2015 Mar; 30(3): 290-297. Accessed online Sept. 10, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4351276/ 
  7. Benoit, S. R., et al (2019). Eye Care Utilization Among Insured People With Diabetes in the U.S., 2010–2014. Diabetes Care, 42(3), 427-433. doi:10.2337/dc18-0828 
  8. Hatef, Vanderver, Fagan, Albert, Alexander. Annual Diabetic Eye Examinations in a Managed Care Medicaid Population. American Journal of Managed Care, 2015 
  9. Ye, J et al (2014). Health care avoidance among people with serious psycholigcal distress: Analyses of 2007 health information national trends survey. J Health Care Poor Underserved. 2012 Nov; 23(4): 1620 – 1629. Accessed online Sept. 10, 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039298/ 
  10. Savage, Sam (2006). U.S. Adults with diabetes fear blindness or vision loss more than premature death. Red Orbit, Health. Accessed online Sept. 14, 2020. https://www.redorbit.com/news/health/757152/us_adults_with_diabetes_fear_blindness_or_vision_loss_more/ 
  11. Varma, R., et al (2016). Visual Impairment and Blindness in Adults in the United States. JAMA Ophthalmology, 134(7), 802. doi:10.1001/jamaophthalmol.2016.1284 
  12. Kollias AN, Ulbig MW. Diabetic retinopathy: Early diagnosis and effective treatment. Dtsch Arztebl Int. 2010 Feb;107(5):75-83; quiz 84. doi: 10.3238/arztebl.2010.0075. Epub 2010 Feb 5. PMID: 20186318; PMCID: PMC2828250. 
  13. Diabetic retinopathy – Prevention. (2017, October 23). Nhs.uk. https://www.nhs.uk/conditions/diabetic-retinopathy/prevention/ 
  14. Liew, G., Michaelides, M., & Bunce, C. (2014). A comparison of the causes of blindness certifications in England and Wales in working age adults (16–64 years), 1999–2000 with 2009–2010. BMJ Open, 4(2), e004015. https://doi.org/10.1136/bmjopen-2013-004015