High Prevalence of Diabetic Retinopathy in an Outpatient Podiatry Clinic and Associated Barriers to Ophthalmic Care

A recent study published in Clinical Ophthalmology highlights a significant prevalence of diabetic retinopathy (DR) among patients receiving diabetic foot care in an outpatient podiatry clinic. The research, conducted by a team from the University of Pittsburgh Department of Ophthalmology, along with the Department of Podiatry and Department of Statistics, aimed to assess the prevalence of DR in this specific patient population and to identify barriers to routine ophthalmic follow-up care. Department of Ophthalmology faculty included on the research team include Andrew M. Williams, MD, and Evan L. Waxman, MD.

Study Overview

The cross-sectional study included 62 patients aged 18 and older who were receiving care for diabetic foot disease in 2021 and 2022. DR status was determined through point-of-care digital retinal imaging or prior DR diagnoses documented in electronic medical records. Retinal images were interpreted remotely by a board-certified ophthalmologist. Additionally, participants who were lost to ophthalmic follow-up were surveyed to identify self-reported barriers to regular eye care and to gather suggestions for incentives that might promote follow-up.

Key Findings

• High Prevalence of DR: The study found that 54% of participants (32 individuals) were diagnosed with DR, and 17% (10 individuals) had sight-threatening DR. Notably, 29% (17 individuals) were newly diagnosed with DR as a direct result of the study.

• Loss to Ophthalmic Care: Nearly half of the participants (47%, or 29 individuals) were not engaged in routine ophthalmic care. All of these individuals reported one or more barriers to receiving eye care, which were predominantly related to competing social, economic, and medical challenges. These challenges led to ophthalmic care being chronically underprioritized.

• Preferred Incentives: Among the participants, financial incentives were most favored as an effective means to promote ophthalmic follow-up.

Conclusions and Recommendations

The study underscores the critical need for improved DR screening in outpatient podiatric settings. Integrating digital fundus cameras into the workflow of podiatric clinics may enhance the detection of DR and prevent vision loss in this high-risk population. Furthermore, addressing the identified barriers to routine ophthalmic care could improve follow-up rates and reduce the burden of DR-related vision loss among patients with diabetic foot disease.

These findings suggest that podiatric clinics could serve as strategic points for DR screening, especially for patients who may not regularly access ophthalmic services. By implementing targeted interventions and addressing systemic barriers, healthcare providers can work towards reducing the incidence of vision loss due to DR in vulnerable populations.