Patient, systemic barriers impede follow-up for diabetic retinopathy

Rishi P. Singh, MD

I congratulate authors Lu and colleagues on their analysis of patient-reported barriers to diabetic retinopathy follow-up. Indeed, their study demonstrates the significant barriers that our diabetic patients face in their assessments. The authors identified forgetting their appointments and other medical conditions were independent barriers associated with noncompliance. The issue of forgetting is complex, involving the lack of reminders from their eye providers and the busy life that patients with diabetes have because they are more likely to be working-aged adults with multiple medical conditions. Those with conditions such as diabetic retinopathy and diabetic macular edema are more likely to have diabetic neuropathy and nephropathy, so one can understand that their visit appointments are complex and significant. Patients within the study suggest having a reminder would improve compliance.
At the Cleveland Clinic, we provide app-based and text-based reminders for appointments days ahead. Transportation is an issue, and recently we have partnered with Uber to provide rides for patients at our cost to and from our faculty for care. Lastly, patients desire more education on the serious effects of diabetes and the importance of follow-ups. Most recent studies of the IRIS AAO database have identified that those with significant retinopathy have hastened rates of severe vision loss (Wykoff AAO 2018). Now in the realm of anti-VEGF treatments for diabetic retinopathy, practitioners have a greater ability to reduce progression in nonproliferative stages of diabetic retinopathy.
In summary, the study is foundational to our understanding of what we as eye can providers can do to help our patients preserve vision in diabetes.