Addressing Barriers to Health Equity: The Role of Timely Diagnosis and Health Literacy in Managing Diabetic Eye Disease

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EP: 1.Addressing Barriers to Health Equity: The Role of Timely Diagnosis and Health Literacy in Managing Diabetic Eye Disease

EP: 2.Challenges in Diabetes Therapy Adherence: Impact on Early Intervention and Long-Term Visual Outcomes

EP: 3.Improving Patient Adherence in Diabetic Macular Edema Eye Care

EP: 4.Impact of Step Therapy and Prior Authorization Requirements in Ophthalmology Practice

EP: 5.Physician Advocacy for Patient Access: Navigating Medication Authorization Challenges

EP: 6.Diversity and Inclusion in Ophthalmology Clinical Trials: Overcoming Challenges and Building Trust

EP: 7.Community Engagement and Long-Term Commitment: Fostering Trust and Collaboration in Clinical Trials for Ophthalmology

EP: 8.Addressing Differences in Social Determinants of Health Among Patients With Diabetes: The Role of Community Engagement

EP: 9.Promoting Equitable Patient Care: A Call for Self-Reflection and Awareness Among Providers

EP: 10.DME Disparities: Socioeconomic Impact and Health Equity

EP: 11.Provider Roles and Collaborative Efforts for DME Disparities

EP: 12.Closing Gaps in DME Care: Harnessing the Power of Comprehensive Data Strategies

EP: 13.Ensuring Equitable Patient Care in DME: Unconscious Bias Training and SDOH Screening

EP: 14.Collaborations and Inclusivity for Equitable DME Care

EP: 15.Building An Equitable Future: Strategies for DME Advocacy

Joseph M. Coney, MD, FACS: Some of the biggest barriers that I face when seeing patients, particularly when it comes to health equity, is the timing of when I see patients. I think the diagnosis of patients is really critical, and there are several barriers that may limit the patients from coming in early enough to be diagnosed [with diabetic macular edema]. We know that the American Diabetes Association recommends patients to be evaluated, particularly those with type 2 diabetes, at the time of diagnosis. The problem is that 50% of individuals who have diabetes don’t come in early enough. There’s a study out of Joslin that shows that of individuals with sight-threatening problems, 50% of them are diabetic but are not even aware of it, so we know that we’re not getting patients [to come in] early enough.

When it comes to the health equity piece, I think health literacy is important. Getting the information out about when patients should actually come in is crucial. The reason why this is important is that the single most important prognostic factor is the level of the disease they present with. When patients come in with more or less severe nonproliferative diabetic retinopathy, I know that 50% of these eyes will experience a loss of vision over the next 2 or 3 years. Unfortunately, this affects underserved communities more because they often come in with much more advanced disease. Oftentimes, insurance may be a barrier as well, and I may be limited in the medications I can give them. This also deals with the burden of therapy, how often someone needs to come in for testing and treatment. Ultimately, it boils down to the efficacy of my therapies in terms of managing the disease and achieving disease stability.

Some individuals will have a greater burden of therapy when it comes to injections, and not everyone will need aggressive injections every 4 to 6 weeks. But because these communities often have much more advanced disease when they present, I think their prognoses tend not to be as good, or at least the rapid improvement in vision may not be as significant. The overall care of the eyes may take a little longer before we can get them stable.

This transcript is AI generated and reviewed by an AJMC® editor.