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

Background: Diabetic retinopathy (DR) is a leading cause of vision loss among working-age adults. However, the prevalence of DR among patients with diabetic foot disease-a signal of advanced systemic diabetes complications-is underexplored. Additionally, the substantial comorbidity burden associated with diabetic foot disease may result in a higher incidence of or distinct barriers to ophthalmic care, including structural (access to healthcare), behavioral (prioritization of care), and economic (cost of care) factors, compounding risk of vision loss. This study assesses the prevalence of DR in a podiatric clinic while also investigating participant-reported barriers to routine ophthalmic follow-up.

Methods: We conducted a cross-sectional study that included patients age ≥18 (n=62) receiving diabetic foot care at an outpatient podiatric clinic in 2021 and 2022. DR status was determined through point-of-care digital retinal images or prior DR diagnosis documented in the electronic medical record. Retinal images were interpreted remotely by a board-certified ophthalmologist. Self-reported barriers to regular ophthalmic care were recorded among participants who were lost to follow-up ophthalmic care. Participants were also surveyed for favorable incentives to promote ophthalmic follow-up.

Results: Our findings revealed a high prevalence of DR, with 32 (54%) participants diagnosed with DR and 10 (17%) participants having sight-threatening DR. Notably, 17 (29%) participants were newly diagnosed with DR as a direct result of this study. Of the 62 participants enrolled, 29 (47%) were lost to ophthalmic care. All of these participations reported one or more barriers to receiving ophthalmic care, predominantly related to competing social, economic, and medical challenges, with ophthalmic care being chronically underprioritized. Financial incentives were most favored by participants as an effective means to promote ophthalmic follow-up.

Conclusion: The high prevalence of DR, especially undiagnosed DR, in conjunction with significant barriers to ophthalmic care highlights a critical need for improved screening in outpatient podiatric settings. Integrating digital fundus cameras into outpatient podiatric clinic workflow may enhance DR detection and prevent vision loss in this high-risk population. Addressing identified barriers to routine ophthalmic care may further improve the rate of follow-up care and reduce the burden of DR-related vision loss among patients with diabetic foot disease.