Decreased Access to Preventive Ophthalmology Screenings in a High Risk Indigent Population in Norfolk, VA

Background: Diabetic retinopathy is the leading cause of blindness in American adults, while glaucoma is the leading cause of irreversible vision loss worldwide. Between 40 to 45 percent of Americans diagnosed with diabetes have some degree of diabetic retinopathy. Prevention is a key element of primary health care, and strict screening protocols significantly reduce the progression of both diabetic retinopathy and glaucoma. This study assessed the lack of preventive screening for diabetic retinopathy and glaucoma in the indigent population of Norfolk, VA.

Methods: A survey of past vision care, co-morbidities, and family history of ophthalmologic disorders was administered to all patients of a student-run free clinic in Norfolk, VA (H.O.P.E.S) over a four-month period. A prospective analysis of survey data was performed.

Results: Ninety unique patients were seen over the data collection period, and 76 patients were included in analysis. 14 patients were excluded due to incomplete data. Of the surveyed sample, 25% had been diagnosed with diabetes, a substantially higher percentage than the 9.3% prevalence rate reported for the US as a whole. Of these surveyed diabetic patients, 52.6% were overdue for diabetic retinopathy screening, and 50.0% of the patients categorized as high glaucoma risk were overdue for glaucoma screening according to American Diabetes Association and American Glaucoma Society guidelines. 

Conclusions: Low income, predominantly African American communities are at increased risk for preventable vision losses resulting from diabetic retinopathy and glaucoma. The population serviced by the H.O.P.E.S. free clinic is at severe risk for preventable vision losses.