Strategies Proposed For Improving Diabetic Retinopathy Screening Adherence

Fluorescence angiogram of retina showing severity 1-A of diabetic retinopathy, associated with diabetes mellitus. The angiogram shows distinct, multiple microaneurysms.
Patients with prior exposure to diabetes through family and friends were more likely to comply with diabetic retinopathy evaluations, a study shows.

Strategies that may improve adherence to diabetic retinopathy (DR) screening include interventions that offer access to an individual with DR-related vision loss, and informative health communication messages, according to a study published in Clinical Ophthalmology

Researchers conducted a qualitative study utilizing semi-structured interviews to identify factors affecting compliance with DR evaluations between speakers of both English and Spanish. They enrolled 51 participants (58.8% men, mean age 56.8±10.7 years) in the study who spoke either English (n=30) or Spanish (n=21) and categorized them as adherent (n=32) or non-adherent (n=19) to DR screening and follow-up.  The researchers considered 59.4% (n=19) of speakers of English and 40.6% (n=13) of those who spoke Spanish to be adherent. 

The team found that adherent patients were more likely to have family and friends with complications related to diabetes (44%), and identify as being responsible for their own diabetic treatment (31%). Those who spoke English were more likely to report assuming personal responsibility for treatment adherence than those who spoke Spanish (30% vs 19%). Significantly more non-adherent patients suggested that beliefs and attitudes were the reasons people missed DR appointments and cited transportation issues (32%), cost (16%), and inconvenient appointment times (16%) as barriers to care.  

Patients who spoke English also reported better relationships with their physicians than those who spoke Spanish and were more likely to confide them with any information (40% vs 14%) or believe that their doctor did a good job of listening to them (67% vs 43%).  

“It is important for physicians to view challenges with DR screening compliance as part of the broader difficulties patients face in managing their diabetes care,” according to the researchers. They suggest that peer interventions that allow patients with DR to access a team member with DR-related vision loss may help to motivate non-adherent patients. They also assert that more information must be communicated to patients via pamphlets, videos, or other appropriate media.

Study limitations include a single center design and a study sample consisting exclusively of individuals from 1 geographic area. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Hudson SM, Modjtahedi BS, Altman D, Jimenez JJ, Luong TQ, Fong DS. Factors affecting compliance with diabetic retinopathy screening: a qualitative study comparing English and Spanish speakers. Clin Ophthalmol. Published online April 4, 2022. doi:10.2147/OPTH.S342965