Visual Aids to Promote Adherence and Compliance with Screening Guideline for Diabetic Retinopathy

Diabetic retinopathy (DR) is the leading cause of adult blindness in the United States. It afflicted 7.7 million Americans in 2010, is anticipated to rise to 11 million by 2030, and will nearly double by 2050. Early DR is a microvascular complication of diabetes with no visual warning symptoms. Studies show that early detection with an annual dilated diabetic eye exam can prevent serious vision loss or blindness caused by advanced DR. Challenges to annual screening adherence include the lack of patient understanding of diabetic eye diseases and the low rate of timely diabetic eye referrals by clinicians. Research supports the use of visual aids to enhance patient education in outpatient settings. Implemented at a primary care clinic with predominantly non-English-speaking Vietnamese patients, this pilot project was an evidence-based initiative to place culturally-appropriate, English and Vietnamese-translated DR infographic posters in exam rooms as a tool to enhance patient education on the importance of annual dilated eye exam and to promote the rate of timely eye referrals by clinicians. Patient surveys confirmed that the presence of DR infographic posters had a positive impact on patient perspective, with 96% of diabetic patients declaring a positive intent to pursue annual DR eye screening. Almost 50% indicated that the presence of DR posters was the sole factor that influenced their decision. Prior to implementation, a review of the clinic’s EMR showed that only 19% of diabetic or pre-diabetic patients had a referral or eye exam report from an eye specialist. This rose to 30% during implementation and increased to 33% post-implementation. The results from this pilot demonstrated that the use of culturally-appropriate visual aids in primary care clinics can influence both patient and clinician behaviors positively towards early and annual DR screening.