The Role of Primary Care Providers in Diabetic Retinopathy Detection

Why Primary Care Providers Matter for Early Detection of Diabetic Retinopathy

38.4 Million patients in the U.S. have diabetes, and 97.6 million are “pre-diabetic”.² Diabetic retinopathy remains the leading cause of blindness among working-age adults in the U.S. Yet, despite clear guidelines and the availability of effective screening tools, a majority of patients with diabetes still go unscreened each year. This is where primary care providers (PCPs) come in.

PCPs are uniquely positioned to help identify patients at risk, initiate screening referrals and reinforce the importance of eye health during routine visits. In many communities, especially those with limited access to ophthalmology services, PCPs may be the only consistent point of contact for patients with diabetes.

Core Responsibilities in Diabetic Retinopathy Detection

The responsibilities of PCPs in diabetic retinopathy detection are threefold:

1.  Screening and Referral: PCPs should ensure patients with diabetes receive annual dilated eye exams or retinal imaging. Given the relatively low compliance rate for the diabetic retinal exam, exploring teleretinal solutions, like the Welch Allyn RetinaVue care delivery model, can help increase access to the exam for patients living with diabetes.

2.  Patient Education: Many patients are unaware that diabetes can lead to significant vision loss, even if their diabetes is under control.³ PCPs play a critical role in educating patients about the importance of regular eye exams, blood sugar control and recognizing early symptoms like blurred vision or floaters.^1,4

3.  Care Coordination: Managing diabetes is a team effort. PCPs can help coordinate care by ensuring eye exam results are shared across providers and follow-up appointments are scheduled when needed.

Challenges on the Front Lines

Despite their central role, PCPs face several challenges in diabetic retinopathy detection:

• Time Constraints: With limited time per patient visit, eye health discussions often take a back seat to more immediate concerns.
• Resource Limitations: Many primary care clinics lack access to retinal imaging equipment or resources to track referral follow-up.⁵
• Patient Engagement: A CDC study found that while most patients were aware diabetes could cause blindness, less than 50% had received a DR screening in the past year.⁶ Barriers like cost, transportation and low health literacy often go unrecognized by providers, leading to missed opportunities for intervention.⁶
• Divergent Perceptions:, Providers often overestimate barriers like language or cultural beliefs, while patients cite depression and financial stress as more significant obstacles.⁶ This disconnect has the potential to hinder effective communication and care planning.

To Improve Diabetic Retinopathy Detection, PCPs can Leverage These Strategies:

To improve diabetic retinopathy detection, PCPs can leverage these strategies:

• Implement Standing Orders or EMR Prompts: Automated reminders can help ensure diabetic retinopathy screening is addressed during regular annual visits.
• Leverage Teleretinal Imaging: Where available, solutions like the RetinaVue care delivery model allow retinal images to be captured in primary care settings and reviewed remotely by specialists — increasing access to exams and helping to close diabetes care gaps.⁷
• Use Patient-Centered Communication: Ask open-ended questions about vision changes and barriers to care. Confirm understanding by having patients repeat key messages.
• Engage Community Resources: Partner with local diabetes educators, community health workers, home care agencies or mobile screening units to reach underserved populations.⁸
• Track and Follow Up: Ensure referrals are completed and results are documented. A closed-loop referral system can prevent patients from falling through the cracks