Black Patients Referred Less Often for Eyecare at Diabetes Diagnosis

The critical gaps in the timely detection and management of DR among Black and Hispanic populations found in this study may contribute to the disproportionate impact of vision-threatening complications in these groups. Photo: Getty Images. Click image to enlarge. While previous research has shown that racial disparities exist regarding the prevalence of and associated vision loss from diabetic retinopathy (DR), not much is known about potential racial and ethnic disparities of diabetic eye exam referral patterns by primary care providers. In a recent study, researchers investigated referral patterns to ophthalmic specialists and found that Black patients were less likely to receive a referral at the time of diabetes diagnosis, and Hispanic patients were more likely to be referred at a more severe HbA1c compared to white patients. The findings were reported in Clinical Ophthalmology.A total of 10,995 patients diagnosed with type II diabetes at a tertiary medical center between 2015 and 2023 were included. Patient demographics, comorbidities, presence or absence of ophthalmology referral, HbA1c and insulin dependence at time of referral, time from referral to first ophthalmic appointment, as well as DR presence/stage at first ophthalmic exam after referral were collected.Of the white patients who were diagnosed with diabetes, 79.3% were referred for ophthalmology screening compared to 75.75% of Black patients. While the absolute difference between these groups was modest, the authors noted that it is a statistically significant difference. Black and Hispanic patients were more likely than white patients to already have DR by the time they attended this referral appointment.Additionally, Hispanic patients were more likely to have an A1c >7% at the time of their first referral as well as have a higher incidence of initiating intravitreal anti-VEGF therapy.The authors found it interesting that there was not a statistically significant difference in whether it took patients less or more than a month from their appointment referral date until their actual appointment.“These findings highlight critical gaps in the timely detection and management of DR among minority populations, which may contribute to the disproportionate impact of vision-threatening complications in these groups,” the authors wrote in their Clinical Ophthalmology paper.“Addressing these disparities requires not only improving referral practices at the point of diabetes diagnosis but also enhancing healthcare accessibility, provider education and patient outreach to ensure more equitable care.”The authors suggested that further research is needed to identify the underlying systemic, structural and clinical factors contributing to these disparities, ultimately aiming to reduce the visual morbidity associated with DR in vulnerable populations.Click here for the journal source. O’Neill KG, Buscho SE, Elmir Digbeu BD, et al. Unequal referral patterns to ophthalmology subspecialists based on race and ethnicity in diabetes mellitus: a retrospective analysis. Clin Ophthalmol. 2025;19:1609-16.