Baseline Characteristics and Clinical Outcomes of Patients Seen Through the Free Diabetes Screening (FDS) Program

Pamela L Nguyen; Jose Amezcua Moreno; Diep Tran; Kathleen McHugh; Fasika A Woreta; Megan E Collins; Cindy X Cai

doi:10.2147/OPTH.S483004

Baseline Characteristics and Clinical Outcomes of Patients Seen Through the Free Diabetes Screening (FDS) Program

Clin Ophthalmol. 2024 Nov 11:18:3227-3236. doi: 10.2147/OPTH.S483004. eCollection 2024.

Authors

Pamela L Nguyen¹, Jose Amezcua Moreno¹, Diep Tran¹, Kathleen McHugh^{2

3}, Fasika A Woreta¹, Megan E Collins^{1

4}, Cindy X Cai^{1

5}

Affiliations

¹ Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Shepherd's Clinic, Baltimore, MD, USA.
³ Primary Care, MedStar Medical Group, Columbia, MD, USA.
⁴ Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA.
⁵ Biomedical Informatics and Data Science, Department of Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD, USA.

Abstract

Purpose: To characterize the baseline characteristics and clinical outcomes of patients seen through the Free Diabetic Screening (FDS) program, a free diabetic retinopathy screening program for uninsured patients, in the ophthalmology resident clinic at the Wilmer Eye Institute.

Patients and methods: This retrospective longitudinal cohort study included uninsured patients ≥18 years with diabetes mellitus seen through the FDS clinic from 2013 to 2023. Data extraction was performed using manual chart review of the first FDS visit, and automated extraction of the data warehouse related to all other office visits. Patient demographic and clinical characteristics at presentation, treatments, and follow-ups were collected.

Results: A total of 422 patients were included in this study (mean age 52 years; 59% female; 47% Hispanic; 49% Spanish as primary language). One-third of patients had some form of diabetic retinopathy or diabetic macular edema, and 12% had vision-threatening diabetic retinopathy at presentation. In all, nearly 10% of patients were referred for further specialty care, and 71% of these patients completed at least one follow-up visit. The majority of patients (55%) returned for care as recommended and were followed for a mean length of 200 weeks and 10 office visits.

Conclusion: The FDS clinic provided much needed diabetic retinopathy screening and treatment for uninsured patients in Baltimore City and surrounding areas. This study highlights the need for strong integration between initial screening and downstream services, as nearly 10% of patients require further sub-specialty intervention or care.

Keywords: diabetic retinopathy; free clinic; health disparities; uninsured.

Grants and funding

This project was supported by a K23 award from the NIH/NEI (award number K23EY033440) (CXC), the Wilmer Summer Scholars Program (PLN), and an unrestricted grant from Research to Prevent Blindness (Wilmer Eye Institute). Dr. Cai is the Jonathan and Marcia Javitt Rising Professor of Ophthalmology.