As a Black ophthalmologist specializing in retinal diseases, I’ve witnessed firsthand the disproportionate impact of diabetic retinopathy on Black communities in the United States. Despite recommended diabetic retinopathy screenings and advancements in treating diabetic eye disease, diabetic retinopathy remains a leading cause of vision loss in working-age adults, affecting Black patients more often. This stems from delayed eye screenings, advanced baseline eye disease, lack of awareness, limited access to specialists, and mistrust in the healthcare system. These barriers have resulted in significant and irreversible damage to blood vessels in the retina that may have been avoided if diagnosed with earlier treatments.
Early detection through regular screening is critical, yet about 50 percent of diabetics are not getting regular eye exams. This percentage is often higher in Black communities due to various systemic barriers. As healthcare providers, we must find ways to close this gap and ensure more Black patients receive timely screening and care to prevent long-term damage. Here are some key issues and potential solutions I’ve observed in my practice:
Meeting Black Patients Where They Are
Many Black patients face unique barriers to accessing specialty care. We need to explore ways to make screening more accessible, such as:
– Deploying screening cameras in primary care offices, community health centers, and Black churches
– Utilizing telemedicine and AI-assisted screening tools to reach underserved areas
– Partnering with Black community organizations to conduct outreach and education
The goal is to detect retinopathy in its early stages, before patients experience symptoms or vision loss. Once we identify at-risk patients, we can then refer them for full exams and any necessary treatment.
Improving Care Coordination and Cultural Competency
As specialists, we often operate in silos, but diabetic care requires a team approach. Some ways we can improve
coordination and cultural competency for Black patients:
– Send detailed letters to patients’ primary care doctors and other specialists after each visit, emphasizing any race-specific considerations
– Leverage EHR systems to improve information sharing between providers
– Have staff follow up with patients to ensure they complete recommended screenings and specialist visits, addressing any cultural or socioeconomic barriers
– Partner with endocrinologists, nephrologists, and other providers who see high-risk Black patients
– Increase diversity in our practices to better reflect the communities we serve
Providers should also strive to communicate clearly with Black patients about the importance of eye exams, even when they have no symptoms. Consider having staff follow up with culturally appropriate reminder calls or texts.
Addressing Socioeconomic Factors in Black Communities
It’s crucial to recognize that diabetic retinopathy disproportionately impacts Black communities, often tied to socioeconomic factors. Black patients often face multiple barriers including:
– Lack of access to healthy foods and safe spaces for physical activity in urban “food deserts”
– Limited health literacy and education about diabetes management and high blood sugar
– Transportation and scheduling challenges for doctor visits
– Cost barriers for medications and care
– Historical mistrust of the healthcare system due to past injustices
As providers, we should be aware of these challenges and work to address them. This may involve:
– Connecting patients with community resources and culturally tailored diabetes education programs
– Discussing potential cost barriers for medications and finding affordable alternatives when possible
– Offering flexible scheduling and telemedicine options when appropriate
– Partnering with Black community organizations to improve health literacy and diabetes self-management skills
Building Trust with Black Patients
For Black patients, there may be an added layer of mistrust in the healthcare system due to historical injustices and ongoing disparities. As providers, we have a responsibility to rebuild that trust. This involves:
– Treating all patients with equal respect and empathy
– Taking time to listen to patients’ concerns and answer questions thoroughly
– Being honest about diagnoses and treatment options
– Recognizing our own potential biases and working to overcome them
– Acknowledging the historical context of medical mistrust in Black communities
In my own practice, I’ve found that taking a few extra minutes to ensure Black patients feel heard and respected goes a long way in building trust and improving adherence to care plans. As a Black physician, I often see firsthand how patients respond positively to having a doctor who looks like them and understands their cultural context.
A Call to Action for Black Doctors
Diabetic retinopathy is largely preventable and treatable when caught early. Yet, too many Black patients are still losing vision unnecessarily. As healthcare providers, we have the power to change this. By improving screening rates, enhancing culturally competent care coordination, addressing socioeconomic barriers, and building trust with our Black patients, we can dramatically reduce the burden of diabetic eye disease in Black communities.
I challenge my fellow healthcare professionals to examine their own practices and the Black communities they serve. Where are the gaps in diabetic eye care? What creative, culturally appropriate solutions can we implement to bridge those gaps? By working together and thinking outside the box, we can ensure that more Black patients receive the timely care they need to preserve their vision and quality of life.
Diabetic retinopathy may not discriminate, but our healthcare system often does. It’s up to us to level the playing field and provide equitable, accessible care to all of our patients, with a particular focus on historically underserved Black communities. The eyes may be the windows to the soul, but for people with diabetes, they are also windows into their overall health. Let’s make sure we’re looking through those windows early and often, especially for our Black patients who have been overlooked for far too long.