On the first Friday of each month, in the Patient Access Center for the Eye (PACE) clinic at Wilmer Eye Institute, Johns Hopkins Medicine, retina specialist Cindy Cai provides eye exams to diabetic patients as part of the Free Diabetic Screening (FDS) program.
Recent data released by the U.S. Census Bureau finds that nearly 7%, or approximately 414,000, Maryland residents and about 8%, or roughly 44,000, Baltimore City residents, are uninsured, respectively.
That’s why Cai says it’s crucial to provide an avenue for the uninsured diabetic patient to have a screening eye exam. “When diabetics miss an annual eye screening or treatment, it could lead to blindness,” warns Cai.
In a 2020 report, the Centers for Disease Control found that about 34 million Americans have been diagnosed with diabetes, while upwards of 85 million American adults are prediabetic. The American Diabetes Association reports that about 42,000 Marylanders are diagnosed with diabetes yearly. Diabetic eye disease manifests in many forms. If not managed properly, uncontrolled diabetes can lead to cataracts, glaucoma, and diabetic retinopathy — the leading cause of vision loss in American adults.
There are two types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). NPDR occurs when blood vessels in the retina become damaged causing leakage and bleeding, sometimes leading to macular edema or vision loss. PDR is more severe. In this case, the retina produces new blood vessels that bleed into the vitreous, a jelly like substance that fills the eye, causing floaters. Additionally, vision-threatening scar tissue can develop, which can cause the retina to detach.
2022 will mark 30 years for the program that stemmed from the critical need to provide uninsured patients with diabetic eye screenings. Spearheaded by Daniel Finkelstein, the Andreas C. Dracopoulos Professor of Ophthalmology, the program offered free diabetic eye exams through Wilmer’s retina division and, if needed, laser treatment in clinic. Finkelstein ran the FDS program in PACE until 2017.
“It is so very important to have programs like these to educate, prevent vision loss, and to provide health advice to those in need,” wrote Finkelstein in the 2016 FDS Annual Report. “We want to do everything in our power to see that the tragedy of unnecessary blindness does not continue to rise.”
Cai points out that the durability and sustainability of the program is due to the work of Finkelstein and the strong partnerships he built with referring clinics, such as the Esperanza Center, Shepherd’s Clinic and Healthcare for the Homeless, as well as the providers themselves.
Cai’s team consists of one research coordinator and four undergraduate students. While in clinic, the team is joined by an ophthalmic technician and a resident. As a recent graduate of the Wilmer residency program herself, Cai says that she is privileged to mentor and contribute to the education of young ophthalmologists.
In her research, Cai is looking into disparities in health care, in particular social determinants that hinder patients from attending doctor’s appointments, such as access to transportation. “I’m hoping to gather enough evidence so that we can address the social determinants of health as part of our medical treatment for patients seeking eye care,” says Cai. “When they visit the eye doctor, we can ask about some of these important issues to help make the best decisions for their eyes and offer resources to promote adherence.”
Cai would like to expand the FDS program by increasing the number of days the clinic is held, expanding the template to allow for more patient scheduling and potentially using artificial intelligence to detect diabetic retinopathy, thereby streamlining patient care.