# Undiagnosed Diabetic Retinopathy: Using Participatory Science to Design an Intervention for Patients at High-Risk for Blindness

> **NIH NIH K23** · YALE UNIVERSITY · 2020 · $254,417

## Abstract

Project Summary/Abstract
There are several gaps in our understanding of the population with diabetic retinopathy (DR) that is not being
screened and how best to manage those at high-risk for DR. Continued existence of these gaps underlies the
difficulty in addressing the long-term goal of the proposed research program: to decrease preventable blindness
from DR. The overall objective of this proposal is to design a patient navigator intervention for those at high-risk
for DR informed by a national analysis of undiagnosed DR. The central hypothesis is that the candidate can
create a feasible and acceptable program to increase utilization of eye care in those at high-risk for DR. The
rationale for the hypothesis is that engaging high-risk patients with diabetes in eye screening will facilitate earlier
treatment of DR and decrease preventable blindness. The proposal features a multi-method approach to
determine the prevalence and the individual and neighborhood level characteristics of undiagnosed DR, and a
patient navigation program pilot study for those at high-risk for DR. The candidate will reach the overall objective
by pursuing the following two specific aims: 1) Determine national prevalence of undiagnosed DR with a focus
on racial and ethnic disparities and geospatial variation; and 2) design and pilot a patient navigator program for
those at high-risk for DR. For the first aim, a representative sample of the US population will be evaluated using
the National Health and Nutrition Examination Survey, 2005-2008. Participants who underwent fundus
photography and were diagnosed with DR based on software-assisted image grading will be included in the
analysis. Those who reported a prior diagnosis of DR in an in-home interview will be compared to those that did
not report a diagnosis of DR. For aim two, the Tailored Implementation for Chronic Disease implementation
science framework will inform the design of the program. First, we will conduct semi-structured interviews with
local community members with diabetes who have not had an eye exam within 1 year. Second, the determinants
identified during the interviews and in the first aim will be applied to the framework. Third, determinants will be
prioritized and a multidisciplinary team of stakeholders will design of the program. Fourth, sixty participants will
be recruited from a population with diabetes stratified by eye care utilization and risk based on data from the
institutional electronic medical record. The program will include an individual patient navigator assessment, a
clinical evaluation, an educational experience, and patient navigator follow-up. This approach is innovative
because it identifies the population with undiagnosed DR, uses a risk calculator to identify those at high risk for
DR, and employs a patient navigator-based program to improve screening for those at high risk for DR. This
study is significant because it investigates the gap between published guidelines and the popula...

## Key facts

- **NIH application ID:** 9987645
- **Project number:** 5K23EY030530-02
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Kristen Nwanyanwu
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $254,417
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9987645

## Citation

> US National Institutes of Health, RePORTER application 9987645, Undiagnosed Diabetic Retinopathy: Using Participatory Science to Design an Intervention for Patients at High-Risk for Blindness (5K23EY030530-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9987645. Licensed CC0.

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