Interpreting Services Bridge Language Gaps in Diabetic Retinopathy Care: A Retrospective Cohort Study

Purpose: In patients with diabetic retinopathy (DR), vision loss can be prevented through consistent follow-up. Patients can be lost to follow-up (LTFU) for several reasons, including language barriers between the patient and the healthcare provider. This language discordance is known to contribute to nonadherence to diabetic care, but its role in non-adherence among patients with DR has not been studied. Here, we compare follow-up between Spanish-speaking patients with interpreters (SSI) and English-speaking (ES) patients receiving intravitreal injections for DR to determine whether language discordance impacts follow-up when interpreting services are provided. Patients and methods: This retrospective cohort study included patients with either non-proliferative DR with diabetic macular edema or proliferative DR, and who received anti-vascular endothelial growth factor injections at The University of Kansas Health System between January 1, 2012, and April 1, 2022. These patients were treated by English-speaking retina specialists, so all Spanish-speaking patients were offered interpreting services. Patients were excluded if they had no injections before April 1, 2021, or if they passed away during the study period. Patients were defined as SSI or ES based on self-reported preferred language. Patients were defined as adherent to follow-up (ATFU) if they returned to clinic within 1 month of the recommended time. LTFU was defined as no subsequent clinic visits within 12 months of an injection. Results: Of the 527 patients, 57 (10.8%) were SSI and 470 (89.2%) were ES. Groups did not significantly differ in rates of ATFU after the initial clinic visit (78.9% SSI vs 82.8% ES; p = 0.475) or after injections (80.7% SSI vs 82.3% ES; p = 0.760). LTFU rates were similar between groups (57.9% SSI vs 67.2% ES; p = 0.159), but the pattern of LTFU differed significantly ( p = 0.045). We found that SSI status was protective against LTFU (HR 0.692; p = 0.047), even after adjusting for demographic and clinical confounders (aHR 0.534; p = 0.024). Conclusion: When language discordance was addressed with interpreting services, SSI patients had similar and even superior follow-up adherence compared to ES counterparts. This demonstrates the value of interpreting services in retina specialty care. Future prospective studies can clarify the relationship between language and follow-up. Plain Language Summary: Diabetic retinopathy is an eye disease that can cause people to lose their vision if they are not monitored and treated appropriately. To protect their vision, many patients with diabetic retinopathy need medicine to be injected into their eyes on a regular basis. However, keeping up with appointments can be difficult, especially when patients do not speak the same language as their healthcare providers. We wanted to know if language discordance could discourage patients from attending follow-up appointments for diabetic retinopathy, even when they had access to professional telephone interpreting services. This study assessed patients at The University of Kansas Health System who received injections for diabetic retinopathy between 2012 and 2022. We compared Spanish-speaking patients with interpreters to English-speaking patients to determine whether language affected their ability to return for follow-up visits. We studied 527 patients. The two groups had similar follow-up rates after their first retina clinic visits and injections. Surprisingly, Spanish-speaking patients stayed in care longer than English-speaking patients. These findings suggest that, when professional telephone interpreting services are available, language barriers do not reduce follow-up adherence, and may even support better long-term engagement with diabetic eye care.