Confronting Unequal Eye Care in Pennsylvania

Diabetic retinopathy is a common eye condition among diabetic adults and can lead to severe
vision impairment and even blindness. African Americans are more likely to have vision loss
from diabetic retinopathy due to a variety of factors, including cultural barriers to care.
The investigators aim to increase the rates of eye exams in diabetic African American adults
by providing culturally relevant home-based interventions. These interventions will
increase the knowledge about diabetes and the eyes and the awareness of ocular risks due to
diabetes.

206 African American adults, over the age of 65, with diabetes will be recruited from
primary care clinics at Thomas Jefferson and Temple University. Eligible patients who
consent to participate will have baseline information taken about medical and ocular
history, understanding of diabetes and a hemoglobin A1C level obtained. The subjects will
then be randomized to one of two treatment conditions: Behavioral Activation or Supportive
Therapy, each of which will be delivered over 4 sessions. Behavioral Activation will
consist of educational materials, referral assistance for eye clinics, and addressing
patient specific barriers to care. Supportive Therapy will consist of supportive but
non-directional interaction with the patient exploring the impact of aging and diabetes on
the patient's life. The investigators hypothesize that more patients who receive Behavioral
Activation will have a dilated fundus exam (the primary outcome variable), understand the
risks of diabetic complications and feel less depression then subjects who receive
Supportive Therapy.