The Biopsychosocial Impact of Diabetes Care Disengagement on Retinopathy Progression: A Case Report

Abstract

Background:

Diabetic retinopathy is a common microvascular complication of diabetes. It is a leading cause of vision loss in adults aged less than 65 in developed countries. Despite established screening and treatment pathways, loss to follow up continues to pose a major barrier to effective disease prevention, particularly in patients with psychological vulnerability or poor social support. This case illustrates the rapid progression of proliferative diabetic retinopathy following a four-year lapse in ophthalmic and endocrine care, highlighting the interplay between mental health, self-management and sustained engagement with health care services.

Methods:

The case study methodology involved a comprehensive review of the patient's ophthalmologic medical history, psychological history, social background, clinical presentation, and retinal imaging. A literature review was done on the pathophysiology of proliferative diabetic retinopathy and on the biopsychosocial model of healthcare. Consent was obtained from the patient prior to drafting the case report.

Results:

This case identified a 25-year-old woman with bilateral proliferative retinopathy secondary to poor glycaemic control. After initial referral with R2M1/R1M disease (pre-proliferative/ background retinopathy with maculopathy), the patient was lost to follow-up for four years. She re-presented with bilateral R3aM1 disease (active proliferative retinopathy with maculopathy) with tractional retinal detachment in the left eye requiring vitrectomy. 

Conclusion:

Psychological distress, social isolation, and systemic barriers contributed to the lapse in follow-up and subsequent disease severity. The case underscores the need for integrated biopsychosocial assessment, structured mental health support, and proactive re-engagement strategies within diabetic eye services to prevent avoidable visual morbidity.