Department of Anthropology, Southern Methodist University, Dallas, Texas, United States.
School of Optometry, University of California, Berkeley, Berkeley, California, United States.
Med Anthropol. 2020 Feb-Mar;39(2):109-122. doi: 10.1080/01459740.2018.1425839. Epub 2018 Mar 20.
Vision loss from diabetic retinopathy should be unnecessary for patients with access to diabetic retinopathy screening, yet it still occurs at high rates and in varied contexts. Precisely because vision loss is only one of many late-stage complications of diabetes, interfering with the management of diabetes and making self-care more difficult, Vision Threatening Diabetic Retinopathy (VTDR) is considered a "high stakes" diagnosis. Our mixed-methods research addressed the contexts of care and treatment seeking in a sample of people with VTDR using safety-net clinic services and eye specialist referrals. We point to conceptual weaknesses in the single disease framework of health care by diagnosis, and we use the framework of "cascades" to clarify why and how certain non-clinical factors come to bear on long-term experiences of complex chronic diseases.
糖尿病性视网膜病变导致的视力丧失对于有条件接受糖尿病性视网膜病变筛查的患者来说本应是可以避免的，但它仍以各种形式在高比例人群中发生。正是因为视力丧失只是糖尿病的众多晚期并发症之一，会干扰糖尿病的管理并使自我护理更加困难，因此威胁视力的糖尿病性视网膜病变（VTDR）被认为是一种“高风险”的诊断。我们的混合方法研究通过使用安全网诊所服务和眼科专家转诊，针对 VTDR 患者的护理和治疗情况进行了抽样调查。我们指出了以诊断为基础的单一疾病框架在医疗保健方面的概念性弱点，并使用“级联”框架来阐明为什么以及哪些非临床因素会对复杂慢性疾病的长期体验产生影响。
