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Predictors of Receiving Annual Dilated Eye Examinations Among US Patients with Diabetes

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Posterboard#: A0027

Abstract Number: 1069 - A0027

AuthorBlock: Sarah Eppley1, Eugene Lowry2, Steven L. Mansberger2, Saras Ramanathan3
1School of Medicine, University of California, San Francisco, San Francisco, California, United States; 2Legacy Devers Eye Institute, Oregon, United States; 3Ophthalmology, University of California, San Francisco, San Francisco, California, United States;

DisclosureBlock: Sarah Eppley, None; Eugene Lowry, None; Steven L. Mansberger, None; Saras Ramanathan, None;

Purpose
To identify the demographic and clinical characteristics that predict adherence to recommended screening eye exams among American diabetic patients.

Methods
A cross-sectional secondary analysis of Americans age 20 and older with diabetes mellitus using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2016. NHANES performs nationally representative surveys every two years and collects demographic and clinical information, as well as time to last dilated eye exam, in all survey cycles. Univariate and multivariable logistic regression determined which factors predicted adherence to diabetic screening eye exams. Adherence was defined as an eye exam within the preceding 12 months, or 24 months in secondary analysis. From 2005-2008, retinal photographs were taken of participants over age 40. This sub-sample was further analyzed to determine predictors of patients correctly reporting retinopathy status.

Results
From 2005-2016, NHANES surveyed 4,072 individuals age 20 and older with self-report of diabetes, representing 20 million diabetic Americans. Within the study population, 63.4% were adherent to the AAO recommendation for annual diabetic eye examinations and 78.7% were adherent to the ADA biennial recommendation. Insurance status, age, education, income, cholesterol levels, duration of diabetes and self-reported retinopathy were all significantly associated with adherence (all p<0.05, logistic regression). Lack of insurance was the single strongest predictor of failure to receive annual eye exams in this study. The overall nonadherence rate of 36.6% for annual eye exams for this national estimate did not change from 2005 to 2016 (p = 0.7, logistic regression). Most patients (71%) with retinopathy on exam denied having ever been given the diagnosis, and 61% of those who incorrectly denied having retinopathy endorsed receiving a dilated exam in the past year.

Conclusions
Significant barriers persist in preventing adherence to recommended eye screenings among patients with diabetes, and rates of adherence to annual diabetic eye exams have not improved in the US over the past decade. Patients generally remain unaware of diabetic eye disease even when compliant with annual eye exams. Further improvements in diabetic retinopathy education and accessibility is needed to improve adherence and reduce the visual morbidity caused by diabetes.

Layman Abstract (optional): Provide a 50-200 word description of your work that non-scientists can understand. Describe the big picture and the implications of your findings, not the study itself and the associated details.
Diabetic retinopathy is a disease of the eyes that affects people with diabetes, and it is a major cause of blindness worldwide. It is recommended that people with diabetes have an eye exam with an ophthalmologist every one to two years, because symptoms often do not appear until it is too late to reverse the damage. However, in reality, not all patients receive eye exams as frequently as they should. The purpose of this study is to describe which types of people with diabetes are receiving regular eye exams, and which patients are not. We found that people without insurance were much less likely to have regular eye exams compared to people with any type of insurance. Additionally, most patients who have signs of retinopathy on exam do not know they have diabetic eye disease. It is important for healthcare providers to understand the characteristics of patients with diabetes who are less likely to receive regular eye exams so that we can improve education and accessibility.